You've been diagnosed with an illness that impacts your ability to work, play and thrive.

You're overwhelmed by the prospect of doctors, employment issues, new expenses, loss of income and the mountains of paperwork standing between you and your benefits.

You're not alone.  We know what you're facing and we will show you the best way to navigate these new challenges.

The Disability Key blog and the Disability Key Website are designed to assist each person in his/her own unique quest to navigate through the difficult and often conflicting and misleading information about coping with a disability.

Carolyn Magura, noted disability expert, has written an e-Book documenting the process that allowed her to:

a) continue to work and receive her “full salary” while on Long Term Disability; and

b) become the first person in her State to qualify for Social Security Disability the FIRST TIME, in UNDER 30 DAYS.

Click on the "download" link to receive Carolyn 's easy-to-read, easy-to-follow guide through this difficult, trying process.

Click Here To Download Now








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Sunday, February 05, 2006

Disabilitykey Introduction

Disabilitykey Introduction

INTRODUCTION
You have just been told by your Primary Care Physician that you have what society politely calls a disability. You are floored! ‘Why me,’ you ask. This is a critical time. It will take considerable effort and courage to come to terms with your new life and this new label.
The most important thing to understand about being disabled is that the sooner you accept your condition, the better off you will be. But just accepting the situation isn’t enough. It requires immediate action and diligence to actually take control of your new life. And taking action while you are still working means you will have more and better options over the long haul.
One of the foremost challenges you will face as a disabled person is that the definition of “disabled” varies between different forms of insurance. The fact that your doctor has stated in writing that you are disabled does not automatically guarantee benefits. This is a difficult and confusing reality, and it happens to be the primary reason 60% of first-time applications are denied.
With that in mind, you need to prepare for your future disability support documentation and qualification requirements. Planning is crucial and everyone will be involved in this process including your spouse, caregiver, immediate and extended family and your medical professionals. Basic knowledge and understanding about your medical condition, your current health insurance coverage and various supplemental disability insurance programs is often a maze of complexities but of critical importance.

Unlocking Your Benefits
This document has been designed to assist you in understanding the complicated world of disability benefits. It is based on the actual experiences of an active healthy, executive-level individual who was diagnosed with secondary progressive Multiple Sclerosis and has successfully made the transition from well-compensated executive to financially secure, fully disabled individual.

Disability Key is designed to assist you in understanding Disability Insurance Benefits, including your options in selecting help and how to begin compiling the documents that will be needed to apply for the benefits for which you are eligible. This process has been specifically designed for wage earners whose disability is not the result of a workplace accident or otherwise covered by Workers’ Compensation[1].
The goal of this particular document is to give you an overview of the various disability insurance plans that may be available and what steps you will have to take as you make your way into the benefits maze.


CHAPTER 1: Getting Started
So now you have realized that you cannot ignore your disability and that it will not go away. Congratulations on taking the first step toward regaining the control you once had over your life. Keep in mind that YOUR ULTIMATE GOAL is to regain control of your life and your financial stability. You’re no doubt wondering how to go forward; where to begin?
Asking Questions, Getting Answers
Can I still work? How much work can I really do?
What and when do I tell my Employer about my situation?
I want to continue working. How do I work within my disability restrictions and still make a living wage?
How do I keep my health insurance if I can’t work?
What if I need to go on to Short or Long Term Disability (STD or LTD)?
Does Social Security apply to me if I am disabled?
Can I get Social Security if I am under the age of 65?
What about Medicare? Can I get Medicare coverage? When does it begin?
If I loose my job, I think that I can get something called COBRA. What is it and how long can I get it? Will it last until I am eligible for Medicare?

These are certainly not all of the questions that you will have, but they are the most common and the most immediately addressable. As you review this document you’ll find answers to these and others, as well as some direction on getting information particular to your situation. As you think about the specifics of your case, you are encouraged to write down your questions in the forms and spaces provided in this document. Do so as often as necessary as you work through the process; no question is too small or insignificant to be asked! If it occurs to you, it must be answered for your ultimate success.

As you move forward into this new life, your primary concerns are likely to be financial. The first order of business is to create a financial safety net for you and your family. By doing so you will be better equipped to spend the time and energy it takes to manage your life around your disability.
Financial Safety Net: What Is It?
The financial safety net is nothing more than ensuring a steady, reliable income through any and all insurance benefits that you may have. Disability Key will assist you in analyzing what you currently have, what you will need going forward, and how to follow the convoluted processes necessary to maintain a “livable” income level given your changed employment situation.
You must determine what benefits could potentially be available to you. Do you have private insurance? Short term? Long term? What’s the Difference? What do I need to Know?
Types of Disability Insurance
Regaining income is most often accomplished by activating the benefits of a disability insurance policy. The insurance company pays out a predetermined sum of money to claimants who have earned the money because they are eligible as a result of premiums paid either by the claimant (you or your spouse) or the claimant’s employer.
In general, eligibility for disability insurance benefit income is dependent upon two (2) major conditions:
There is a non-Workers’ Compensation disability that impacts your normal daily living activities (NDL) so that you no longer can work. This symptom impact keeps you from performing your same occupation, and/or any occupation. And,
You and/or your employer have been paying premiums on these types of insurance policies and they are currently in force. The policies can be Short Term Disability (STD) or Long Term Disability (LTD)
You may also qualify for Social Security Disability Insurance (SSDI). You qualify for SSDI if you have worked for at least 40 calendar quarters, and have contributed into the Social Security System. (Note: there are other ways to qualify for Social Security. They are not addressed here. See www.socialsecurity.gov for additional information.)
In general, STD and LTD coverage’s are either individually purchased by you, or are plans offered by your Employer and are most likely ERISA qualified. ERISA refers to Employee Retirement Income Security Act of 1974. This is the law that governs LTD plans and sets standards for the administration of these plans. Your employer can verify if your company’s issued policy is ERISA qualified.

Documentation
Get Details
The process for qualifying for any disability benefit is paper intensive. It is critical to collect and organize all documents detailing your medical history and current condition application forms. You will also need to gather all of the documents relating to your medical, STD, and LTD insurance policies when applicable. Your employer is obligated to provide you with copies of any insurance policies that would apply to you.
In addition to the general medical and insurance information described above, you will need all documentation relating specifically to your disability. This will include records of doctor visits, results of laboratory tests and all physical exam reports. You can request this information through your doctor’s office, (you may be asked to sign a Medical Records Release Form to obtain them). Some hospitals, clinics and medical facilities may require a nominal fee ($25 - $35) for this service.
The government periodically sends you information about your Social Security earnings, so you should already have these on file. If you do not have copies, you can request a current statement from the Social Security Administration office (find that contact information in the Resources section at back of this booklet).
Get Educated
Know The Disease. Another key to success in this process is to learn as much as you can about the condition causing your disability. Collect brochures or booklets from your doctor’s office or from drug companies. Visit your local library or bookstore, or search on-line book retailers. The Internet is an excellent resource, but must be used cautiously to make sure you are getting the most valid information from the best sources. The most serious and chronic diseases have specific organizations dedicated to serving those affected. They often provide a great deal of information and support via the Internet, and can be invaluable.
Employment Regulations and Insurance. As you plan what you need to do in order to prepare for you disability insurance claim, consider the following general pieces of information concerning disability timeframes and document requirements:
If you loose your job, you can usually continue your company-provided health insurance through COBRA (Consolidated Omnibus Budget Reconciliation Act) for up to18 months. This is a step you need to examine closely up front. COBRA insurance coverage tends to be far more expensive than what you may have contributed to previously while fully employed. Should you elect to use COBRA, you are personally responsible for all of the premiums necessary to keep the current policy in effect. Avoid unwanted surprises by getting a complete understanding of the costs involved, in writing, before going forward.
You need to be covered by SSDI (Social Security Disability Insurance) for 24 months before you qualify for Medicare. Note: this 24 month time frame is really 29 months, as you must wait 5 months after having qualified for SSDI to begin receiving payments. The Medicare qualification is triggered by the date of the first SSDI payment, NOT the date of application or acceptance. Keep this in mind when creating budgets
Within the first 30 days after receiving your SSDI qualification, you can ask your COBRA Administrator to extend COBRA for an additional (11) eleven months based on disability. This extension is called OBRA, and is granted only for disability purposes.
And getting educated isn’t just about the outside world of medical records, employment issues and insurance carriers. Listen carefully to your body and monitor its reaction to each of the symptoms. Learn to describe those symptoms in graphic detail. This information will be critical when completing the matrices within in this workbook. It is strongly recommended that you keep a daily diary or journal of what is happening with your body. With every new symptom, try to identify and document the trigger. Also document how you managed out of, or around the symptom.

CHAPTER 2: Obtaining Disability Insurance
Do not be surprised if your claim for benefits are denied at the initial stage of the SSDI and/or LTD insurance benefit claim process. The numbers are sobering: Roughly 60% of all claims are rejected on the first attempt, and 80% of those are rejected at the Reconsideration stage.
The odds start to improve somewhat in the next stage, which is the Hearing. The case is heard in an informal setting by an Administrative Law Judge and his/her secretary. Often times the judge will have a vocational expert present to testify as to what jobs the individual can perform.
The challenge in attaining and retaining LTD status depends entirely upon your ability to document and to prove that your disease symptoms impair you from both your own occupation and any occupation. AND you’ll be expected to prove your status not just once, but several times periodically throughout the duration of your LTD benefit.
Help Options
As a result of the complexity of attaining and retaining these disability insurance benefits, increasing numbers of applicants are deciding to get help with the process. There are two major options available to you.
Option I - Hire An Attorney To Represent You
As a rule, attorneys do not collected fees if your Social Security Disability Insurance claim is not granted. While some attorneys require retainers, they are usually willing to collect their fees on the back end of the successful disability claim. Most Attorneys receive 25% of the back benefits, with a not-to-exceed limit of $4,000.00.
Advantages:
· Statistically, claimants being represented by an attorney are more likely to win their claim in the earlier stages
· An experienced attorney knows what proof the Social Security Administration and the SSDI system requires
· Using legal help eliminates the necessity of having to wait in long government lines
· All aspects of your case including complicated paperwork will be handled professionally
In order to understand the potential costs associated with the use of an attorney, you should understand the real numbers involved. Some attorneys might charge up to $150.00 per hour just to hear your case before considering whether or not to help you. Let us say that you have accrued SSDI back eligibility of $1,000 per month; you are due 12 months back pay, for a total of $12,000.00. If your attorney is eligible for 25% of this amount, it would cost you $3,000.00 in legal fees – or three full month’s worth of your benefits.
Option II – Use Experiential Support
There are a growing number of Disability Advocates ranging from independent consultants, web sites, non-profit organizations to quasi government agencies all specializing in helping individuals qualify for disability benefits. The costs and success rates for these services vary as widely as the groups themselves. We recommend that you thoroughly understand what someone is promising to do and exactly how that fits with what you are trying to accomplish.
Option III – DIY (with a little help)
You will always be your own best advocate. It’s your condition, your body, and your future on the line. No one can know those issues better than you and, with some help, you’ll have everything needed to make a good case.
Our proven processes:
· Will walk you through the decision-making processes using thorough timelines and checklists to help you remember critical steps;
· Allow you to take each step in your own time, at your own pace;
· Contain proprietary forms, guidelines and actual examples to help you describe what’s happening to you and how it’s impacting your life; and most importantly,
· Have been written by a Nationally-recognized Human Resources expert who is disabled and used these same processes and documents to regain control of her life.
Visit our web site at www.disabilitykey.com to learn more about applying for disability benefits. As an example of what you will find in our various packages, here is a document for you to use as you begin your documentation process.



[1] Note: There is a separate Worker’s Compensation Workbook designed to assist someone advocate for Worker’s Compensation benefits.
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Monday, January 16, 2006

Sample Job Description

Job Description
Job Title: Ship Superintendent Pay Grade: 7
Department: Production FLSA Status: Exempt
Reports To: Vice President Production Manpower and Technical Services
Date: 4/21/98 (revised 8-00)
SUMMARY: As a seasoned Ship Superintendent, is responsible for all activities associated with the profitable repair of ships. Key responsibility for the planning, manning, equipping, and management of a profitable project. Plans, coordinates, manages, and evaluates the effectiveness of work required to repair or modify marine vessels. Work is performed to produce safe, timely, profitable results and satisfied customers.
ESSENTIAL DUTIES AND RESPONSIBILITIES - Independently, and/or through subordinate supervisors, performs the following essential duties and responsibilities:
· Working closely with Craft Directors, the local Unions and Employee Services, determines the appropriate manning levels to result in a profitable project. Works to develop the manpower planning and dispatch function, appropriately capturing the work skills of each employee.

· Plans, coordinates and directs production activities on assigned projects. In conjunction with Project Management and Manpower Dispatch, plans the daily staffing of each project. Audits reports & job progress to ensure the accurate allocation of manpower based on bid proposal and job requirements. Makes appropriate changes where necessary.
· Works closely with the Contracting & Estimating Department to estimate, plan execute, and settle projects. Provides all necessary documentation for bill settlement and negotiation of change orders. Conducts a post mortem on each project completed to determine what went right and should be done again; what went wrong and should be changed; Works with the C & E Dept. to develop and implement a ship repair relational data base.
· Interprets specifications and in coordinates various phases of the repair process, to prevent delays. Ensures that all change order requests and CFR’s are properly written, and approves them before providing them to the Project Management team.
· Writes accurate and timely records or documentation for each job and contributes accordingly to final written specifications. Confers with supervision and project management staff, and project inspectors and suppliers of materials, to resolve repair problems, and to improve repair methods.
· Prepares or reviews reports on work progress, materials used and costs, and adjusts work schedules as indicated by reports. Ensures adherence to the work processes through constant inspection and examination of work in progress
· Through project supervisors, ensures each employee who works on the project receives a fair and accurate performance appraisal throughout each project. Works closely with Craft Managers and Supervisors to resolve complaints and disputes within the workforce.
· Advises contract department of opportunities to increase profits and avoid losses.
· Maintains effective working relationship with craft workers, customers, and contract administrators.
· Ensures that worker safety and environmental concerns are constantly monitored, and that problems are effectively resolved.
· Meets or exceeds Customers’ realistic expectations for quality, productivity, and safety on projects.
· Remains technically competent, ensuring personal skills remain consistent with Cascade’s productivity improvement initiatives.
EDUCATION & EXPERIENCE: An advanced degree in any technical skill associated with ship repair, and/or eight to ten (8-10) years of progressively more complex work experience that demonstrate the acquired ship repair and production knowledge and expertise; or the equivalent combination of education and experience. Three – five (3-5) years experience with successful projects directly resulting from his/her management experience.
The overriding qualifications are the specific demonstrated successful experience staffing, supervising, and ensuring the technical competence of employees in complex, multi-phased, extensive, long-term, high dollar valued projects.
KNOWLEDGES, SKILLS, & ABILITIES
· Demonstrated experience managing a diverse, complex, technical workforce in a union environment.
· Computer familiarity (MS Word, Powerpoint, Excel, Primavera, etc.)
· Excellent proven communication (both oral and written) skills.
· Excellent informal influence skills; the ability to succeed in accomplishing tasks when the performers are not necessarily in the direct line of authority.
· Demonstrated expertise in maximizing revenue and profits on projects through the art and science of negotiation.
· Strong customer service skills.
· Demonstrated ability to effectively plan and execute ship repair projects.
· Demonstrated success communicating effectively and decisively to many and varied customers both internally and externally, while in the midst of chaotic, constantly changing environments.
· Demonstrated ability to translate the requirements of a complex, multi-tasked function into the staffing hours required for efficient and effective project completion.
· Ability to define problems, collect data, establish facts, and draw valid conclusions.
· Working knowledge of the Shipyard and the sequencing of activities necessary for a profitable, efficient project completion.
· Familiarity in working with union contracts.
· Ability to interpret an extensive variety of technical instructions in mathematical or diagram form, and deal with several abstract and concrete variables.
· Strong Shipyard “smarts”.
SUPERVISORY RESPONSIBILITIES: Few to many employees with varying degrees of technical expertise.
CERTIFICATES, LICENSES, REGISTRATIONS: None required.
PHYSICAL DEMANDS: The physical demands for this position are moderate to heavy (see below). The incumbent of this position is required to stand for extensive periods of time, in external climates, and in internal climates exacerbated by external conditions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT: The work environment for this job is demanding and potentially hazardous due to work on or inside ships as well as travel around ship repair yard. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
ESSENTIAL PHYSICAL REQUIREMENTS

Not Required
Rarely
Occasionally
Frequently
Continually
NR
1% or less
1 – 33%
34 – 65%
66 – 100%
It is important to understand that the work performed by this position in a physical capacity requires walking, standing, sitting, twisting, crouching, and maintaining that posture for extensive periods of time in order to estimate the time necessary to perform work; to observe and inspect the quality of one, multiple, and sequential tasks from any and all of 10 (ten) separate craft functions; and to critique the finished products.
1. Sitting: Occasional -- From 45 minutes up to six hours per day, for meetings with employees, peers, management and customers. Also, to perform computer work.
2. Standing: Frequently -- Stands while inspecting work up to 50 minutes at a time, up to a total of six hours per day. Stands on all types and conditions of surface.
3. Walking: Frequently -- Walks up to 1/2 mile, uninterrupted, on level ground or ramps, up to six times per day. There may be obstructions to be walked around, depending upon the work site on ships.
4. Twisting: Knees – Occasional -- While inspecting in confined areas. Waist – Occasional -- Less than 5 minutes at a time, up to four hours per day. Neck – Frequent -- Up to 30 minutes at a time uninterrupted, up to four hours per day in any direction.
5. Stooping/Bending: Occasional -- Stoops up to 15 minutes at a time, up to 3-4 hours per day while critiquing work.
6. Kneeling: Frequent -- Kneels up to 15 minutes at a time, up to 3-4 hours per day on various types and conditions of surface. May kneel on one knee or both, according to available space and personal preference.
7. Crouching: Occasional -- Crouches for 15 minutes at a time, up to 3-4 hours per day while performing activities.
8. Crawling: Occasional -- Crawls up to 150 feet, 3-4 times per day when in various spaces – both open and confined.
9. Climbing: Frequently -- Climbs ladders, scaffolding, stairs and climbs over obstructions, to as much as 100 feet in height, up to four times per day. The scaffolding and ladders in a tanker are difficult to climb, established to maximize access while allowing work to be done in adjacent areas.
10. Balancing: Frequent -- Walks on various types and conditions of surfaces, wide and narrow.
11. Pushing/Pulling: Rarely
12. Reaching :above shoulder height: Occasional -- Reaches in all directions to test the final product. At shoulder height: Occasional
13. Grasping (firm): Rarely
14. Manipulating hands or fingers (e.g., type, assemble, etc.): Frequent -- Uses fingers to manipulate the computer to prepare many documents. Can be using hands in small motor coordination 4-6 hours per day.
15. Use feet to operate controls: Rarely
16. Lifting/Carrying: Rarely: less than 10 pounds.
ESSENTIAL USE OF SENSES
1. Talking: Continually talks in person or on radio, phone etc. with employees and other production supervision and management to coordinate work efforts and to ensure safety, and to comment on work in progress. Critiques work in progress and resolves problems on the spot. Negotiates and resolves CFR’s (Condition Found Reports), work orders, and bills internally, and externally with customers.
2. Hearing: Continually listens to information from all sources to carry out functions listed under “talking”. Also, must have acute hearing to “read” the work environment, particularly machinery, and rectify problems when they arise.
3. Vision: Continually observes surrounding activities.
· Near Acuity (clarity of vision at 20 inches or less): Inspects fine detailed welding requiring near acuity.
· Far Acuity (clarity of vision at 20 feet of more): Necessary for safety in work environment, and for inspection.
· Depth Perception (three-dimensional vision to judge distance/ spatial relationships): Necessary for safety in work environment, and again, in inspection of work in all stages.
· Color Vision (if required to distinguish colors for job performance or safety): Needed to identify leads and safety tags.
· Field of Vision (if required to observe a large field of vision while keeping eye fixed on a given point for job performance or safety): Must have normal field of vision in order to work safely in the ship areas.
4. Smell: Useful for detecting fire and other potential issues while “environmentally scanning” the work area.
5. Mental Agility: As indicated above under Knowledges, Skills and Abilities, this is a highly technical and complex analytical position. At this, the Senior level, the incumbent is expected to draw upon his/her substantial technical and practical experiences to accomplish the work of ship repair in an ever increasing “faster, cheaper, smarter” way. S/he must have superior deduction, induction, communication and intuition skills. S/he must be able to process an extreme amount of data to all senses, and immediately come up with the optimum solution. Mastery of multi-tasking is critical.
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Sunday, January 15, 2006

Long Term Disability (LTD) APPLICATION PROCESS

Long Term Disability (LTD) APPLICATION PROCESS

This document is a checklist provided to walk you through the LTD application process. As you read, and complete each section, check it off so that you can keep track of where you are in the process.

What and Why LTD?

Long Term Disability (LTD) is defined as a severe illness or injury that prevents you from working at all or prevents you from working full-time, for a period of six months or longer.

The purpose of an LTD plan is to protect you and your family from complete loss of income should you suffer a long term disability.

This “How-To” document summarizes a generic Long Term Disability application process in everyday language and explains how and when to apply for benefits. Please refer to your LTD Summary Plan Description as you proceed through this checklist.

LTD plans usually are provided in two ways:
v Paid for by a company as part of the company’s employee benefit package; and,
v Paid for by a person as an individual insurance plan

q My LTD plan is:  Company paid;  Self paid.

q I am eligible for LTD.

A long term disability plan usually covers a physical or mental illness that prevents employees from performing the job that they occupied at the time the illness/accident occurred.

To be eligible, a plan participant usually has to meet at least three conditions:

1. S/he has been covered (i.e., have worked for the company, or have owned the policy) for the length of time prescribed in the SPD;
2. S/he expects the condition to last at least a specific period of time (usually, longer than the short term disability plan lasts – six to twelve months); and,
3. The “triggering” illness/accident is both the specific reason that you cannot do your job, and, the impact is that you have lost “work pay”.

A wide range of conditions usually are covered, including (but not limited to):

• progressive, uncontrolled cancer;
• loss of major functions of arms and/or legs;
• serious brain damage;
• alcohol or drug addiction;
• and severe mental illness.

q Is there a pre-existing restriction for illness or injury in your plan?
q If yes, does it apply to you? Yes  No 

Some plans have a pre-existing condition provision. That is, if you were treated (or if a prudent person would have been treated) for a condition within 3 months prior to entering the plan, long term disability benefits would not be available during the first 12 months of coverage for that condition only. Coverage would be immediately available for other conditions.

q I understand how my LTD plan works.

Usually, under an LTD, monthly benefits are paid to the qualified applicant who is totally or partially disabled for a period longer than a specific number of days. That first period of time is called the waiting or elimination period, and no benefits are paid during that time. Often, the STD or Short Term Disability plan covers this period of time, or, a combination of STD coverage and sick leave. (Check the STD checklist for further information.)

q My LTD Plan elimination period is _______________ days. I will obtain income during this time through the use of: ________________________________________________________

q My LTD benefits will last until: ____________________.

Disability benefits usually continue until the earlier of the date that you complete the maximum benefit period, are able to return to work (see below the difference between work of “own occupation”, or “work of any occupation”), retire or die. Assuming that your retirement age will be age 65 or older, your LTD benefits, once received, should last until you are able to return to work; you retire; or you die, unless the plan specifies another date. Some plans offer benefits until age 70, for example.

q My LTD benefits will equal _______% of my pre-incident monthly income, or _____________.

q I have the other types and amount of income that will deducted from my LTD monthly income:
q Worker’s compensation:______________
q Social Security Disability Income:____________
q Third Party Disability:_____________
q Other:______________

The monthly benefit is equal to a certain percentage of your basic monthly pre-incident earnings, minus the amount of certain other types of income you receive, such as Social Security or third party disability payments and Workers' Compensation benefits. If you are partially disabled, partial benefits may be payable.

q There are other conditions in my LTD plan that I must be aware of. They are: _________________________________________________________

For example: in some plans you may find that you can still be covered, and remain in a pay status, if the illness “goes away” for a short (usually, 30 days) period of time. The only time this is not applicable, usually, is if this “illness break” occurs during the elimination period. That means, if, during your, say 120 day elimination period before receiving income from your LTD policy, you have an “illness break” of two weeks, that two week time frame extends your 120 day time frame an additional two weeks.

q My LTD “days” are:  week days only;  calendar days.
q I must use my accumulated/accrued sick leave during my elimination period. Yes  No 
q I must use my accumulated/accrued vacation time during my elimination period. Yes  No 
q My sick leave days are:___________________
q My vacation days are:____________________


Check your SPD to see if you are required to use all the sick/vacation leave you have built up. If you must take them, use them for income during your LTD elimination time frame.


UNDERSTANDING THE LTD FORM

Prior to working on the actual LTD form, it is important to remember that this is an INSURANCE PROCESS. What this means, is, that you are preparing to “convince” your LTD insurance company that you have an illness or accident that keeps you from doing your “job”; because of this, you do not receive pay for work performed.

Earlier, we mentioned two types of “job”. They are:

1. Your own, or your “pre-incident” job or occupation; and
2. ANY job that your age, education, and prior work experience qualifies you to perform.

Your SPD will tell you how long your LTD insurance will cover you from being able to perform your own job, and any job.

q My LTD insurance will pay me for not being able to perform “my own occupation”, which is: ____________________________________ ; for ___________.
q My LTD insurance will pay me for not being able to perform “any occupation” beginning: _______________________________.


DOCUMENTING YOUR INABILITY TO PERFORM YOUR “OWN OCCUPATION”

The first thing you need to review is your own job description. Hopefully, your job description will contain what is called “physical capacity criteria” that indicate what specific physical, mental, and social “levels of interaction” are required when performing your job. (See attachment ----, an example of a job description that includes the physical capacity criteria.)

If your job description does not include such criteria, you will need to develop them. For example, in your job:
1. If you need to use a computer, this activity could require you to be able to carry out small motor skills proficiently for 2-4 hours per day, or longer.
2. In using this computer, you would be required to sit for 2-4, and up to 6 hours per day.
3. In using this computer, you would be required to have visual skills capable of viewing a computer screen for 2-6 hours per day.
4. If your job requires you to inspect a warehouse, this activity requires you to walk for 2-4 hours at a time; for distances up to 2 miles; to conduct activities in a non-office work environment that could reflect temperature differences between heat and cold.
5. This warehouse inspection could require you to climb the equivalent of 5 flights of stairs at least 4 times per day.
6. As a Welder of iron plating, you could be required to stand, sit, bend, for 4-7 hours per day.


These are just a few examples of how activities of a job correlate to the physical activities of normal daily living. What you need to do is to develop the physical requirements of your job. Please see appendix___________ as an example.

q I have developed the physical requirements of my job.
q I have provided a copy of these requirements to both my supervisor, and to the appropriate person in my company’s human resources department. Both have signed off on the document that it is accurate.

Your next step is to complete the “Before and After” activity matrix found at attachment _______. It is important to keep in mind what your end result needs to be. You are documenting YOUR LIFE, to communicate to someone who does not know you what you did before your disease/accident had an impact on your life.

As you review the MS-specific example of Before and After, you will see that the Before section describes Ms. Magura’s physical activities associated with her job as Vice President of Human Resources for Cascade General, the Portland Ship Repair Yard. Please read Ms. Magura’s example carefully. Note that she discusses the job activities in great detail:
1. When the workday began.
2. What type of activities needed to be performed.
3. What type, frequency, duration, and intensity of interpersonal actions with others needed to be performed.
4. The diversity of activities being performed; the length of each workday; the volume of activities; the requirement for multi-tasking, etc.
5. The number of hours being worked each day;
6. What activities were accomplished after work each day; during the weekend.

In summary, what you are doing is “painting a picture” of your life BEFORE your illness/accident forced you to change your activities. You need to be as specific and as detailed as you can be. What you are doing is explain what your “Normal Daily Living” looked like!

Next, you need to complete the “After” side. Again, read Ms. Magura’s example to see how detailed she is in explaining the impact that MS symptoms have had on her ability to perform her normal daily living activities and the physical, mental, and interpersonal actions of her job.

The Symptom Matrix (Attachment ____________) that you have already completed to document your symptoms to better discuss their impact with your doctor, are helpful when documenting your “After” side of this matrix. Again, be as specific and as detailed as you possibly can. When you are finished, provide the Before and After matrix to someone who knows you and ask them to critique it. Ask them the following question: “If you were an Insurance Adjuster, does this matrix provide enough information for you to get a clear picture of the impact that my illness has had on me; of the level of impairment that the illness has had on my normal daily living?” If the answer is yes, then you are ready to continue. If no, revise the matrix until the answer is yes.

q I have completed my Before and After matrix.
q My matrix adequately describes the impact that my illness has on me, and of the level of impairment that the illness has had on my normal daily living.


Working with your Doctor

The next step is to review the information about what your Doctor needs to know to help you by completing the Physical Capacity Evaluation or Residual Capacity Assessment Form. (See Appendix ------ for the instructions for your doctor. See Appendix ------ for a copy of a letter that you can copy to explain to your doctor what you need for him/her to do to assist you with your LTD application. See Appendix ----- for a copy of a Physical Capacity Evaluation (PCE) Form for your Doctor to use. Finally, see Appendix ---- for a copy of an Insurance Company’s “Attending Physician’s Statement of Disability”.)

Make sure that you have 2 copies of both forms. Complete one yourself, as you see yourself impaired by your illness. Provide them, with the blank forms, to your doctor, along with the information document, and your letter of instructions.

REMEMBER: If your doctor has any differences of opinion about your limitations, make sure that the two of you resolve the differences before the doctor completes the Insurance forms for you.

q You have received back from your Doctor, the completed Insurance forms.


Completing the LTD Application

When you complete the Application, you will also need to complete the Insurance Company’s document called “Claimant Questionnaire for Long Term Disability” (or something like this). See Appendix ----- for an example of a completed document. Ms. Magura placed the questionnaire on the computer, and created a Matrix out of it, so that it can be updated whenever the Insurance Company requests its periodic update.

You now have all of the information needed to complete the LTD application process. Make sure that you have a copy for your records of all of the documents. They should be:

q Insurance Company’s Claimant’s Questionnaire.
q Symptom Matrix.
q Attending Physician’s Statement of Disability (or, Continued Disability)
q Before and After Matrix.
q Physical Capacity Evaluation form.
q Actual Application.

Ensure that you send all of these documents by registered mail, so that you will have proof of receipt. Retain the copy of the receipt with your copy of the documentation.

Documenting Your Inability To Perform “Any Occupation”

By looking into your LTD summary plan description, you should be able to determine how long you can be considered disabled from your own job/occupation. You will also be able to determine when you will need to document your inability to perform any occupation.

What is meant by “any occupation”? Simply stated, this means that your illness has so incapacitated you that you are unable to perform any job that is either full or part time, and which is paid any amount.

To reach this level, your Doctor must agree that you have reached the stage in your illness that you no longer are capable of working. You also must ensure that all of your documentation supports this decision.

You have all of the tools necessary to file for Long Term Disability. Make sure that you keep all of your documents together, so you will be able to find them, when needed.

Good Luck!
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Saturday, January 14, 2006

Expanded Disability Status Scale (EDSS) - Multiple Sclerosis

This matrix describes the Body’s Basic Functional Systems based on the Expanded Disability Status Scale (EDSS); the impact Multiple Sclerosis has had on Your Name’s body; and how the limitations impact her daily normal activities. This matrix has been updated for Your Company LTD, effective April 2003. (Written and edited by Your Name) This scale, like the other matrixes, were also provided to SSA as evidence for SSDI.

Body
System
What it Covers
How MS Symptoms have Impacted
Your Name
How MS Symptoms Impact
Your Name’s Daily Normal Activities
UPDATED TO YOUR DATE OF COMPLETION

Pyramidal
Ability to walk
Ø My left foot has been numb since about 1985; the right foot since about 1999.
Ø Both feet have the “pins & needles” sensation continuously, along with severe pain when rotated or moved.
Ø The left leg is numb to about 3 inches above the knee, and the numbness is increasing up the thigh
Ø The right leg’s numbness is traveling up about half-way to the knee.

Ø Currently, I use a brace on my left leg, as it has the famous “MS Drop”, and is unusable.
Ø I have two forearm crutches.
Ø I cannot walk more than 10 feet without assistance; the 10 feet requires “wall walking”.
Ø I have a 3-wheel scooter to use in any distance moving to conserve energy for the “here” and the “there”.
Ø I cannot stand for more than 10 minutes at a time; sometimes this is only 5 minutes.
Ø I do dishes about one time a week; luckily, I can bend and rest against the wall in my new kitchen.
Ø Having moved in with my son and daughter-in-law recently, I have help with household living chores.
Ø I have a pedicure every month, as I cannot take care of my feet properly.
Ø I sit in the shower; air-dry my hair, and normally avoid standing. I have a chair in the bathroom, so that activities can be accomplished sitting down.

Cerebellar
Coordination
Ø My feet are no longer coordinated. It seems that they do not do what I tell them to do. Part of this is the spasticity of the muscles. For example, I can sit, and my leg muscles will jump and twitch all by themselves. In 2003, this spasticity has spread to both legs.
Ø My hands and arms also are not coordinated in major and minor movements.
Ø The biggest coordination problem that I have is the vertigo that comes from my vision problems. Scanning left to right makes me dizzy and nauseous; also, fast movement makes me dizzy, nauseous, and I loose my balance.

Ø As the numbness increased in my right leg, I changed my driving to concentrate on visual cues, as I could not feel the driving pedals. This, coupled with the increasing visual problems (see below) caused me to loose my license effective September 2002.
Ø The lack of coordination in my legs makes standing, walking and climbing difficult.
Ø I find that I can no longer lift much of anything; I have someone else do my bringing in of groceries and the mail.
Ø I no longer cook. Thank goodness for the microwave, fresh fruits and vegetables. Now that I am living with family, I can enjoy home cooked food once again!
Ø The lack of proper hand coordination is a symptom that I find during my typing on the computer. I’ll mix letters; consistently leave out the “o” in you; think one letter, and type another, etc. (It took me 4 weeks to do this matrix. 8 corrections!)
Ø Walking in large open spaces, having to look left and right to avoid traffic makes me want to throw up. I avoid it at all costs.
Ø I do stretching exercises for about an hour each day to work on keeping what coordination I have.
Ø I have continual bruises, cuts and bumps from falls and walking into things.

Brainstem
Includes speech and swallowing
Ø At least once a week I’ll choke while swallowing, and liquid will go down into the lungs.
Ø I consistently wake up at night choking on saliva; or regurgitating.
Ø I am beginning to have problems speaking. My mouth feels like I have mush in it; I consistently forget words.
Ø I follow the Dr.’s instructions, and do not eat raw carrots, peas or rice without liquid to make sure they are swallowed correctly.
Ø I have raised the head of my bed about 6 inches to keep from choking at night. I also sleep on multiple pillows to keep my swallowing working with gravity.
Ø As the face and head become more and more numb, I find that speech, at times, is more difficult than at other times.

Sensory
Includes touch and pain
Ø No one told me that MS causes pain. Well, let me correct that – there is a lot of pain with MS. The best way to describe the overall sensation is that at it’s worst, all of the muscles of the body feel like the worst flu that you ever have had, and NOTHING can make it go away. The headaches, due to the optic nerve problems, result in severe pain at one side of the temple, going across the top of the head, to the other temple. This takes about 12 hours.
Ø Numbness also is a factor. The entire right side of my face is numb about 25-30%. It feels like the Novocain you get from the dentist – but it does not go away. This numbness has increased to cover the entire scalp.
Ø When the nerves don’t adequately “talk” to the muscles, the resulting impact on the muscle is to clench up – like a “charlie horse”. As my abdomen has nerve-muscle problems, any way that I twist results in a severe cramp in the torso.
Ø Another pain that is hard to avoid is bending the chin down, and having electric shocks go down the back.
Ø Any prolonged position (over 15 minutes) will cause the muscles and joints to cramp.
Ø I used to take advil (up to 4 extra strength tablets at a time) for the pain. At the bad times, this amount of medication didn’t even phase the level of the pain. What is almost worst is the “dull toothache” overall pain every night when I try to go to sleep. Now that I take Vioxx for the pain, it offers some relief. The Baclafen for the spasticity offers some help, at least during the day. I don’t twitch and “jump” all day through. Trying to sleep is another matter. It takes about 3-4 hours each night to get the muscles to relax to get to sleep – MS form of insomnia! Then, once asleep, I DO NOT want to get up – the MS fatigue factor.
Ø After the move to the new home, I went for a week without Vioxx. The muscle pain and cramps and joint pain (like the worst arthritis ever) came for days.
Ø The abdominal cramps make going to the bathroom a daily exercise in pain and anxiety. More than once I have cried in pain in the bathroom until the pain stoped. More than once I have fallen off of the toilet (once even sticking to the toilet seat, and landing on the bathroom floor still on the seat) just trying to wipe my bottom.
Ø The muscle pains are still such that I no longer stand in the shower; I do not bother with make-up, as I can’t hold my arms up long enough to apply it. I have a “wash and wear” hairdo.
Ø I’ve mentioned before that the right side of my face/head is partially numb. Two examples of the impact of this are: 1) if I pinch my right ear lobe, I can “feel” it for up to 10 minutes. 2) I must wear earrings that I know won’t fall out, because I cannot feel the earring in the right ear. As of January of 2003, this numbness has spread to cover the entire face and scalp.
Ø The arms now are becoming numb, and it hurts to lift anything without assistance.

Bowel
Impaired function
Ø Bluntly, the anus muscle no longer closes, nor does it “clench” to push out the fecal matter.
Ø Balancing a diet to keep regular – not too hard and not too runny is a daily challenge.
Ø The Doctors have told me that at some point, I will have to “train” my bowels to work at the same time each day.
Ø It takes about 30-45 minutes for each bowel movement.
Ø I wear pads, and need to change often. Any laugh, sneeze, cough, bend will cause the bowels to release.
Ø Forget about controlling flatulence – one just avoids food that will cause it.
Ø Wiping and trying to remain hygienic has led to the constant presence of hemorrhoids and continual cuts and pain. I tried zinc oxide and Aveeno, with limited success. My Doctor prescribed Calmoseptine, and it appears to work better. I use it 2-3 times each day.
Ø I take daily stool softeners to remain regular.

Bladder
Impaired function
Ø I never thought that one could have incontinence and “failure to empty” at the same time! Now I know that you can.
Ø Balancing having enough liquids without spending all the time in the bathroom is a consistent challenge.
Ø When I first started having to go to the bathroom 4-5 times each night, then fought to get back to sleep, I took Ditropan. This left me drier all right – I didn’t have enough “spit” left at all! Also, it led to nosebleeds from dry sinuses. So, I stopped taking that medicine.
Ø Thanks to the continual pads that I wear, I catch leaks.
Ø Going to the bathroom takes about 5 minutes. One has the urgency until you sit on the toilet. Then, you go through gymnastics to get the urine to come out. I realize that daily catheterazation is on the horizon.
Ø I have learned that laughing and coughing always cause leakage.
Ø It becomes a daily challenge to ensure that body odors are properly “managed”.

Visual
Impaired function
Ø When I had my first optic neuritis attack, the Doctor said that I had a migraine, without the headache. Now I know what they are, and can better manage them.
Ø In 1998, I had my eyes checked, and new glasses prescribed; within 6 weeks, my vision had so deteriorated that I could no longer see. Going back to the Eye Dr., I needed a completely new prescription, and trifocals. He sent me back to my Neurologist, who did the Spinal Tap.
Ø “Black holes” in my vision are scary, but manageable.
Ø Double vision, the inability to focus on things near or far, problems with depth perception, night blindness are all daily challenges for me to manage.
Ø As indicated above, balance, dizziness and nausea also are daily if not hourly occurrences.

Ø Up until about 3 years ago, I was able to read 3-4 books each week. I still love reading, but I need to balance close-in vision with far vision. If I try to read too much, or look in the far distance too much, I risk the dreaded nausea and/or headache. I still read – just much, much less than before. I also have to reread pages as my “logic retention” is not as great as it once was.
Ø My driving ended when, coupled with the leg numbness and incoordination, visual blackout frequencies continued, making driving hazardous.
Ø The visual challenges often trigger panic attacks. If I get too hot, too tired, upset, or anything emotional, the vision “holes” come, followed by headaches. I’ve come to identify headaches as my body’s way of saying SLOW DOWN! Cold showers; a cold wash cloth; music and a darkened room with time seem to be the only relief here.
Ø I no longer go to the movies very often (once a year); the motion on the wide screen makes me violently nauseous.
Ø When watching TV, I cannot watch any action – it is too hard for my eyes to follow, and I get instantly dizzy and nauseous.
Mental
Impaired memory and cognitive functions
Ø I often forget names, words, trains of thought. This irritates me, which can lead to anxiety attacks.
Ø Any task requiring multi steps, I now avoid with a passion.
Ø If you look at my home, you’ll find stick-it notes all over the home to remind me of things.
Ø I have developed strict patterns of behavior to avoid having to “remember” things. For example, the telephone and the TV remote must stay in the same place, so I won’t find them in the refrigerator by using my cell phone to call my home phone to locate it.
Ø I no longer watch movie rentals, as I can’t figure out how to work the VCR. One of my children helps reset the clocks at home every 6 months.
Ø Similar words present problems. Work and word for example; “Country Squire” and “Country Singer” were the challenges last night (I love watching A&E’s mysteries). Tuesday and Thursday are often mixed-up for me. If I am not careful, the alarm clock will be set for PM when I need AM; etc.

Other

Includes any other neurological findings attributable to MS (fatigue; sleep problems; aversion to heat, depression, panic attacks, social issues, etc.)
Ø FATIGUE is a huge factor for me. Up until about 5 years ago, I routinely could work 70-80 hour work weeks; take care of the home; raise two kids; and still have time and energy to get involved in social and volunteer situations. Today, just the thought of getting out of bed is hard; emptying the dishwasher takes 3 - 10 minute tasks. Forget doing the dishes!
Ø The irony with the fatigue is that for SLEEP it is coupled always (at least for me) with insomnia! No matter what I do, even when I take 2 more Baclafin tablets 1 hour before bedtime, it will take me 2-3 hours to fall asleep each night! Then, I cannot seem to wake up in the morning.
Ø HEAT – I cannot stand heat! I have twice “passed out” from not monitoring the heat level of my body. I’ve now learned, and have a “cooling vest”, many fans, and with the move, have central air conditioning!
Ø As can be seen in other documents provided, I am an extremely positive person. Before I went to See Dr. XXXX, my Neurologist in 1997, I went through some difficult personal times (1993-1997). Depression hit me in a big way, as did panic attacks – the first that I had ever had. I tried to talk myself out of them, and when my thoughts turned to suicide, I went to Dr. ZZZZZ.
Ø Social Issues crop up, and must be managed. It is too easy to become a hermit.

Ø Dealing with the MS fatigue has been very hard for someone like me, likened to a “heat-seeking missile” when focused on a task! If I were to give in to the fatigue, I would never get out of bed! Just the though of writing a check is hard and seems like it’ll take too much effort. As an example: On mornings when I shower, even though I sit in the shower, and do not “mess” with “doing” my hair, I have to sit for at least an hour to regain my energy before proceeding to the next task.
Ø The fatigue is such that you CANNOT ignore it. If I push my limits, the flu-like symptoms that I get are so bad that they are the “10” level on my pain scale, and NOTHING can take the ache in every muscle of the body away!
Ø Learning to “manage” the fatigue; to balance the insomnia; and to make sure that the bills get paid, the groceries picked up every now and then – all of this has become my full time “job”.
Ø I’ve learned through research that when the myelin has been impacted, the nerves have to work many multiple times to get the “message” to the muscles. Hence, trying to “cool the body down” takes away whatever little energy I have even faster. On hot days I become a mole – a cool dark room; lots of water, slow to no movements, and survive! (The new home has central air!)
Ø Depression and panic attacks, I learned, are real, and one cannot just “talk oneself” out of them. Dr. ZZZZZ prescribed Paxil in 20mg pills. These worked wonders up until I started taking the Avonex. Finding out that the MS was real; that I would be having to inject myself with Avonex on a weekly basis – Dr. ZZZZZ upped the Paxil level to the 40 mg pill level. I cannot express in words how devastating this disease is. No one can tell you what to expect; how the symptoms will progress; what to do to manage. AND, company STD and LTD plans are not easy to understand and manage!
Ø I set a goal to do something social once a week – even if it is just a face-to-face activity with friends.



Bottomline: As of Date of Completion, (the date of this update for Your Company LTD) my week day and week-end days have become pretty much the same. Up between 11 am and 1 pm. Then rest; shower, meal, 10 minute chores and rest. Now that I am in the new home with family, there is help with chores like groceries, laundry, changing the bed, house cleaning, and bill paying - (greatly appreciated!). Nap in the afternoon; music, some reading, some TV; dinner; lots of fruit, vegetables, and liquids. Between 11 pm and midnight, I usually go on the computer to answer email messages, and to assist folks with disabilities through “Ask the Expert, on About.com. Attempt to go to sleep about 2-5 am; toss and turn until the muscles stop aching and twitching enough to get to sleep. I have learned how to go to sleep with music, or to the drone of the television (alarm set for 30 minutes). Final note: As an indication of my mental capabilities change, I had to have my son proof read these documents, after I typed and proofed them myself up to 7 times. He found many errors – particularly the kind where the left-right hand word error could occur (i.e., seft instead of left; work instead of word;).
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Thursday, January 12, 2006

Sample Before & After Matrix (Multiple Sclerosis)

DATE OF COMPLETION

The following matrix describes a “typical” day/week in the life of Your Name before the multiple symptoms of Multiple Sclerosis, and at this point of time: Date of Completion. This matrix will be (and has been) updated as needed. The last update was (whenever. Use this statement only when this is a follow-up document.)

As of Date, I have changed my living arrangements. I purchased a home with my son and daughter-in-law. The home has a separate “mother-in-law” apartment. This arrangement allows me greater assistance in my day-to-day living, as indicated below.

Activity/
Timeframe

1996 until 4-13-00
(Similar work times 1990-1996)
Daily Activities as of
Date of Completion
Monday through
Friday, daily
activities
Ø Arise 6:00 am
Ø Leave for work 6:45 am
Ø Work from about 7:15 am until about 6:00 pm, straight through. Meals taken at desk or in a meeting.
Ø During the evening on work days, there always seemed to be an “event” of some sort. Keeping up with the kids; teaching at the Shipyard from 4:00 pm to 10:00 pm three nights a week for a 10-week session, 5 times; teaching at Portland State once or twice a quarter; professional meetings; Church-related meetings (Small Group Ministry; etc.). If no event, time on the computer/Internet, or catching up on reading for work.
Ø Sleep at about 10:00pm.
Ø Arise between 11:00am and 1:00pm.
Ø Prepare and eat a meal. Take medications; and perform stretch exercises. Every other day, take a shower in a specially equipped shower with a stool; safety bars; water direction assistance, etc. Taking a shower and recovering from same can take up to one and one-half hours.
Ø Nap between 4:00pm and 6:00pm.
Ø I lost the ability to drive effective September 1, 2002. My PCP (Primary Care Physician), Dr. ZZZZ and I decided that, because of the numbness of both of my legs, coupled with my increasing visual problems, it was no longer safe for me to drive.
Ø Evenings: reading, music, watching TV, and checking the Internet for information that could assist in my areas of interest.
Ø Between Midnight and about 2:00am I can be on the Internet, answering questions for others with disabilities on a volunteer basis. Typing takes much longer, now, as sometimes the wrong key is hit (i.e., when I want the e, the o comes; the p becomes a w; etc.)
Ø 2-3 hours per day devoted to “daily normal living” activities. These have been adequately discussed in the companion document entitled "Company LTD Claimant Questionnaire; Completion Date”.
Ø Paying bills is a big chore, as it taxes my cognitive and memory skills. Changing the sheets on the bed can take hours, as the activity can be accomplished in only 10 minute intervals.
Ø I begin to try and sleep between 2:00am and 5:00am. I toss and turn until muscles relax. The medication taken helps somewhat, but it still takes about 2 hours to be able to go to sleep.
Ø Sleep is interrupted each night about 4-5 times to go to the bathroom, and to get a sip of water because of the “choking” problems associated with what I now know is “mild Dysphagia”.
Ø As I now live in a daylight basement, the temperature can be regulated to keep cool. The new home has central air. This change will greatly assist in coping with heat in the summers.
Ø My feet are continually freezing; I can be in short sleeves and shorts, and have to wear socks!
Ø As my right leg is becoming as numb as the left, I am careful, and use my two forearm crutches when walking.

Weekends
Ø 4-6 hours of office work, either at the office, or at home.
Ø Socialize at least one night each weekend. This could be just with friends; with a Church social group (i.e., Presbyterian Mariner’s group); a movie, something.
Ø Church each Sunday morning.
Ø Part of each weekend shopping at one or more of the malls. I loved just walking in the mall, browsing, going to the music and bookstores, looking at people. Didn’t need to acquire anything, just looking.
Ø Grocery shopping.
Ø Cleaning home (two stories). During this timeframe, I also refurbished the entire house.
Ø I attempt to keep the volunteer and/or mentoring to only 4 days per week, late at night.
Ø Saturday and Sunday mornings are just the same as week-days.
Ø It takes the entire weekend to do laundry and cleaning, in 10 minute intervals.
Ø I’ve changed my habits to ordering books, music, and clothes over the TV and the Internet (Amazon.com).
Ø I have learned how to get groceries over the Internet. Safeway delivers to the home. Sunday night appears to be the best time to order.
Ø To ensure I do not fall, I sit in the shower, and have someone else do my toenails (the toes are so numb, the feet need care). (See the LTD Questionnaire for more information.)

Now that I am living with the kids, it will be easier to ensure that there is food in the house, and that the bills are paid. Also, I will be able to ensure that my medications are always available. This is a very important development in my life. For a week, I was not able to obtain my medications. It was quite a shock! I have learned to “manage” my symptoms to allow me to live as great a life as I can. However, without my medications, I felt that I had the worst case of influenza that I ever had! I ached in every muscle, including my earlobes; coupled with this, severe arthritis in every muscle and joint! For example, my hands cramped so badly, that I could not grip anything, and could not type on the computer, hold a toothbrush, or dial a phone. NEVER WANT TO EXPERIENCE THIS AGAIN!

Typical “Job” Duties
Ø In the late 1980’s, I was the VP-HR for the Pacific Northwest’s largest Savings and Loan.
Ø From there I went to a large Manufacturing company, as a Plant HR Director, and a corporate Benefits Director.
Ø My next job, in the mid-‘90’s was as VP-HR for an investment company.
Ø From 1994 - early 1996 I was a Senior Consultant with a Human Resources consulting company. One of my clients was 1234 Company, the Portland Shipyard (a privately owned, 100 million $/year company). I worked at the Shipyard from July 1996 until I joined Cascade as VP-HR in May of 1997. I retained that position until I went on LTD 4-13-00.
Ø As a “Type A” personality, my jobs always have required 55-60 hours of work per week. This time commitment increased at the Shipyard. We have anywhere from 500-2,500 employees at any one time, and from one day to the next. We have 11 unions. I supervised up to 25 employees, and started the first Human Resources Department that the Shipyard had ever had, in over 100 years of operations!
Ø I was responsible for, and/or did all the work for Employee Relations; Labor Relations; compensation; benefits; Workers Compensation (averaging 300-400 incidents per year). We had a Training Center, on site that was my responsibility. I also personally handled all of the Employment litigation. This meant representing Cascade in court and other legal/labor proceedings.
Ø Each day was crammed full of meetings, crises, activities, etc.
Ø The job required extensive patience, experience, maturity, tact, expertise, and the ability to remain calm in the middle of multiple crises.
Ø The day I knew that I had to cut back will remain always in my mind: I had a Craft Manager and his Union Business Agent and Shop Steward in my office, very agitated; I had the Safety Director and an employee out in the hallway; I had the Executive VP for Production on my cell phone; and I had the Owner on my land line (phone). All were talking (yelling) at me at once. Now, this was typical, but for the first time I froze; I could not multi-task effectively to provide the customer service to all of these clients in the manner that they deserved. My vision left (big black holes in my right eye; “heat waves” in my left – Optic Neuritis); my MS had reached the stage that I was too tired and too befuddled to effectively manage the work. I set in motion the process to lead to LTD.

Ø The computer work is great, as I can work for 15-30 minutes, take a break, read some, and get back to it – correcting all of my typing errors! Also, I have a large computer screen to assist in the visual problems. I find that by changing my “up close” reading/typing with my watching TV or looking out my back yard window at the garden helps with the vision.
Ø I do Internet searches for information.
Ø The Volunteer work falls into the following categories:
1. MS Chapter Committees. I am on the Government Relations and the Employment Committees of the Portland, OR MS Chapter. This work requires occasional meetings (I participate via a telephone conference call now, without a car); reading and responding to emails; keeping up to date, primarily through the Internet, about what’s going on in the employment world.
2. Volunteer “Expert” on disability and other related issues. I am a volunteer expert; I receive about 2 or so questions every week. Most of the time they can be easily answered. Some, like the one I am working on now, require research and 2 or three times to respond. To date, I have assisted up to 98 folks.
3. Because of my helping others, and because I have been on Avonex (weekly IM [inter-muscular] injections) for 4 years, I have been interviewed for an article in the Spring 2003 edition of the BIOGEN magazine entitled “The Avonex Alliance”. In this article, I have been interviewed as a Mentor; I recommend that others use matrixes like this to assist their doctors in their care.
4. My long term goal is to work with Insurance companies to change the nature of STD and LTD plans to provide company discounts to companies who hire the disabled and the retired; to work with all disability organizations to form a coalition and work together for their constituents, and not to compete with each other for funds; to get the local, state and federal governments to offer tax breaks to companies to hire the disabled and the retired; and, to allow the disabled and the retired to work longer and continue to feel valued in whatever they do.
5. As the honorary “Executive Vice President” for A Company., I have the opportunity to add value to work as a “mentor”; as an experienced person who has “been there, done that”. Often, I can assist Executives and Managers over the phone with employee relations issues. I have no financial interest in the company; I do, however, receive satisfaction in that I am still a contributing adult, and not just an “ill person”!



In general, I’m listening to my body, and trying to do what is right for me. I have enclosed the last two physical “updates” that I provide to my Doctors with each visit.



The other significant change is that I was granted SSDI coverage, as you know. This was a significant success, in that I have been told that I am still the only person in the my area who was granted coverage the first time, in under 30 days! The 2001 issue of this matrix, along with other documents were of significant value in obtaining this coverage.
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Wednesday, January 11, 2006

Social Security Disability Insurance (SSDI) APPLICATION PROCESS

Social Security Disability Insurance (SSDI) APPLICATION PROCESS

This document is a checklist provided to walk you through the SSDI application process. As you read, and complete each section, check it off so that you can keep track of where you are in the process.

What and Why SSDI?

You have successful filed for, and have been accepted for, Long Term Disability (LTD) insurance. OR, you do not have access to LTD, or have been declined for LTD. (Note: a denial on behalf of an insurance company for LTD, does not have an impact on your ability to successfully apply for, and be accepted for, Social Security Disability Insurance coverage. The Social Security Administration uses the same and different criteria to determine eligibility..)


If you are a worker who has qualified for SSDI by working a sufficient length of time, (place link to SSA personal statement page here) suffering from a disability, you may be able to receive monetary benefits from the Social Security Administration. Also, in some situations these disability benefits may be awarded to you and your dependents. To determine if your dependents are eligible for benefits, please refer to place SSA link here. This document describes the steps involved in applying for benefits for yourself, as a worker, suffering from a disability.

In general, the Social Security Administration will pay cash benefits to people who are unable to work for a year or more because of a physical or mental disability. In order to receive these benefits, you must prove that you are in fact disabled or suffering from a disability. This document describes the process of “proving disability” in step-by-step detail. As a further assistance, included are forms to help in your proof; both completed documents by someone with the same disease as you have, to serve as examples, and the blank forms available for you to use to describe your own situation.

Disability under Social Security is based on your inability to work. You will be considered disabled if you cannot do the work that you did before (i.e., the job or occupation that you performed at the time when your illness/condition became disabling), and that you cannot adjust to other types of work (given your specific age, level of impairment, past work history, and level of education) because of your medical condition(s). Your disability also must last or be expected to last for at least a year or to result in death.



Why is it so hard to Qualify for SSDI?

There are three primary reasons why it is so difficult to qualify for SSDI:

Ø The applicant thinks that s/he is disabled, but the symptoms have not sufficiently impaired the applicant’s ability to perform “work” as defined by the Social Security Administration.
Ø The applicant has not successfully “proven” that s/he is disabled.
Ø The applicant leaves the “evidence of proof of disability” up to the Social Security Administration, or to another third party, rather than compiling and presenting the evidence to the Adjudicator her/himself.

An individual will be determined to be disabled if his or her impairment "meets" or "equals" the requirements of the Listing of Impairments (found in what is called the Social Security “Blue Book”). This is a list of physical and mental illnesses that the Social Security Administration (SSA) considers to be so severe that they warrant an automatic finding of disability. The link to the Social Security “Blue Book” matrix of illnesses and what they consider “proof of impairment” can be found here: http://208.56.213.87/listings.html


However, if an impairment does not meet or equal the Listing Requirements, the patient will be determined disabled only if s/he is unable to perform work s/he did in the past 15 years and s/he is unable to do any other type of work considering residual functional capacity, age, education, and work experience. It is important to know that the proof of impairment – the documentation of this impairment – is the responsibility of the claimant and his/her supporting Medical team.

This requirement on the part of the claimant to “prove” the claim is the primary reason for so many denials. Recent documents indicate that the denial for first time applicants is up to 60%. Denials for second time applicants are up to 80%.
However, applicants who take the time and effort to understand their illness; who take the time to help their doctors, friends and families help them describe in detail how the impairments of the disease have so impacted you that you cannot perform either your job or any job; and, who take the time to compile all of the data for themselves and present the completed file to the Social Security Administration; these are the applicants that have a much higher chance of obtaining approval the first time around. The proof of this statement is that the author, Carolyn Magura, developed this process; developed and used the evidentiary forms and letters; and was approved for SSDI the first time around in under 30 days.

q I understand the why it is so hard to qualify for SSDI.
q I also understand that I must be able to demonstrate that my symptoms impair my normal daily functions in such a way that I meet the Social Security Administration’s definition of “disability”.
q Finally, I understand that I need to document, in great detail, how my symptoms have impaired me.
q I have obtained a copy of my Social Security qualification document.
q If I qualify for SSDI I will be eligible for approximately ____________ amount per month.


Understanding the SSDI Qualification Process

Prior to compiling and completing the documents that will supplement the actual SSDI Application, it is important to consider the following criteria that the Social Security Administration has placed on prospective applicants.

They are:
“1. Are you working?
If you are working in 2002 and your earnings average more than $780 a month, you generally cannot be considered disabled. If you are working in 2003 and your earnings average more than $800 a month, you generally cannot be considered disabled. If you are not working, we go to Step 2.
2. Is your condition "severe"?
Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, we will find that you are not disabled. If your condition does interfere with basic work-related activities, we go to Step #3.
3. Is your condition found in the list of disabling conditions?
For each of the major body systems, we maintain a list of medical conditions that are so severe they automatically mean that you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to a medical condition that is on the list. If it is, we will find that you are disabled. If it is not, we then go to Step 4.

4. Can you do the work you did previously?
If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then we must determine if it interferes with your ability to do the work you did previously. If it does not, your claim will be denied. If it does, we proceed to Step 5.

5. Can you do any other type of work?
If you cannot do the work you did in the past, we see if you are able to adjust to other work. We consider your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.” Note: copied directly from the SSA Online website at this link: http://www.ssa.gov/dibplan/dqualify5.htm

In addition, to these general rules, there are specific rules for what the SSA calls “special conditions”. Check here to see if you qualify for one of these special conditions. http://www.ssa.gov/dibplan/dqualify7.htm


Compiling and documenting the evidence of your Disability

The following process will walk you, step-by-step through the documents to focus your evidence to show:

Ø That you have an illness (Multiple Sclerosis) and are suffering from documented symptoms, over time.
Ø That these symptoms meet the SSA definition of “disability”.
Ø That these symptoms impair your normal daily living activities.
Ø That this impairment will last for at least 12 months.
Ø That this impairment will keep you from performing “any occupation”.
Note: this process only will work if, in fact, you do have the illness; you do have the symptoms; the symptoms can be documented and proven by supporting information by Doctors, friends, family, and co-workers; and, that you actually are impaired from performing work of any occupation. This is NOT a process for use in attempting to defraud the Social Security Administration.

 Having read the SSA definitions above, I believe that I am disabled; and that this disability does impair me from working.
 My Doctors, family, friends, and co-workers also agree, and are willing to support me in this process.


DOCUMENTATION!

Step #1: Complete the Symptom Matrix in great detail. Use attachment # 333, and use attachment #444 as an example. Remember, this is your best opportunity to describe how you feel; how your illness, MS, impacts you. This is NOT the time to portray a “stiff upper lip”; it is the time to “complain all that you want”!

 I have completed the first draft of my Symptom Matrix.

Step #2: Review your current job description. Hopefully, your job description will contain what is called “physical capacity criteria” that indicate what specific physical, mental, and social “levels of interaction” are required when performing your job. (See attachment ----, an example of a job description that includes the physical capacity criteria.)

If your job description does not include such criteria, you will need to develop them. For example, in your job:
1. If you need to use a computer, this activity could require you to be able to carry out small motor skills proficiently for 2-4 hours per day, or longer.
2. In using this computer, you would be required to sit for 2-4, and up to 6 hours per day.
3. In using this computer, you would be required to have visual skills capable of viewing a computer screen for 2-6 hours per day.
4. If your job requires you to inspect a warehouse, this activity requires you to walk for 2-4 hours at a time; for distances up to 2 miles; to conduct activities in a non-office work environment that could reflect temperature differences between heat and cold.
5. This warehouse inspection could require you to climb the equivalent of 5 flights of stairs at least 4 times per day.
6. As a Welder of iron plating, you could be required to stand, sit, bend, for 4-7 hours per day.


These are just a few examples of how activities of a job correlate to the physical activities of normal daily living. What you need to do is to develop the physical requirements of your job. Please see appendix___________ as an example.

q I have developed the physical requirements of my job.

Step #3: Your next step is to complete the “Before and After” activity matrix found at attachment _______. It is important to keep in mind what your end result needs to be. You are documenting YOUR LIFE, to communicate to someone who does not know you what you did before your disease/accident had an impact on your life.

As you review the MS-specific example of Before and After, you will see that the Before section describes Ms. Magura’s physical activities associated with her job as Vice President of Human Resources for Cascade General, the Portland Ship Repair Yard. Please read Ms. Magura’s example carefully. Note that she discusses the job activities in great detail:
1. When the workday began.
2. What type of activities needed to be performed.
3. What type, frequency, duration, and intensity of interpersonal actions with others needed to be performed.
4. The diversity of activities being performed; the length of each workday; the volume of activities; the requirement for multi-tasking, etc.
5. The number of hours being worked each day;
6. What activities were accomplished after work each day; during the weekend.
7. Please see that she “described”, in the “Before” the job activities. By comparing the before and after, one can see that the symptoms, as described in the Symptom Matrix, are, in the after, not able to be performed.

In summary, what you are doing is “painting a picture” of your life BEFORE your illness/accident forced you to change your activities. You need to be as specific and as detailed as you can be. What you are doing is explain what your “Normal Daily Living” looked like!

Next, you need to complete the “After” side. Again, read Ms. Magura’s example to see how detailed she is in explaining the impact that MS symptoms have had on her ability to perform her normal daily living activities and the physical, mental, and interpersonal actions of her job.

Review the Symptom Matrix (Attachment ____________) that you have already completed to document your symptoms when documenting your “After” side of this matrix. Again, be as specific and as detailed as you possibly can.

When you are finished, provide the Before and After matrix, your job description, and your Symptom matrix to someone who knows you and ask them to critique the matrixes as they compare both to your job description, and to how they have observed your change over time. Ask them the following question: “If you were an Insurance Adjuster, do these matrixes provide enough information for you to get a clear picture of the impact that my illness has had on me; of the level of impairment that the illness has had on my normal daily living?” If the answer is yes, then you are ready to continue. If no, revise the matrixes until the answer is yes.

After your friends, family, and co-worker(s) have reviewed the documents, select no less than 2, and preferably 3, to write a letter on your behalf to the Social Security Administration. As an example, see attachments 99999 and 8888.

q I have completed my Before and After matrix.
q I have provided copies of my matrixes and my job description to friends and families. They critiqued them.
q My matrixes adequately describes the impact that my illness has on me, and of the level of impairment that the illness has had on my normal daily living.
q I have copies of letters from friends and co-workers describing how they have witnessed my symptoms’ impact my daily normal living over time.


Working with your Doctor

Step #4: is to review the information about what your Doctor needs to know to help you by completing the Physical Capacity Evaluation or Residual Capacity Assessment Form. (See Appendix ------ for the instructions for your doctor. See Appendix ------ for a copy of a letter that you can copy to explain to your doctor what you need for him/her to do to assist you with your SSDI application. See Appendix ----- for a copy of a Physical Capacity Evaluation (PCE) Form for your Doctor to use. )

Make sure that you have 2 copies of the PCE form. Complete one yourself, as you see yourself impaired by your illness. Your previously completed matrixes will help you here. After filling out your copy, as you see yourself, review your job description once again.

Provide a copy of your matrixes, a copy of the instructions to your doctor along with the cover letter, a copy of your letters from friends and co-workers, along with the blank PCE form, to your doctor.


REMEMBER: If your doctor has any differences of opinion about your symptoms and limitations; make sure that the two of you resolve the differences before the doctor completes the Insurance forms for you.

When you get the letter(s), the PCE form and the chart notes from your doctor(s), be sure that you read them carefully. You will need to be sure that whatever symptoms, conditions, and issues noted by the doctor(s) are adequately addressed in your matrices.

One more key step in the “proof” arena. If you have had any “tests” performed to determine the presence of MS (i.e., MRI, spinal tap, eye tests, etc.) make sure that the test results also are included in the chart note information received from your doctor(s). Also, print from this website, to include in your documentation, how to interpret the test results when MS is the diagnosis: http://www.mscentralsupport.com/diagnosing.html


 You have resolved any differences of opinion about your symptoms and your limitations with your Doctor(s).
q You have received back from your Doctor(s), the completed PCE form, the letter(s), and the chart notes.
q You have read the chart notes, and have made sure that anything noted is reflected in your matrixes.
q If you have had tests conducted, you have printed out the information that shows how to interpret the test results when MS is the diagnosis.



Completing the SSDI Application

It is recommended that you now make an appointment with your local Social Security Administration. Your local SSA office can be located through the following link.

http://www.ssa.gov/dibplan/dapply.htm

After you have made the appointment (probably for some time in the future, because they are usually backed-up) please see the link below and download the actual application.

https://s3abaca.ssa.gov/pro/isba3/wwwrmain.shtml


Complete as much of it as you can. This is another document to take with you to your appointment.

Next, the SSA recommends that you also include the following:
· A copy of your social security card, showing your number;
· Names, addresses and phone numbers of doctors, hospitals, clinics and institutions that treated you and dates of treatment;
· Names of all medications you are taking;
· Medical records from your doctors, therapists, hospitals, clinics and caseworkers;
· Laboratory and test results;
· A summary of where you worked and the kind of work you did;
· A copy of your W-2 Form (Wage and Tax Statement), or, if you are self-employed, your federal tax return for the past year;
· A certified copy of your divorce decree if you are divorced; and,
· An original of your birth certificate.


In addition to these documents, you also will be taking copies of the documents that you have just finished compiling:
· Your Symptom Matrix;
· Your Before and After Matrix;
· Your Doctor Completed PCE
· Your letters from your doctor(s); your friend(s); from your co-worker(s);
· Your doctor chart notes; and,
· If tests were performed, an explanation of how to read the test results when MS is the diagnosis.

You might want to compile all of the information into a binder. The SSA will have you take the documents out of the binder, and place them in a file folder.



q You have compiled all of the documentation that proves that you have a disability; that the symptoms of that disability impair your normal daily living; and, that you cannot return to work.
q You have made sure that you have kept an entire set of documentation for yourself.


CONGRATULATIONS! You are now ready for your appointment with the Social Security Administration!

Good Luck
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A Message to Your Doctor (Social Security Disability)

A Message to Your Doctor


Your patient is in the process of attempting to qualify for disability benefits from either an insurance carrier or the Social Security Administration and will need specific details when documenting their symptom’s impact on a Functional Capacity Evaluation (PCE) form. (Note: this process also can be called a Residual Functional Capacity [RFC] assessment”. It is used extensively by the Social Security Administration; it is form SSA-4734.)

The patient has provided this explanation to you, so that you can better assist them in completing the necessary forms. The patient also has taken the first step of completing the form as s/he sees symptoms impacting his/her normal daily functions. If you have a difference in opinion about your patient’s perception, please resolve the differences with the patient before completing the form.
Doctors with patients who have been injured or have Social Security disability claims are usually asked to provide evidence. But what do the Social Security people mean by "disability"? And what kind of evidence do they need from doctors?
There is no universal definition of "disability." It depends on who is defining it - Veterans administration, Worker's Compensation, ADA.
A functional capacity evaluation can be an essential tool in determining whether a patient is disabled for purposes of Social Security disability benefits. It is one of the primary reasons for SPECIFICALLY documenting the impairment a disease or illness has on a patient’s normal daily living (NDL).
An individual will be determined to be disabled if his or her impairment "meets" or "equals" the requirements of the Listing of Impairments (found in what is called the Social Security “Blue Book”. This is a list of physical and mental illnesses that the Social Security Administration (SSA) considers to be so severe that they warrant an automatic finding of disability.
However, if an impairment does not meet or equal the Listing Requirements, the patient will be determined disabled only if s/he is unable to perform work s/he did in the past 15 years and s/he is unable to do any other type of work considering residual functional capacity, age, education, and work experience. It is important to know that the proof of impairment – the documentation of this impairment – is the responsibility of the patient and his/her supporting Medical team.
An individual's "residual functional capacity" (RFC) means what an individual can do despite the limitations of the individual's impairment. The tool used to determine a patient's RFC is the functional capacity evaluation, which assesses a patient's capacity to do work-related physical and mental tasks on a regular and continuing basis--which means eight hours a day, five days a week.
A useful functional capacity evaluation needs to assess three important areas: physical abilities, mental limitations, and other non-exertional impairments and restrictions. All of a patient's impairments that are supported by medical records, even those that are not sever, should be addressed in the functional capacity evaluation since the combination of impairments may adversely affect the patient's ability to work.
1. Physical Abilities. This section of the functional capacity evaluation should describe the patient's limitations regarding physical activities. All potential activities that might be required for a work situation should be addressed: sitting, standing, walking, lifting, carrying, bending, squatting, crawling, climbing, reaching, stooping, kneeling, and so on. The patient's ability to do particular types of repetitive motions should also be considered. Please bee sure to note any necessary restrictions on the patient's physical activities. For example, can the patient lift up to 10 pounds? Over 50 pounds? And how often can the patient engage in such activity? Never? Occasionally? Frequently?
2. Mental Limitations. This part of the functional capacity evaluation should fully describe any of the patient's limitations in understanding, remembering, and following through on instructions. Also, be sure to note any limitations the patient has with respect to responding appropriately to common work situations, such as the ability to handle work pressures, receive supervision, or relate to co-workers.
3. Non-Exertional Impairments. This part of the evaluation should include information on other factors such as a patient's pain, environmental restrictions, the need for rest breaks, and any side effects of medication. When describing pain, be sure to note any objective signs of pain, the degree of pain, and the frequency of pain experienced by the patient. The evaluation should also explain whether the patient will need unscheduled breaks because of pain.
Any applicable environmental restrictions should be included in the functional capacity evaluation, as well. Must the patient avoid exposure to dust, fumes, or smoke? Can the patient tolerate heights?
The evaluation should address the patient's need for rest breaks, time off, and effects of the patient's medication. Is it likely that the patient will miss days of work because of pain or the side effects of medication? All such limitations should be fully described as they will affect the patient's ability to do work.
It is very important that the patient’s Doctors are very specific about the occupational limitations (including additional information not requested on the forms, if necessary). Also, it is important that NO ONE assume that a symptom or illness will automatically equate to functional impairment. You cannot depend on common sense to tell you who is disabled under the Social Security law. For example: with Multiple Sclerosis patients, an MRI that shows lesions does not necessarily equate to physical impairment, without the Doctor providing the actual “link” examples for that specific patient. SSA evaluators do not necessarily assume an MRI, which shows demyelinating disease, equals vocationally limiting fatigue, for example, unless a medical professional makes and explains the connection.
Here are some more examples:
1. A 48 year-old construction worker has done heavy, unskilled labor since age 16. He has a 4th grade education and a "low/normal" I.Q. He can read only basic things, like inventory lists and simple instructions. His heart condition limits him to sedentary work. He is not disabled under Social Security law unless he has an additional limitation.
2. A 38 year-old machine operator has done unskilled, medium exertion factory work since graduating from high school. A cardiovascular impairment limits him to sedentary work, and a permanent injury of the right hand limits him to work not requiring bi-manual dexterity. He is disabled under Social Security law.
3. A 61 year-old truck driver has been driving trucks all his life. But during a downturn in the trucking industry ten yeas ago he worked 18 months at a sedentary office job for his brother-in-law. Now a pulmonary impairment limits him to sedentary work. He is not disabled under Social Security law because he is still capable of doing the office job.
The Social Security Administration (SSA) defines disability as:
"Inability to perform substantial gainful activity by reason of a medically determinable physical or mental impairment, or combination of impairments, which has lasted or is expected to last at least 12 consecutive months, or end in death, taking into account the individual's age, education and work history."

The ultimate decision regarding a patient's residual functional capacity rests with the SSA, which may request a functional capacity evaluation to be performed by its own medical consultants. However, the importance of a functional capacity evaluation done by the treating physician or other health care professional cannot be underestimated. After all, it is that person who is most knowledgeable about the patient's condition and any resulting occupational limitations. The treating health care professional's functional capacity evaluation can greatly assist a patient in obtaining much-needed disability benefits.

Thank you very much for taking the time to assist your patient in this difficult process.
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Tuesday, January 10, 2006

Sample Doctor SSDI Letter

DATE OF REQUEST


Dear Dr. ZZZZZ and Dr. XXXX:

XXXX Fax # fax # NOTE: YOU CAN USE THEIR ADDRESSES IF
ZZZZZ Fax # fax # YOU ARE WRITING TO THEM, INSTEAD OF
FAXING THE INFORMATION.

I am in the process of working with the Social Security Administration (SSA) to obtain my Disability Insurance. (OR, I AM IN THE PROCESS OF WORKING WITH MY LONG TERM DISABILITY (LTD) CCOMPANY TO OBTAIN MY LTD INSURANCE.) My appointment is scheduled for YOUR DATE. I am taking the liberty of faxing this information to you, and request that you fax back to me (111-111-1111) the requested information no later than Deadline Date.

Your assistance is needed in this process as follows:

1. Attached is a document that explains what I need from you; why I need the information; and how to make the direct links between my illness symptoms and their impact on my life.

2. Attached is a copy of a Residual Functional Capacity Questionnaire for you to complete on me, based on your findings. I have completed my own, as I see myself impacted, and have attached it for your information.

3. A letter to the SSA, (or, to the LTD Insurance Company) on your letterhead, stating that you have been treating me since (appropriate date for Dr. XXXX; appropriate date for Dr. ZZZZZ).

Ø Your prognosis about my condition. (Dr. ZZZZZ is calling it chronic progressive. If you two could be consistent, it would help the decision makers.)
Ø Your prognosis about my ability to return to any type of work (never).
Ø A statement about my overall physical condition. For example: I also am providing you by fax, a copy of how I believe that each bodily system is impacted by my illness that I am providing to SSA/LTD. A statement could look like this:

“Ms. Your Name’s illness symptoms have been steadily increasing in magnitude since conclusive diagnosis through symptom-specific tests in (appropriate date). The impact of these symptoms on the patient’s daily activities are adequately described in my chart notes, and in the patient’s diary notes.

Due to the magnitude, scope, and complexity of this patient’s condition, it is unreasonable at this time to expect that she will be able to work at any time in the near or distant future. At best, medication can only decrease the rate of increase of this chronic disease. In my opinion, this patient would be a liability to any employer, and would be unable to sustain gainful employment of any sort, due to her physical, mental, emotional, and psychological limitations.”

Either of you may add, if you so wish, that you had to cut me back in work hours from a “full time” of 65-70 hours per week to a “part time of 40 hours” in July or August of 1999, and to no more than 32 hours since 4-1-00. I have been on full Long Term Disability, with no work since 4-1-01.

The following SSA criteria for your information comes from their “Blue Book”, used to evaluate candidates for SSDI:

“Disability Evaluation Under Social Security
(Also known as The Blue Book)
Medical criteria for evaluating Social Security disability claims

Medical Evidence from Treating Sources

Currently, many disability claims are decided on the basis of medical evidence from treating sources. SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed longitudinal picture of the claimant's impairments and may bring a unique perspective to the medical evidence that cannot be obtained from the medical findings alone or from reports of individual examinations or brief hospitalizations. Therefore, timely, accurate, and adequate medical reports from treating sources accelerate the processing of the claim because they can greatly reduce or eliminate the need for additional medical evidence to complete the claim.”

Finally, Dr. ZZZZZ, as my Primary Doctor, could you please have a copy of all information in my medical file pertaining to the diagnosis of my illness. The information should include, but not be limited to: Doctor notes; chart notes; lab results; x-ray results; disease-specific test results; the chart notes from the Physical and Occupational therapists that I saw through Dr. PPPPP. (Note: I have Dr. PPPPP’s first write-up on me.)

I do not need this info by my SSA appointment date. However, as soon as possible would be nice. If someone could call me on OWN PHONE # I’ll come by in person and pick up the information.

THANK YOU BOTH FOR YOUR CONTINUED SUPPORT AND HELP!
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Monday, January 09, 2006

PHYSICAL CAPACITIES EVALUATION(PCE) / RESIDUAL FUNCTIONAL CAPACITY (RFC) FORM

PHYSICAL CAPACITIES EVALUATION(PCE) / RESIDUAL FUNCTIONAL CAPACITY (RFC) FORM

Patient:____________________________________ SS #:_______________
Date Of Birth:_______________
Dear Doctor:
Please answer the following questions with regard to your patient's claim for Social Security disability benefits or Supplemental Security Income (SSI) and/or with regard to your patient’s claim for Long Term Disability (LTD). Please base your answers on how your patient's medical conditions affect his or her ability to function.

1.Nature, frequency and length of contact:
2.Please describe patient's symptoms (including patient's reports of pain, dizziness, etc.):
3.State all clinical findings and laboratory/test results (or enclose copy of same): Please link findings to specific limitations.
4.Diagnosis:
5.Treatment and response (including list of medications and their effect and side-effects):
6.Prognosis:
7.Has the patient's impairment lasted, or can it be expected to last, at least twelve months?Yes _____ No _____
8.Can the patient continuously stand for at least 6 of 8 hours?Yes _____ No _____ How long CAN the patient stand? ____________

9.Can the patient continuously sit upright for at least 6 of 8 hours?Yes ______ No ______ How long CAN the patient sit upright? ______

10.If the answer to either number 8 or number 9 is NO, why is the patient unable to sit or stand?11.Does the patient have to lie down during the day? Yes ______ No ______ If yes, please explain why:12.How many city blocks can the patient walk without stopping?
Please check the frequency that the patient can perform the following activities:
Never Occ. Freq. Const.
0-33% 34-67% 68-100%
Reach Above shoulder ______ ______ ______ _______
At waist level ______ ______ ______ _______
Below waist level ______ ______ ______ _______
Handling (gross motor) ______ ______ ______ _______
Fingering (fine motor) ______ ______ ______ _______
Feeling ______ ______ ______ _______
14. How many pounds can the patient frequently lift over an 8 hour period?_____ Less than 5 _____5-10 _____11-20 _____21-50 _____over 50

15. How many pounds can the patient frequently carry?____ Less than 5 _____5-10 _____11-20 _____21-50 _____over 50

16. Does the patient have any problems performing such functions as grasping, pulling, pushing, or doing fine manipulations with his or her hands? PLEASE BE SPECIFIC.17.Does the patient have any problems with the following movements? (Please indicate any applicable range of motion studies):Bending ______________________________________Squatting ______________________________________Kneeling ______________________________________Turning any parts of the body ________________________
18. Is the patient able to travel alone? Yes _____ No ______Why?
19. Are there any other factors affecting the patient's ability to work (e.g. exposure to fumes, gases; ability to tolerate heights; restriction of exposure to moving machinery)?20. If your patient complains of any pain, please indicate the nature and severity of the complaints and your opinion of the patient's credibility with respect to his or her complaints:If there is an objective basis for the patient's pain, give specific details for this basis (i.e. degenerative changes in the spine):21. Considering your diagnosis of the patient's condition and his/her prognosis, is the patient capable of returning to his/her past job?
Yes _____ No _____ State why or why not:
22. Considering the same factors, is there any work the patient is capable of? State why or why not:___________________________________________________________
Please note whether the above restrictions are:

____ Not likely to change.

____Temporary From:_________To:____________


Date patient can return to work:______________

_______Without Restrictions

_______With Restrictions as noted above

Please attach copies of your clinical records on this patient. Use the space below for any additional comments you may have:

Date Report Completed:
______________________________
Signature of Physician:
______________________________
Physician Name:
______________________________
Address:
______________________________
Telephone:
______________________________
Specialty:
______________________________
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Sunday, January 08, 2006

The Nuts and Bolts of Functional Capacity Evaluations

The Nuts and Bolts of Functional Capacity Evaluations

An Explanation of the Form and its Purposes

(Note: this process also can be called “Residual Functional Capacity [RFC] Assessment”. It is used extensively by the Social Security Administration; it is form SSA-4734-U8, or- BK.)

The purpose of this document is to explain the need for specific details when documenting a patient’s symptom impact on a Functional Capacity Evaluation. The patient has provided this explanation to you, the doctor, so that you can better assist in completing the form. The patient also has taken the first step of completing the form as s/he sees symptoms impacting his/her normal daily functions. If you, as the primary doctor, have a difference in opinion about your patient’s perception, please resolve the differences with the patient before completing the form.

Doctors with patients who have been injured or who have an illness and who have Social Security disability claims, are usually asked to provide evidence. But what do the Social Security people mean by "disability"? And what kind of evidence do they need from doctors?

There is no universal definition of "disability." It depends on who is defining it - Veterans administration, Worker's Compensation, ADA.

A functional capacity evaluation can be an essential tool in determining whether a patient is disabled for purposes of Social Security disability benefits. It is one of the primary reasons for SPECIFICALLY documenting the impairment a disease or illness has on a patient’s normal daily living (NDL).

An individual will be determined to be disabled if his or her impairment "meets" or "equals" the requirements of the Listing of Impairments (found in what is called the Social Security “Blue Book”. This is a list of physical and mental illnesses that the Social Security Administration (SSA) considers to be so severe that they warrant an automatic finding of disability.

However, if an impairment does not meet or equal the Listing Requirements, the patient will be determined disabled only if s/he is unable to perform work s/he did in the past 15 years and s/he is unable to do any other type of work considering residual functional capacity, age, education, and work experience. It is important to know that the proof of impairment – the documentation of this impairment – is the responsibility of the patient and his/her supporting Medical team.

An individual's "residual functional capacity" (RFC) means what an individual can do despite the limitations of the individual's impairment. The tool used to determine a patient's RFC is the functional capacity evaluation, which assesses a patient's capacity to do work-related physical and mental tasks on a regular and continuing basis--which means eight hours a day, five days a week.

A useful functional capacity evaluation needs to assess three important areas: physical abilities, mental limitations, and other non-exertional impairments and restrictions. All of a patient's impairments that are supported by medical records, even those that are not sever, should be addressed in the functional capacity evaluation since the combination of impairments may adversely affect the patient's ability to work.


Physical Abilities.

This section of the functional capacity evaluation should describe the patient's limitations regarding physical activities. All potential activities that might be required for a work situation should be addressed: sitting, standing, walking, lifting, carrying, bending, squatting, crawling, climbing, reaching, stooping, kneeling, and so on. The patient's ability to do particular types of repetitive motions should also be considered. Please bee sure to note any necessary restrictions on the patient's physical activities. For example, can the patient lift up to 10 pounds? Over 50 pounds? And how often can the patient engage in such activity? Never? Occasionally? Frequently?

Mental Limitations.

This part of the functional capacity evaluation should fully describe any of the patient's limitations in understanding, remembering, and following through on instructions. Also, be sure to note any limitations the patient has with respect to responding appropriately to common work situations, such as the ability to handle work pressures, receive supervision, or relate to co-workers.


Non-Exertional Impairments.

This part of the evaluation should include information on other factors such as a patient's pain, environmental restrictions, the need for rest breaks, and any side effects of medication. When describing pain, be sure to note any objective signs of pain, the degree of pain, and the frequency of pain experienced by the patient. The evaluation should also explain whether the patient will need unscheduled breaks because of pain.

Any applicable environmental restrictions should be included in the functional capacity evaluation, as well. Must the patient avoid exposure to dust, fumes, or smoke? Can the patient tolerate heights?

The evaluation should address the patient's need for rest breaks, time off, and effects of the patient's medication. Is it likely that the patient will miss days of work because of pain or the side effects of medication? All such limitations should be fully described as they will affect the patient's ability to do work.

It is very important that the patient’s Doctors are very specific about the occupational limitations (including additional information not requested on the forms, if necessary). Also, it is important that NO ONE assume that a symptom or illness will automatically equate to functional impairment. You cannot depend on common sense to tell you who is disabled under the Social Security law. For example: with Multiple Sclerosis patients, an MRI that shows lesions does not necessarily equate to physical impairment, without the Doctor providing the actual “link” examples for that specific patient. SSA evaluators do not necessarily assume an MRI, which shows demyelinating disease, equals vocationally limiting fatigue, for example, unless a medical professional makes and explains the connection.

Here are some more examples:

A 48 year-old construction worker has done heavy, unskilled labor since age 16. He has a 4th grade education and a "low/normal" I.Q. He can read only basic things, like inventory lists and simple instructions. His heart condition limits him to sedentary work. He is not disabled under Social Security law unless he has an additional limitation.

A 38 year-old machine operator has done unskilled, medium exertion factory work since graduating from high school. A cardiovascular impairment limits him to sedentary work, and a permanent injury of the right hand limits him to work not requiring bi-manual dexterity. He is disabled under Social Security law.


A 61 year-old truck driver has been driving trucks all his life. But during a downturn in the trucking industry ten yeas ago he worked 18 months at a sedentary office job for his brother-in-law. Now a pulmonary impairment limits him to sedentary work. He is not disabled under Social Security law because he is still capable of doing the office job.
The Social Security Administration (SSA) defines disability as:

"Inability to perform substantial gainful activity by reason of a medically determinable physical or mental impairment, or combination of impairments, which has lasted or is expected to last at least 12 consecutive months, or end in death, taking into account the individual's age, education and work history."

The ultimate decision regarding a patient's residual functional capacity rests with the SSA, which may request a functional capacity evaluation to be performed by its own medical consultants. However, the importance of a functional capacity evaluation done by the treating physician or other health care professional cannot be underestimated. After all, it is that person who is most knowledgeable about the patient's condition and any resulting occupational limitations. The treating health care professional's functional capacity evaluation can greatly assist a patient in obtaining much-needed disability benefits.

Thank you very much for taking the time to assist your patient in this difficult process.
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Saturday, January 07, 2006

Sample Co-Worker Letter

July 12, 2001


Social Security Administration

Re: Carolyn Magura

To Whom It May Concern:

A long time friend of mine, by the name of Carolyn Magura, has asked me to write a letter to your office on how I've seen MS impact her life activities.

To begin with our families have shared a close relationship for more than 17 years. We have frequently socialized together, vacationed as families, worked together professionally and shared many holidays. Carolyn and I have become even closer since we both went through a divorce almost 8 years ago.

When Carolyn asked me to write this letter she requested I provide you with some facts on my observations on how MS has had an impact on her life over the past 17 years. As I look back at the years a number of examples come to mind. As part of my letter I included a few examples:

During the early years of our friendship we frequently enjoyed camping together as families. The vacations were active adventures that always included daily hikes. Carolyn was always an active participant on these outings and we found ourselves continually busy from sunup to sundown. Unfortunately as the children grew up Carolyn's health began to limit her participation in our outings. She would begin to hike shorter distances and then return to camp and sometimes would stay behind all together. These changes appeared to be gradual until eventually we noticed that her balance was impacting her ability to participate safely, so she would wait in camp for our return.
For the past 10 years I have watched her struggle with her personal balance and standing stability. At first I would watch, as she would tightly grasp handrails to safely descend stairs. Over the past 5 years she has required the use of walking supports and frequently requires the assistance of another to safely use stairs.
For the past 8 years I have watched a steady decline in her abilities to walk even short distances without becoming fatigued, overheated and exhausted. Our shopping trips to the mall are an activity of the past. Even visiting one store is an activity that must be planned and requires a nap or period of rest before she embarks on even the simplest trip.
About 2.5 years ago I discussed with Carolyn the need to live in a home with wheelchair access. Two years ago she purchased her current single level home in Wilsonville. Moving was an exhaustive process for her and required the support of many friends to get her packed and settled. It has become apparent since her move that she was fortunate to relocate when she did, as we have seen over the past 2 years an accelerated deterioration in her overall health.
As a close friend there are times we have tried to see the humor of her disease. One consequence of the progression of her MS is that she is always hot and overheated. There is many a time I transport her by car in mild weather and we are driving with the air conditioner on. As the driver I’m wearing a sweater and freezing and she is sitting next to me fanning her face and complaining about the heat.
I would describe Carolyn’s career of one that required long hours, high pressure and the ability to respond to an employment crisis at any hour of the day. Over the past 10 years I have watched as she has rapidly deteriorated from 70-hour weeks to no longer being able to work.

I could go on and on by providing you examples on how I have seen Carolyn’s health deteriorate over the 17 years I have known her. It is safe to say that the progression of MS has dramatically increased in the past 7 years to the point she spends most of her days at home. The weekends are a time for sleep and rest for her. Each Sunday I pick her up and transport her to church, after services I drop her back home for a much-needed nap, as the outing has exhausted her. I remember about 4 years ago when she took a vacation that required her to fly, she was unable to get to her connecting flight in time because they were unable to find a wheelchair, this experience made her realize that vacationing was probably an experience of her past.

Should you have any additional questions or wish to contact me directly, you may reach me during business hours at XXX-XXX-XXXX.

Sincerely,
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Friday, January 06, 2006

Sample Letter To Social Security Administration

July 12, 2001


Social Security Administration

Re: Carolyn Magura

To Whom It May Concern:

A long time friend of mine, by the name of Carolyn Magura, has asked me to write a letter to your office on how I've seen MS impact her life activities.

To begin with our families have shared a close relationship for more than 17 years. We have frequently socialized together, vacationed as families, worked together professionally and shared many holidays. Carolyn and I have become even closer since we both went through a divorce almost 8 years ago.

When Carolyn asked me to write this letter she requested I provide you with some facts on my observations on how MS has had an impact on her life over the past 17 years. As I look back at the years a number of examples come to mind. As part of my letter I included a few examples:

During the early years of our friendship we frequently enjoyed camping together as families. The vacations were active adventures that always included daily hikes. Carolyn was always an active participant on these outings and we found ourselves continually busy from sunup to sundown. Unfortunately as the children grew up Carolyn's health began to limit her participation in our outings. She would begin to hike shorter distances and then return to camp and sometimes would stay behind all together. These changes appeared to be gradual until eventually we noticed that her balance was impacting her ability to participate safely, so she would wait in camp for our return.
For the past 10 years I have watched her struggle with her personal balance and standing stability. At first I would watch, as she would tightly grasp handrails to safely descend stairs. Over the past 5 years she has required the use of walking supports and frequently requires the assistance of another to safely use stairs.
For the past 8 years I have watched a steady decline in her abilities to walk even short distances without becoming fatigued, overheated and exhausted. Our shopping trips to the mall are an activity of the past. Even visiting one store is an activity that must be planned and requires a nap or period of rest before she embarks on even the simplest trip.
About 2.5 years ago I discussed with Carolyn the need to live in a home with wheelchair access. Two years ago she purchased her current single level home in Wilsonville. Moving was an exhaustive process for her and required the support of many friends to get her packed and settled. It has become apparent since her move that she was fortunate to relocate when she did, as we have seen over the past 2 years an accelerated deterioration in her overall health.
As a close friend there are times we have tried to see the humor of her disease. One consequence of the progression of her MS is that she is always hot and overheated. There is many a time I transport her by car in mild weather and we are driving with the air conditioner on. As the driver I’m wearing a sweater and freezing and she is sitting next to me fanning her face and complaining about the heat.
I would describe Carolyn’s career of one that required long hours, high pressure and the ability to respond to an employment crisis at any hour of the day. Over the past 10 years I have watched as she has rapidly deteriorated from 70-hour weeks to no longer being able to work.

I could go on and on by providing you examples on how I have seen Carolyn’s health deteriorate over the 17 years I have known her. It is safe to say that the progression of MS has dramatically increased in the past 7 years to the point she spends most of her days at home. The weekends are a time for sleep and rest for her. Each Sunday I pick her up and transport her to church, after services I drop her back home for a much-needed nap, as the outing has exhausted her. I remember about 4 years ago when she took a vacation that required her to fly, she was unable to get to her connecting flight in time because they were unable to find a wheelchair, this experience made her realize that vacationing was probably an experience of her past.

Should you have any additional questions or wish to contact me directly, you may reach me during business hours at XXX-XXX-XXXX.

Sincerely,
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Thursday, January 05, 2006

Sample Doctor Letter

DATE OF REQUEST
Dr. XXXX Fax # or address Dr. ZZZZ Fax # or address

Dear Dr. ZZZZ and Dr. XXXX:
I am in the process of working with the Social Security Administration (SSA) to obtain my Disability Insurance. (OR, I AM IN THE PROCESS OF WORKING WITH MY LONG TERM DISABILITY (LTD) CCOMPANY TO OBTAIN MY LTD INSURANCE.) My appointment is scheduled for YOUR DATE. I am taking the liberty of faxing this information to you, and request that you fax back to me (111-111-1111) the requested information no later than [Deadline Date].
Your assistance is needed in this process as follows:
1. Attached is a document that explains what I need from you; why I need the information; and how to make the direct links between my illness symptoms and their impact on my life.
2. Attached is a copy of a Residual Functional Capacity Questionnaire for you to complete on me, based on your findings. I have also included a completed RFC describing how I’ve experience the impact.
3. A letter to the SSA, (or, to the LTD Insurance Company) on your letterhead, stating that you have been treating me since (appropriate date for Dr. XXXX; appropriate date for Dr. ZZZZ).
· Your prognosis about my condition. (Dr. ZZZZ is calling it chronic progressive. If you two could be consistent, it would help the decision makers.)
· Your prognosis about my ability to return to any type of work (never).
· A statement about my overall physical condition. For example: I also am providing you by fax, a copy of how I believe that each bodily system is impacted by YOUR ILLNESS that I am providing to SSA/LTD. A statement could look like this:

“[Your Name]YOUR ILLNESS symptoms have been steadily increasing in magnitude since conclusive diagnosis through MRI and spinal tap in (appropriate date). The impact of these symptoms on the patient’s daily activities is adequately described in my chart notes, and in the patient’s diary notes.
Due to the magnitude, scope, and complexity of this patient’s condition, it is unreasonable at this time to expect that she will be able to work at any time in the near or distant future. At best, medication can only decrease the rate of increase of this chronic disease. In my opinion, this patient would be a liability to any employer, and would be unable to sustain gainful employment of any sort, due to her physical, mental, emotional, and psychological limitations.”
Either of you may add, if you so wish, that you had to cut me back in work hours from a full time+ of 65-70 hours per week to a part time of 40 hours in July or August of 1999, and to no more than 32 hours since 4-1-00. I have been on full Long Term Disability with no work since 4-1-01.
The following SSA criteria for your information comes from their Blue Book used to evaluate candidates for SSDI:
Disability Evaluation under Social Security (The Blue Book) Medical criteria for evaluating Social Security disability claims
Medical Evidence from Treating Sources
Currently, many disability claims are decided on the basis of medical evidence from treating sources. SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed longitudinal picture of the claimant's impairments and may bring a unique perspective to the medical evidence that cannot be obtained from the medical findings alone or from reports of individual examinations or brief hospitalizations. Therefore, timely, accurate, and adequate medical reports from treating sources accelerate the processing of the claim because they can greatly reduce or eliminate the need for additional medical evidence to complete the claim.

Finally, Dr. ZZZZ, as my Primary Doctor, could you please have a copy of all information in my medical file pertaining to the diagnosis of YOUR ILLNESS. The information should include, but not be limited to: Doctor notes, chart notes, lab results, x-ray results, MRI results, Spinal Tap results, the chart notes from the Physical and Occupational therapists that I saw through Dr. PPPPP.
(Note: I have Dr. PPPPP’s first write-up on me.)
I do not need this info by my SSA appointment date. However, as soon as possible would be nice. If someone could call me at [YOUR PHONE #] I’ll come by in person and pick up the information.
THANK YOU FOR YOUR CONTINUED SUPPORT AND HELP!
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Monday, January 02, 2006

The Long Term Disability (LTD) Key

The Long Term Disability (LTD) Key

Linking an Applicants Disease Symptoms to Limitations and Jobs


Introduction

You have read both the Disability Overview Key, and the Physician Key. In addition to what you gleaned from the Overview Key, you now have:
q A segment that contains an overall explanation for your Doctor(s);
q An example of a letter from you to your Doctor(s) explaining precisely what you want from them;
q A disease-specific (Multiple Sclerosis) medical history document that you complete to better remind your Doctor(s) about your symptoms and their specific impact on you;
q An actual experiential example of this document completed to assist you in completing your own; and,
q A blank copy of a Physical Capacity Evaluation (PCE)/Residual Functional Capacity assessment (RFC) form that allows your Doctor(s) to quantify the effect your disease symptoms have on you.

You have determined that you do have a Long Term Disability (LTD) plan; you do have a copy of the Summary Plan Description (SPD) for your plan, and you have decided to apply for LTD. Successfully documenting your disease-specific symptoms so that you can apply for LTD is the purpose of this document: The Long Term Disability Key.

The value of this Long Term Disability (LTD) Key document is:
1. Just as you did for your Doctor(s) in the last Key document, you need to gather together all of the proof for your LTD Insurance Company so that they do not have to do any “additional” work themselves. In essence, you are “proving” to them that not only do you have a disease, and that disease impairs you, the impairment is grave enough that you no longer can perform “work”.
2. By completing the sections contained herein, you will learn so much about the disability insurance benefit process, that it will no longer be intimidating to you when you periodically (they usually seem to run on an every 2 year cycle) have to “prove” that you are still disabled.

As an explanation of the value of this document, the following comment was expressed by a reviewer with MS needing assistance with the LTD “recertification” process:

“…The ‘checklist’ format [of the How-To segment] is ideal. I like the concept of going through all of the steps from the very beginning. Your points regarding documentation and records are the essential details that every disabled person needs to know, understand, and complete. I wish I knew ‘then’ what I know now – but I’m coming from behind and I will win!”

You get the opportunity, with this Key, to “know” ahead of time what is needed, and NOT to have to come from behind!

This Long Term Disability (LTD) Key is segmented into the following components:

q #1 LTD Key: An detailed How-To checklist that walks you through the LTD process.
q #2 LTD Key: A Job Description that includes the PCE’s (physical capacity evaluation) of the essential duties of that “job”. It is included so that you can use it as an example when describing the specific physical, mental and environmental capacity expectations needed for your own job.
q #3 LTD Key: A disease-specific (Multiple Sclerosis) symptom Matrix to use to document your symptoms and the impact on your normal daily living (NDL) activities; both blank and a completed example to use as a reference.
q #4 LTD Key: A Before and After Matrix to use to describe IN DETAIL your NDL when you were working, and now that you are symptom-impaired; again, both blank and a completed example to use as a reference.
q #5 LTD Key: An example of an “actual” LTD application form that has been completed, as an example to assist you.
q #6 LTD Key: Two examples of letters (one from a friend and one from a co-worker) that describe your specific symptom-impairment on your normal daily living (NDL).

Let’s Begin.


#1 LTD Key: An detailed How-To checklist that walks you through the LTD process.

Long Term Disability (LTD) APPLICATION PROCESS

This segment is a checklist provided to walk you through the LTD application process. As you read, and complete each section, check it off so that you can keep track of where you are in the process.

What and Why LTD?

Long Term Disability (LTD) is defined as a severe illness or injury that prevents you from working at all or prevents you from working full-time, for a period of six months or longer.

The purpose of an LTD plan is to protect you and your family from complete loss of income should you suffer a long term disability.

This “How-To” document summarizes a generic Long Term Disability application process in everyday language and explains how and when to apply for benefits. Please refer to your LTD Summary Plan Description as you proceed through this checklist.

LTD plans usually are provided in two ways:
v Paid for by a company as part of the company’s employee benefit package; and,
v Paid for by a person as an individual insurance plan

q My LTD plan is:  Company paid;  Self paid.

q I am eligible for LTD.

A long term disability plan usually covers a physical or mental illness that prevents employees from performing the job that they occupied at the time the illness/accident occurred.

To be eligible, a plan participant usually has to meet at least three conditions:

1. S/he has been covered (i.e., have worked for the company, or have owned the policy) for the length of time prescribed in the SPD;
2. S/he expects the condition to last at least a specific period of time (usually, longer than the short term disability plan lasts – six to twelve months); and,
3. The “triggering” illness/accident is both the specific reason that you cannot do your job, and, the impact is that you have lost “work pay”.

A wide range of conditions usually are covered, including (but not limited to):

• progressive, uncontrolled cancer;
• loss of major functions of arms and/or legs;
• serious brain damage;
• alcohol or drug addiction;
• and severe mental illness.

q Is there a pre-existing restriction for illness or injury in your plan?
q If yes, does it apply to you? Yes  No 

Some plans have a pre-existing condition provision. That is, if you were treated (or if a prudent person would have been treated) for a condition within 3 months prior to entering the plan, long term disability benefits would not be available during the first 12 months of coverage for that condition only. Coverage would be immediately available for other conditions.

q I understand how my LTD plan works.

Usually, under an LTD, monthly benefits are paid to the qualified applicant who is totally or partially disabled for a period longer than a specific number of days. That first period of time is called the waiting or elimination period, and no benefits are paid during that time. Often, the STD or Short Term Disability plan covers this period of time, or, a combination of STD coverage and sick leave. (Check the STD checklist for further information.)

q My LTD Plan elimination period is _______________ days. I will obtain income during this time through the use of: _______________________________________________________________

q My LTD benefits will last until: ____________________.

Disability benefits usually continue until the earlier of the date that you complete the maximum benefit period, are able to return to work (see below the difference between work of “own occupation”, or “work of any occupation”), retire or die. Assuming that your retirement age will be age 65 or older, your LTD benefits, once received, should last until you are able to return to work; you retire; or you die, unless the plan specifies another date. Some plans offer benefits until age 70, for example.

q My LTD benefits will equal _______% of my pre-incident monthly income, or _____________.

q I have the other types and amount of income that will deducted from my LTD monthly income:
q Worker’s compensation:______________
q Social Security Disability Income:____________
q Third Party Disability:_____________
q Other:______________

The monthly benefit is equal to a certain percentage of your basic monthly pre-incident earnings, minus the amount of certain other types of income you receive, such as Social Security or third party disability payments and Workers' Compensation benefits. If you are partially disabled, partial benefits may be payable.

q There are other conditions in my LTD plan that I must be aware of. They are:
For example: in some plans you may find that you can still be covered, and remain in a pay status, if the illness “goes away” for a short (usually, 30 days) period of time. The only time this is not applicable, usually, is if this “illness break” occurs during the elimination period. That means, if, during your, say 120 day elimination period before receiving income from your LTD policy, you have an “illness break” of two weeks, that two week time frame extends your 120 day time frame an additional two weeks.

q My LTD “days” are:  week days only;  calendar days.
q I must use my accumulated/accrued sick leave during my elimination period. Yes  No 
q I must use my accumulated/accrued vacation time during my elimination period. Yes  No 
q My sick leave days are:___________________
q My vacation days are:____________________


Check your SPD to see if you are required to use all the sick/vacation leave you have built up. If you must take them, use them for income during your LTD elimination time frame.


UNDERSTANDING THE LTD FORM

Prior to working on the actual LTD form, it is important to remember that this is an INSURANCE PROCESS. What this means, is, that you are preparing to “convince” your LTD insurance company that you have an illness or accident that keeps you from doing your “job”; because of this, you do not receive pay for work performed.

Earlier, we mentioned two types of “job”. They are:

1. Your own, or your “pre-incident” job or occupation; and
2. ANY job that your age, education, and prior work experience qualifies you to perform.

Your SPD will tell you how long your LTD insurance will cover you from being able to perform your own job, and any job.

q My LTD insurance will pay me for not being able to perform “my own occupation”, which is: ____________________________________ ; for ___________.
q My LTD insurance will pay me for not being able to perform “any occupation” beginning: _______________________________.


DOCUMENTING YOUR INABILITY TO PERFORM YOUR “OWN OCCUPATION”

The first thing you need to review is your own job description. Hopefully, your job description will contain what is called “physical capacity criteria” that indicate what specific physical, mental, and social “levels of interaction” are required when performing your job. (See LTD Key #2, an example of a job description that includes the physical capacity criteria.)

If your job description does not include such criteria, you will need to develop them. For example, in your job:
1. If you need to use a computer, this activity could require you to be able to carry out small motor skills proficiently for 2-4 hours per day, or longer.
2. In using this computer, you would be required to sit for 2-4, and up to 6 hours per day.
3. In using this computer, you would be required to have visual skills capable of viewing a computer screen for 2-6 hours per day.
4. If your job requires you to inspect a warehouse, this activity requires you to walk for 2-4 hours at a time; for distances up to 2 miles; to conduct activities in a non-office work environment that could reflect temperature differences between heat and cold.
5. This warehouse inspection could require you to climb the equivalent of 5 flights of stairs at least 4 times per day.
6. As a Welder of iron plating, you could be required to stand, sit, bend, for 4-7 hours per day.


These are just a few examples of how activities of a job correlate to the physical activities of normal daily living. What you need to do is to develop the physical requirements of your job. Please see #2 LTD Key as an example.

q I have developed the physical requirements of my job.
q I have provided a copy of these requirements to both my supervisor, and to the appropriate person in my company’s human resources department. Both have signed off on the document that it is accurate.

Your next step is to complete the “Before and After” activity matrix found at $4 LTD Key. It is important to keep in mind what your end result needs to be. You are documenting YOUR LIFE, to communicate to someone who does not know you what you did before your disease/accident had an impact on your life.

As you review the MS-specific example of Before and After, you will see that the Before section describes Ms. Magura’s physical activities associated with her job as Vice President of Human Resources for Cascade General, the Portland Ship Repair Yard. Please read Ms. Magura’s example carefully. Note that she discusses the job activities in great detail:
1. When the workday began.
2. What type of activities needed to be performed.
3. What type, frequency, duration, and intensity of interpersonal actions with others needed to be performed.
4. The diversity of activities being performed; the length of each workday; the volume of activities; the requirement for multi-tasking, etc.
5. The number of hours being worked each day;
6. What activities were accomplished after work each day; during the weekend.

In summary, what you are doing is “painting a picture” of your life BEFORE your illness/accident forced you to change your activities. You need to be as specific and as detailed as you can be. What you are doing is explain what your “Normal Daily Living” looked like!

Next, you need to complete the “After” side. Again, read Ms. Magura’s example to see how detailed she is in explaining the impact that MS symptoms have had on her ability to perform her normal daily living activities and the physical, mental, and interpersonal actions of her job.

The Symptom Matrix #3 LTD Key that you have already completed to document your symptoms to better discuss their impact with your doctor, are helpful when documenting your “After” side of this matrix. Again, be as specific and as detailed as you possibly can. When you are finished, provide the Before and After matrix to someone who knows you and ask them to critique it. Ask them the following question: “If you were an Insurance Adjuster, does this matrix provide enough information for you to get a clear picture of the impact that my illness has had on me; of the level of impairment that the illness has had on my normal daily living?” If the answer is yes, then you are ready to continue. If no, revise the matrix until the answer is yes.
q I have completed my Disease-specific symptom matrix.
q I have completed my Before and After matrix.
q My matrix adequately describes the impact that my illness has on me, and of the level of impairment that the illness has had on my normal daily living.


Working with your Doctor Reminder

The next step is to review the information about what your Doctor needs to know to help you by completing the Physical Capacity Evaluation or Residual Capacity Assessment Form. (See #1 Dr. Key for the instructions for your doctor. See #2 Dr. Key for a copy of a letter that you can copy to explain to your doctor what you need for him/her to do to assist you with your LTD application. See #5 Dr. Key for a copy of a Physical Capacity Evaluation (PCE) Form for your Doctor to use. )

Make sure that you have 2 copies of both forms. Complete one yourself, as you see yourself impaired by your illness. Provide them, with the blank forms, to your doctor, along with the information document, and your letter of instructions.

REMEMBER: If your doctor has any differences of opinion about your limitations, make sure that the two of you resolve the differences before the doctor completes the Insurance forms for you.

q You have received back from your Doctor, the completed Insurance forms.


Completing the LTD Application

When you complete the Application, you will also need to complete the Insurance Company’s document called “Claimant Questionnaire for Long Term Disability” (or something like this). See #6 LTD Key for an example of a completed document. Ms. Magura placed the questionnaire on the computer, and created a Matrix out of it, so that it can be updated whenever the Insurance Company requests its periodic update.

You now have all of the information needed to complete the LTD application process. Make sure that you have a copy for your records of all of the documents. They should be:

q Insurance Company’s Claimant’s Questionnaire.
q Symptom Matrix.
q Attending Physician’s disability letter.
q Before and After Matrix.
q Physical Capacity Evaluation form.
q Actual Application.

Ensure that you send all of these documents by registered mail, so that you will have proof of receipt. Retain the copy of the receipt with your copy of the documentation.

Documenting Your Inability To Perform “Any Occupation”

By looking into your LTD summary plan description, you should be able to determine how long you can be considered disabled from your own job/occupation. You will also be able to determine when you will need to document your inability to perform any occupation.

What is meant by “any occupation”? Simply stated, this means that your illness has so incapacitated you that you are unable to perform any job that is either full or part time, and which is paid any amount.

To reach this level, your Doctor must agree that you have reached the stage in your illness that you no longer are capable of working. You also must ensure that all of your documentation supports this decision.

You have all of the tools necessary to file for Long Term Disability. Make sure that you keep all of your documents together, so you will be able to find them, when needed.


#2 LTD Key: A Job Description with Essential Duty Physical Capacities
Cascade General, Inc.
Job Description
Job Title: Ship Superintendent Pay Grade: 7
Department: Production FLSA Status: Exempt
Reports To: Vice President Production Manpower and Technical Services
Date: 4/21/98 (revised 8-00)
SUMMARY: As a seasoned Ship Superintendent, is responsible for all activities associated with the profitable repair of ships. Key responsibility for the planning, manning, equipping, and management of a profitable project. Plans, coordinates, manages, and evaluates the effectiveness of work required to repair or modify marine vessels. Work is performed to produce safe, timely, profitable results and satisfied customers.
ESSENTIAL DUTIES AND RESPONSIBILITIES - Independently, and/or through subordinate supervisors, performs the following essential duties and responsibilities:
· Working closely with Craft Directors, the local Unions and Employee Services, determines the appropriate manning levels to result in a profitable project. Works to develop the manpower planning and dispatch function, appropriately capturing the work skills of each employee.

· Plans, coordinates and directs production activities on assigned projects. In conjunction with Project Management and Manpower Dispatch, plans the daily staffing of each project. Audits reports & job progress to ensure the accurate allocation of manpower based on bid proposal and job requirements. Makes appropriate changes where necessary.
· Works closely with the Contracting & Estimating Department to estimate, plan execute, and settle projects. Provides all necessary documentation for bill settlement and negotiation of change orders. Conducts a post mortem on each project completed to determine what went right and should be done again; what went wrong and should be changed; Works with the C & E Dept. to develop and implement a ship repair relational data base.
· Interprets specifications and in coordinates various phases of the repair process, to prevent delays. Ensures that all change order requests and CFR’s are properly written, and approves them before providing them to the Project Management team.
· Writes accurate and timely records or documentation for each job and contributes accordingly to final written specifications. Confers with supervision and project management staff, and project inspectors and suppliers of materials, to resolve repair problems, and to improve repair methods.
· Prepares or reviews reports on work progress, materials used and costs, and adjusts work schedules as indicated by reports. Ensures adherence to the work processes through constant inspection and examination of work in progress
· Through project supervisors, ensures each employee who works on the project receives a fair and accurate performance appraisal throughout each project. Works closely with Craft Managers and Supervisors to resolve complaints and disputes within the workforce.
· Advises contract department of opportunities to increase profits and avoid losses.
· Maintains effective working relationship with craft workers, customers, and contract administrators.
· Ensures that worker safety and environmental concerns are constantly monitored, and that problems are effectively resolved.
· Meets or exceeds Customers’ realistic expectations for quality, productivity, and safety on projects.
· Remains technically competent, ensuring personal skills remain consistent with Cascade’s productivity improvement initiatives.
EDUCATION & EXPERIENCE: An advanced degree in any technical skill associated with ship repair, and/or eight to ten (8-10) years of progressively more complex work experience that demonstrate the acquired ship repair and production knowledge and expertise; or the equivalent combination of education and experience. Three – five (3-5) years experience with successful projects directly resulting from his/her management experience.
The overriding qualifications are the specific demonstrated successful experience staffing, supervising, and ensuring the technical competence of employees in complex, multi-phased, extensive, long-term, high dollar valued projects.
KNOWLEDGES, SKILLS, & ABILITIES
· Demonstrated experience managing a diverse, complex, technical workforce in a union environment.
· Computer familiarity (MS Word, Powerpoint, Excel, Primavera, etc.)
· Excellent proven communication (both oral and written) skills.
· Excellent informal influence skills; the ability to succeed in accomplishing tasks when the performers are not necessarily in the direct line of authority.
· Demonstrated expertise in maximizing revenue and profits on projects through the art and science of negotiation.
· Strong customer service skills.
· Demonstrated ability to effectively plan and execute ship repair projects.
· Demonstrated success communicating effectively and decisively to many and varied customers both internally and externally, while in the midst of chaotic, constantly changing environments.
· Demonstrated ability to translate the requirements of a complex, multi-tasked function into the staffing hours required for efficient and effective project completion.
· Ability to define problems, collect data, establish facts, and draw valid conclusions.
· Working knowledge of the Shipyard and the sequencing of activities necessary for a profitable, efficient project completion.
· Familiarity in working with union contracts.
· Ability to interpret an extensive variety of technical instructions in mathematical or diagram form, and deal with several abstract and concrete variables.
· Strong Shipyard “smarts”.
SUPERVISORY RESPONSIBILITIES: Few to many employees with varying degrees of technical expertise.
CERTIFICATES, LICENSES, REGISTRATIONS: None required.
PHYSICAL DEMANDS: The physical demands for this position are moderate to heavy (see below). The incumbent of this position is required to stand for extensive periods of time, in external climates, and in internal climates exacerbated by external conditions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT: The work environment for this job is demanding and potentially hazardous due to work on or inside ships as well as travel around ship repair yard. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
ESSENTIAL PHYSICAL REQUIREMENTS

Not Required
Rarely
Occasionally
Frequently
Continually
NR
1% or less
1 – 33%
34 – 65%
66 – 100%
It is important to understand that the work performed by this position in a physical capacity requires walking, standing, sitting, twisting, crouching, and maintaining that posture for extensive periods of time in order to estimate the time necessary to perform work; to observe and inspect the quality of one, multiple, and sequential tasks from any and all of 10 (ten) separate craft functions; and to critique the finished products.
1. Sitting: Occasional -- From 45 minutes up to six hours per day, for meetings with employees, peers, management and customers. Also, to perform computer work.
2. Standing: Frequently -- Stands while inspecting work up to 50 minutes at a time, up to a total of six hours per day. Stands on all types and conditions of surface.
3. Walking: Frequently -- Walks up to 1/2 mile, uninterrupted, on level ground or ramps, up to six times per day. There may be obstructions to be walked around, depending upon the work site on ships.
4. Twisting: Knees – Occasional -- While inspecting in confined areas. Waist – Occasional -- Less than 5 minutes at a time, up to four hours per day. Neck – Frequent -- Up to 30 minutes at a time uninterrupted, up to four hours per day in any direction.
5. Stooping/Bending: Occasional -- Stoops up to 15 minutes at a time, up to 3-4 hours per day while critiquing work.
6. Kneeling: Frequent -- Kneels up to 15 minutes at a time, up to 3-4 hours per day on various types and conditions of surface. May kneel on one knee or both, according to available space and personal preference.
7. Crouching: Occasional -- Crouches for 15 minutes at a time, up to 3-4 hours per day while performing activities.
8. Crawling: Occasional -- Crawls up to 150 feet, 3-4 times per day when in various spaces – both open and confined.
9. Climbing: Frequently -- Climbs ladders, scaffolding, stairs and climbs over obstructions, to as much as 100 feet in height, up to four times per day. The scaffolding and ladders in a tanker are difficult to climb, established to maximize access while allowing work to be done in adjacent areas.
10. Balancing: Frequent -- Walks on various types and conditions of surfaces, wide and narrow.
11. Pushing/Pulling: Rarely
12. Reaching :above shoulder height: Occasional -- Reaches in all directions to test the final product. At shoulder height: Occasional
13. Grasping (firm): Rarely
14. Manipulating hands or fingers (e.g., type, assemble, etc.): Frequent -- Uses fingers to manipulate the computer to prepare many documents. Can be using hands in small motor coordination 4-6 hours per day.
15. Use feet to operate controls: Rarely
16. Lifting/Carrying: Rarely: less than 10 pounds.
ESSENTIAL USE OF SENSES
1. Talking: Continually talks in person or on radio, phone etc. with employees and other production supervision and management to coordinate work efforts and to ensure safety, and to comment on work in progress. Critiques work in progress and resolves problems on the spot. Negotiates and resolves CFR’s (Condition Found Reports), work orders, and bills internally, and externally with customers.
2. Hearing: Continually listens to information from all sources to carry out functions listed under “talking”. Also, must have acute hearing to “read” the work environment, particularly machinery, and rectify problems when they arise.
3. Vision: Continually observes surrounding activities.
· Near Acuity (clarity of vision at 20 inches or less): Inspects fine detailed welding requiring near acuity.
· Far Acuity (clarity of vision at 20 feet of more): Necessary for safety in work environment, and for inspection.
· Depth Perception (three-dimensional vision to judge distance/ spatial relationships): Necessary for safety in work environment, and again, in inspection of work in all stages.
· Color Vision (if required to distinguish colors for job performance or safety): Needed to identify leads and safety tags.
· Field of Vision (if required to observe a large field of vision while keeping eye fixed on a given point for job performance or safety): Must have normal field of vision in order to work safely in the ship areas.
4. Smell: Useful for detecting fire and other potential issues while “environmentally scanning” the work area.
5. Mental Agility: As indicated above under Knowledges, Skills and Abilities, this is a highly technical and complex analytical position. At this, the Senior level, the incumbent is expected to draw upon his/her substantial technical and practical experiences to accomplish the work of ship repair in an ever increasing “faster, cheaper, smarter” way. S/he must have superior deduction, induction, communication and intuition skills. S/he must be able to process an extreme amount of data to all senses, and immediately come up with the optimum solution. Mastery of multi-tasking is critical.








#3LTD Key: Disease-Specific (MS) Symptom Matrix

This Matrix is the Blank TEMPLATE for you to use to document your own symptoms.
This matrix describes the Body’s Basic Functional Systems based on the Expanded Disability Status Scale (EDSS); the impact Multiple Sclerosis has had on Your Name’s body; and how the limitations impact her daily normal activities. This matrix has been updated for Your Company LTD, effective April 2003. (Written and edited by Your Name) This scale, like the other matrixes, were also provided to SSA as evidence for SSDI.

Body
System
What it Covers
How MS Symptoms have Impacted
Your Name
How MS Symptoms Impact
Your Name’s Daily Normal Activities
UPDATED TO YOUR DATE OF COMPLETION

Pyramidal
Ability to walk
Ø My left foot has been numb since about 1985; the right foot since about 1999.
Ø Both feet have the “pins & needles” sensation continuously, along with severe pain when rotated or moved.
Ø The left leg is numb to about 3 inches above the knee, and the numbness is increasing up the thigh
Ø The right leg’s numbness is traveling up about half-way to the knee.

Ø Currently, I use a brace on my left leg, as it has the famous “MS Drop”, and is unusable.
Ø I have two forearm crutches.
Ø I cannot walk more than 10 feet without assistance; the 10 feet requires “wall walking”.
Ø I have a 3-wheel scooter to use in any distance moving to conserve energy for the “here” and the “there”.
Ø I cannot stand for more than 10 minutes at a time; sometimes this is only 5 minutes.
Ø I do dishes about one time a week; luckily, I can bend and rest against the wall in my new kitchen.
Ø Having moved in with my son and daughter-in-law recently, I have help with household living chores.
Ø I have a pedicure every month, as I cannot take care of my feet properly.
Ø I sit in the shower; air-dry my hair, and normally avoid standing. I have a chair in the bathroom, so that activities can be accomplished sitting down.

Cerebellar
Coordination
Ø My feet are no longer coordinated. It seems that they do not do what I tell them to do. Part of this is the spasticity of the muscles. For example, I can sit, and my leg muscles will jump and twitch all by themselves. In 2003, this spasticity has spread to both legs.
Ø My hands and arms also are not coordinated in major and minor movements.
Ø The biggest coordination problem that I have is the vertigo that comes from my vision problems. Scanning left to right makes me dizzy and nauseous; also, fast movement makes me dizzy, nauseous, and I loose my balance.

Ø As the numbness increased in my right leg, I changed my driving to concentrate on visual cues, as I could not feel the driving pedals. This, coupled with the increasing visual problems (see below) caused me to loose my license effective September 2002.
Ø The lack of coordination in my legs makes standing, walking and climbing difficult.
Ø I find that I can no longer lift much of anything; I have someone else do my bringing in of groceries and the mail.
Ø I no longer cook. Thank goodness for the microwave, fresh fruits and vegetables. Now that I am living with family, I can enjoy home cooked food once again!
Ø The lack of proper hand coordination is a symptom that I find during my typing on the computer. I’ll mix letters; consistently leave out the “o” in you; think one letter, and type another, etc. (It took me 4 weeks to do this matrix. 8 corrections!)
Ø Walking in large open spaces, having to look left and right to avoid traffic makes me want to throw up. I avoid it at all costs.
Ø I do stretching exercises for about an hour each day to work on keeping what coordination I have.
Ø I have continual bruises, cuts and bumps from falls and walking into things.

Brainstem
Includes speech and swallowing
Ø At least once a week I’ll choke while swallowing, and liquid will go down into the lungs.
Ø I consistently wake up at night choking on saliva; or regurgitating.
Ø I am beginning to have problems speaking. My mouth feels like I have mush in it; I consistently forget words.
Ø I follow the Dr.’s instructions, and do not eat raw carrots, peas or rice without liquid to make sure they are swallowed correctly.
Ø I have raised the head of my bed about 6 inches to keep from choking at night. I also sleep on multiple pillows to keep my swallowing working with gravity.
Ø As the face and head become more and more numb, I find that speech, at times, is more difficult than at other times.

Sensory
Includes touch and pain
Ø No one told me that MS causes pain. Well, let me correct that – there is a lot of pain with MS. The best way to describe the overall sensation is that at it’s worst, all of the muscles of the body feel like the worst flu that you ever have had, and NOTHING can make it go away. The headaches, due to the optic nerve problems, result in severe pain at one side of the temple, going across the top of the head, to the other temple. This takes about 12 hours.
Ø Numbness also is a factor. The entire right side of my face is numb about 25-30%. It feels like the Novocain you get from the dentist – but it does not go away. This numbness has increased to cover the entire scalp.
Ø When the nerves don’t adequately “talk” to the muscles, the resulting impact on the muscle is to clench up – like a “charlie horse”. As my abdomen has nerve-muscle problems, any way that I twist results in a severe cramp in the torso.
Ø Another pain that is hard to avoid is bending the chin down, and having electric shocks go down the back.
Ø Any prolonged position (over 15 minutes) will cause the muscles and joints to cramp.
Ø I used to take advil (up to 4 extra strength tablets at a time) for the pain. At the bad times, this amount of medication didn’t even phase the level of the pain. What is almost worst is the “dull toothache” overall pain every night when I try to go to sleep. Now that I take Vioxx for the pain, it offers some relief. The Baclafen for the spasticity offers some help, at least during the day. I don’t twitch and “jump” all day through. Trying to sleep is another matter. It takes about 3-4 hours each night to get the muscles to relax to get to sleep – MS form of insomnia! Then, once asleep, I DO NOT want to get up – the MS fatigue factor.
Ø After the move to the new home, I went for a week without Vioxx. The muscle pain and cramps and joint pain (like the worst arthritis ever) came for days.
Ø The abdominal cramps make going to the bathroom a daily exercise in pain and anxiety. More than once I have cried in pain in the bathroom until the pain stoped. More than once I have fallen off of the toilet (once even sticking to the toilet seat, and landing on the bathroom floor still on the seat) just trying to wipe my bottom.
Ø The muscle pains are still such that I no longer stand in the shower; I do not bother with make-up, as I can’t hold my arms up long enough to apply it. I have a “wash and wear” hairdo.
Ø I’ve mentioned before that the right side of my face/head is partially numb. Two examples of the impact of this are: 1) if I pinch my right ear lobe, I can “feel” it for up to 10 minutes. 2) I must wear earrings that I know won’t fall out, because I cannot feel the earring in the right ear. As of January of 2003, this numbness has spread to cover the entire face and scalp.
Ø The arms now are becoming numb, and it hurts to lift anything without assistance.

Bowel
Impaired function
Ø Bluntly, the anus muscle no longer closes, nor does it “clench” to push out the fecal matter.
Ø Balancing a diet to keep regular – not too hard and not too runny is a daily challenge.
Ø The Doctors have told me that at some point, I will have to “train” my bowels to work at the same time each day.
Ø It takes about 30-45 minutes for each bowel movement.
Ø I wear pads, and need to change often. Any laugh, sneeze, cough, bend will cause the bowels to release.
Ø Forget about controlling flatulence – one just avoids food that will cause it.
Ø Wiping and trying to remain hygienic has led to the constant presence of hemorrhoids and continual cuts and pain. I tried zinc oxide and Aveeno, with limited success. My Doctor prescribed Calmoseptine, and it appears to work better. I use it 2-3 times each day.
Ø I take daily stool softeners to remain regular.

Bladder
Impaired function
Ø I never thought that one could have incontinence and “failure to empty” at the same time! Now I know that you can.
Ø Balancing having enough liquids without spending all the time in the bathroom is a consistent challenge.
Ø When I first started having to go to the bathroom 4-5 times each night, then fought to get back to sleep, I took Ditropan. This left me drier all right – I didn’t have enough “spit” left at all! Also, it led to nosebleeds from dry sinuses. So, I stopped taking that medicine.
Ø Thanks to the continual pads that I wear, I catch leaks.
Ø Going to the bathroom takes about 5 minutes. One has the urgency until you sit on the toilet. Then, you go through gymnastics to get the urine to come out. I realize that daily catheterazation is on the horizon.
Ø I have learned that laughing and coughing always cause leakage.
Ø It becomes a daily challenge to ensure that body odors are properly “managed”.

Visual
Impaired function
Ø When I had my first optic neuritis attack, the Doctor said that I had a migraine, without the headache. Now I know what they are, and can better manage them.
Ø In 1998, I had my eyes checked, and new glasses prescribed; within 6 weeks, my vision had so deteriorated that I could no longer see. Going back to the Eye Dr., I needed a completely new prescription, and trifocals. He sent me back to my Neurologist, who did the Spinal Tap.
Ø “Black holes” in my vision are scary, but manageable.
Ø Double vision, the inability to focus on things near or far, problems with depth perception, night blindness are all daily challenges for me to manage.
Ø As indicated above, balance, dizziness and nausea also are daily if not hourly occurrences.

Ø Up until about 3 years ago, I was able to read 3-4 books each week. I still love reading, but I need to balance close-in vision with far vision. If I try to read too much, or look in the far distance too much, I risk the dreaded nausea and/or headache. I still read – just much, much less than before. I also have to reread pages as my “logic retention” is not as great as it once was.
Ø My driving ended when, coupled with the leg numbness and incoordination, visual blackout frequencies continued, making driving hazardous.
Ø The visual challenges often trigger panic attacks. If I get too hot, too tired, upset, or anything emotional, the vision “holes” come, followed by headaches. I’ve come to identify headaches as my body’s way of saying SLOW DOWN! Cold showers; a cold wash cloth; music and a darkened room with time seem to be the only relief here.
Ø I no longer go to the movies very often (once a year); the motion on the wide screen makes me violently nauseous.
Ø When watching TV, I cannot watch any action – it is too hard for my eyes to follow, and I get instantly dizzy and nauseous.
Mental
Impaired memory and cognitive functions
Ø I often forget names, words, trains of thought. This irritates me, which can lead to anxiety attacks.
Ø Any task requiring multi steps, I now avoid with a passion.
Ø If you look at my home, you’ll find stick-it notes all over the home to remind me of things.
Ø I have developed strict patterns of behavior to avoid having to “remember” things. For example, the telephone and the TV remote must stay in the same place, so I won’t find them in the refrigerator by using my cell phone to call my home phone to locate it.
Ø I no longer watch movie rentals, as I can’t figure out how to work the VCR. One of my children helps reset the clocks at home every 6 months.
Ø Similar words present problems. Work and word for example; “Country Squire” and “Country Singer” were the challenges last night (I love watching A&E’s mysteries). Tuesday and Thursday are often mixed-up for me. If I am not careful, the alarm clock will be set for PM when I need AM; etc.

Other

Includes any other neurological findings attributable to MS (fatigue; sleep problems; aversion to heat, depression, panic attacks, social issues, etc.)
Ø FATIGUE is a huge factor for me. Up until about 5 years ago, I routinely could work 70-80 hour work weeks; take care of the home; raise two kids; and still have time and energy to get involved in social and volunteer situations. Today, just the thought of getting out of bed is hard; emptying the dishwasher takes 3 - 10 minute tasks. Forget doing the dishes!
Ø The irony with the fatigue is that for SLEEP it is coupled always (at least for me) with insomnia! No matter what I do, even when I take 2 more Baclafin tablets 1 hour before bedtime, it will take me 2-3 hours to fall asleep each night! Then, I cannot seem to wake up in the morning.
Ø HEAT – I cannot stand heat! I have twice “passed out” from not monitoring the heat level of my body. I’ve now learned, and have a “cooling vest”, many fans, and with the move, have central air conditioning!
Ø As can be seen in other documents provided, I am an extremely positive person. Before I went to See Dr. XXXX, my Neurologist in 1997, I went through some difficult personal times (1993-1997). Depression hit me in a big way, as did panic attacks – the first that I had ever had. I tried to talk myself out of them, and when my thoughts turned to suicide, I went to Dr. ZZZZZ.
Ø Social Issues crop up, and must be managed. It is too easy to become a hermit.

Ø Dealing with the MS fatigue has been very hard for someone like me, likened to a “heat-seeking missile” when focused on a task! If I were to give in to the fatigue, I would never get out of bed! Just the though of writing a check is hard and seems like it’ll take too much effort. As an example: On mornings when I shower, even though I sit in the shower, and do not “mess” with “doing” my hair, I have to sit for at least an hour to regain my energy before proceeding to the next task.
Ø The fatigue is such that you CANNOT ignore it. If I push my limits, the flu-like symptoms that I get are so bad that they are the “10” level on my pain scale, and NOTHING can take the ache in every muscle of the body away!
Ø Learning to “manage” the fatigue; to balance the insomnia; and to make sure that the bills get paid, the groceries picked up every now and then – all of this has become my full time “job”.
Ø I’ve learned through research that when the myelin has been impacted, the nerves have to work many multiple times to get the “message” to the muscles. Hence, trying to “cool the body down” takes away whatever little energy I have even faster. On hot days I become a mole – a cool dark room; lots of water, slow to no movements, and survive! (The new home has central air!)
Ø Depression and panic attacks, I learned, are real, and one cannot just “talk oneself” out of them. Dr. ZZZZZ prescribed Paxil in 20mg pills. These worked wonders up until I started taking the Avonex. Finding out that the MS was real; that I would be having to inject myself with Avonex on a weekly basis – Dr. ZZZZZ upped the Paxil level to the 40 mg pill level. I cannot express in words how devastating this disease is. No one can tell you what to expect; how the symptoms will progress; what to do to manage. AND, company STD and LTD plans are not easy to understand and manage!
Ø I set a goal to do something social once a week – even if it is just a face-to-face activity with friends.



Bottomline: As of Date of Completion, (the date of this update for Your Company LTD) my week day and week-end days have become pretty much the same. Up between 11 am and 1 pm. Then rest; shower, meal, 10 minute chores and rest. Now that I am in the new home with family, there is help with chores like groceries, laundry, changing the bed, house cleaning, and bill paying - (greatly appreciated!). Nap in the afternoon; music, some reading, some TV; dinner; lots of fruit, vegetables, and liquids. Between 11 pm and midnight, I usually go on the computer to answer email messages, and to assist folks with disabilities through “Ask the Expert, on About.com. Attempt to go to sleep about 2-5 am; toss and turn until the muscles stop aching and twitching enough to get to sleep. I have learned how to go to sleep with music, or to the drone of the television (alarm set for 30 minutes). Final note: As an indication of my mental capabilities change, I had to have my son proof read these documents, after I typed and proofed them myself up to 7 times. He found many errors – particularly the kind where the left-right hand word error could occur (i.e., seft instead of left; work instead of word;).



This is the Disease-specific symptom Matrix that has been completed by the Author, Ms. Magura.


This matrix describes the Body’s Basic Functional Systems based on the Expanded Disability Status Scale (EDSS); the impact Multiple Sclerosis has had on Your Name’s body; and how the limitations impact her daily normal activities. This matrix has been updated for Your Company LTD, effective April 2003. (Written and edited by Your Name) This scale, like the other matrixes, were also provided to SSA as evidence for SSDI.

Body
System
What it Covers
How MS Symptoms have Impacted
Your Name
How MS Symptoms Impact
Your Name’s Daily Normal Activities
UPDATED TO YOUR DATE OF COMPLETION

Pyramidal
Ability to walk
Ø My left foot has been numb since about 1985; the right foot since about 1999.
Ø Both feet have the “pins & needles” sensation continuously, along with severe pain when rotated or moved.
Ø The left leg is numb to about 3 inches above the knee, and the numbness is increasing up the thigh
Ø The right leg’s numbness is traveling up about half-way to the knee.

Ø Currently, I use a brace on my left leg, as it has the famous “MS Drop”, and is unusable.
Ø I have two forearm crutches.
Ø I cannot walk more than 10 feet without assistance; the 10 feet requires “wall walking”.
Ø I have a 3-wheel scooter to use in any distance moving to conserve energy for the “here” and the “there”.
Ø I cannot stand for more than 10 minutes at a time; sometimes this is only 5 minutes.
Ø I do dishes about one time a week; luckily, I can bend and rest against the wall in my new kitchen.
Ø Having moved in with my son and daughter-in-law recently, I have help with household living chores.
Ø I have a pedicure every month, as I cannot take care of my feet properly.
Ø I sit in the shower; air-dry my hair, and normally avoid standing. I have a chair in the bathroom, so that activities can be accomplished sitting down.

Cerebellar
Coordination
Ø My feet are no longer coordinated. It seems that they do not do what I tell them to do. Part of this is the spasticity of the muscles. For example, I can sit, and my leg muscles will jump and twitch all by themselves. In 2003, this spasticity has spread to both legs.
Ø My hands and arms also are not coordinated in major and minor movements.
Ø The biggest coordination problem that I have is the vertigo that comes from my vision problems. Scanning left to right makes me dizzy and nauseous; also, fast movement makes me dizzy, nauseous, and I loose my balance.

Ø As the numbness increased in my right leg, I changed my driving to concentrate on visual cues, as I could not feel the driving pedals. This, coupled with the increasing visual problems (see below) caused me to loose my license effective September 2002.
Ø The lack of coordination in my legs makes standing, walking and climbing difficult.
Ø I find that I can no longer lift much of anything; I have someone else do my bringing in of groceries and the mail.
Ø I no longer cook. Thank goodness for the microwave, fresh fruits and vegetables. Now that I am living with family, I can enjoy home cooked food once again!
Ø The lack of proper hand coordination is a symptom that I find during my typing on the computer. I’ll mix letters; consistently leave out the “o” in you; think one letter, and type another, etc. (It took me 4 weeks to do this matrix. 8 corrections!)
Ø Walking in large open spaces, having to look left and right to avoid traffic makes me want to throw up. I avoid it at all costs.
Ø I do stretching exercises for about an hour each day to work on keeping what coordination I have.
Ø I have continual bruises, cuts and bumps from falls and walking into things.

Brainstem
Includes speech and swallowing
Ø At least once a week I’ll choke while swallowing, and liquid will go down into the lungs.
Ø I consistently wake up at night choking on saliva; or regurgitating.
Ø I am beginning to have problems speaking. My mouth feels like I have mush in it; I consistently forget words.
Ø I follow the Dr.’s instructions, and do not eat raw carrots, peas or rice without liquid to make sure they are swallowed correctly.
Ø I have raised the head of my bed about 6 inches to keep from choking at night. I also sleep on multiple pillows to keep my swallowing working with gravity.
Ø As the face and head become more and more numb, I find that speech, at times, is more difficult than at other times.

Sensory
Includes touch and pain
Ø No one told me that MS causes pain. Well, let me correct that – there is a lot of pain with MS. The best way to describe the overall sensation is that at it’s worst, all of the muscles of the body feel like the worst flu that you ever have had, and NOTHING can make it go away. The headaches, due to the optic nerve problems, result in severe pain at one side of the temple, going across the top of the head, to the other temple. This takes about 12 hours.
Ø Numbness also is a factor. The entire right side of my face is numb about 25-30%. It feels like the Novocain you get from the dentist – but it does not go away. This numbness has increased to cover the entire scalp.
Ø When the nerves don’t adequately “talk” to the muscles, the resulting impact on the muscle is to clench up – like a “charlie horse”. As my abdomen has nerve-muscle problems, any way that I twist results in a severe cramp in the torso.
Ø Another pain that is hard to avoid is bending the chin down, and having electric shocks go down the back.
Ø Any prolonged position (over 15 minutes) will cause the muscles and joints to cramp.
Ø I used to take advil (up to 4 extra strength tablets at a time) for the pain. At the bad times, this amount of medication didn’t even phase the level of the pain. What is almost worst is the “dull toothache” overall pain every night when I try to go to sleep. Now that I take Vioxx for the pain, it offers some relief. The Baclafen for the spasticity offers some help, at least during the day. I don’t twitch and “jump” all day through. Trying to sleep is another matter. It takes about 3-4 hours each night to get the muscles to relax to get to sleep – MS form of insomnia! Then, once asleep, I DO NOT want to get up – the MS fatigue factor.
Ø After the move to the new home, I went for a week without Vioxx. The muscle pain and cramps and joint pain (like the worst arthritis ever) came for days.
Ø The abdominal cramps make going to the bathroom a daily exercise in pain and anxiety. More than once I have cried in pain in the bathroom until the pain stoped. More than once I have fallen off of the toilet (once even sticking to the toilet seat, and landing on the bathroom floor still on the seat) just trying to wipe my bottom.
Ø The muscle pains are still such that I no longer stand in the shower; I do not bother with make-up, as I can’t hold my arms up long enough to apply it. I have a “wash and wear” hairdo.
Ø I’ve mentioned before that the right side of my face/head is partially numb. Two examples of the impact of this are: 1) if I pinch my right ear lobe, I can “feel” it for up to 10 minutes. 2) I must wear earrings that I know won’t fall out, because I cannot feel the earring in the right ear. As of January of 2003, this numbness has spread to cover the entire face and scalp.
Ø The arms now are becoming numb, and it hurts to lift anything without assistance.

Bowel
Impaired function
Ø Bluntly, the anus muscle no longer closes, nor does it “clench” to push out the fecal matter.
Ø Balancing a diet to keep regular – not too hard and not too runny is a daily challenge.
Ø The Doctors have told me that at some point, I will have to “train” my bowels to work at the same time each day.
Ø It takes about 30-45 minutes for each bowel movement.
Ø I wear pads, and need to change often. Any laugh, sneeze, cough, bend will cause the bowels to release.
Ø Forget about controlling flatulence – one just avoids food that will cause it.
Ø Wiping and trying to remain hygienic has led to the constant presence of hemorrhoids and continual cuts and pain. I tried zinc oxide and Aveeno, with limited success. My Doctor prescribed Calmoseptine, and it appears to work better. I use it 2-3 times each day.
Ø I take daily stool softeners to remain regular.

Bladder
Impaired function
Ø I never thought that one could have incontinence and “failure to empty” at the same time! Now I know that you can.
Ø Balancing having enough liquids without spending all the time in the bathroom is a consistent challenge.
Ø When I first started having to go to the bathroom 4-5 times each night, then fought to get back to sleep, I took Ditropan. This left me drier all right – I didn’t have enough “spit” left at all! Also, it led to nosebleeds from dry sinuses. So, I stopped taking that medicine.
Ø Thanks to the continual pads that I wear, I catch leaks.
Ø Going to the bathroom takes about 5 minutes. One has the urgency until you sit on the toilet. Then, you go through gymnastics to get the urine to come out. I realize that daily catheterazation is on the horizon.
Ø I have learned that laughing and coughing always cause leakage.
Ø It becomes a daily challenge to ensure that body odors are properly “managed”.

Visual
Impaired function
Ø When I had my first optic neuritis attack, the Doctor said that I had a migraine, without the headache. Now I know what they are, and can better manage them.
Ø In 1998, I had my eyes checked, and new glasses prescribed; within 6 weeks, my vision had so deteriorated that I could no longer see. Going back to the Eye Dr., I needed a completely new prescription, and trifocals. He sent me back to my Neurologist, who did the Spinal Tap.
Ø “Black holes” in my vision are scary, but manageable.
Ø Double vision, the inability to focus on things near or far, problems with depth perception, night blindness are all daily challenges for me to manage.
Ø As indicated above, balance, dizziness and nausea also are daily if not hourly occurrences.

Ø Up until about 3 years ago, I was able to read 3-4 books each week. I still love reading, but I need to balance close-in vision with far vision. If I try to read too much, or look in the far distance too much, I risk the dreaded nausea and/or headache. I still read – just much, much less than before. I also have to reread pages as my “logic retention” is not as great as it once was.
Ø My driving ended when, coupled with the leg numbness and incoordination, visual blackout frequencies continued, making driving hazardous.
Ø The visual challenges often trigger panic attacks. If I get too hot, too tired, upset, or anything emotional, the vision “holes” come, followed by headaches. I’ve come to identify headaches as my body’s way of saying SLOW DOWN! Cold showers; a cold wash cloth; music and a darkened room with time seem to be the only relief here.
Ø I no longer go to the movies very often (once a year); the motion on the wide screen makes me violently nauseous.
Ø When watching TV, I cannot watch any action – it is too hard for my eyes to follow, and I get instantly dizzy and nauseous.
Mental
Impaired memory and cognitive functions
Ø I often forget names, words, trains of thought. This irritates me, which can lead to anxiety attacks.
Ø Any task requiring multi steps, I now avoid with a passion.
Ø If you look at my home, you’ll find stick-it notes all over the home to remind me of things.
Ø I have developed strict patterns of behavior to avoid having to “remember” things. For example, the telephone and the TV remote must stay in the same place, so I won’t find them in the refrigerator by using my cell phone to call my home phone to locate it.
Ø I no longer watch movie rentals, as I can’t figure out how to work the VCR. One of my children helps reset the clocks at home every 6 months.
Ø Similar words present problems. Work and word for example; “Country Squire” and “Country Singer” were the challenges last night (I love watching A&E’s mysteries). Tuesday and Thursday are often mixed-up for me. If I am not careful, the alarm clock will be set for PM when I need AM; etc.

Other

Includes any other neurological findings attributable to MS (fatigue; sleep problems; aversion to heat, depression, panic attacks, social issues, etc.)
Ø FATIGUE is a huge factor for me. Up until about 5 years ago, I routinely could work 70-80 hour work weeks; take care of the home; raise two kids; and still have time and energy to get involved in social and volunteer situations. Today, just the thought of getting out of bed is hard; emptying the dishwasher takes 3 - 10 minute tasks. Forget doing the dishes!
Ø The irony with the fatigue is that for SLEEP it is coupled always (at least for me) with insomnia! No matter what I do, even when I take 2 more Baclafin tablets 1 hour before bedtime, it will take me 2-3 hours to fall asleep each night! Then, I cannot seem to wake up in the morning.
Ø HEAT – I cannot stand heat! I have twice “passed out” from not monitoring the heat level of my body. I’ve now learned, and have a “cooling vest”, many fans, and with the move, have central air conditioning!
Ø As can be seen in other documents provided, I am an extremely positive person. Before I went to See Dr. XXXX, my Neurologist in 1997, I went through some difficult personal times (1993-1997). Depression hit me in a big way, as did panic attacks – the first that I had ever had. I tried to talk myself out of them, and when my thoughts turned to suicide, I went to Dr. ZZZZZ.
Ø Social Issues crop up, and must be managed. It is too easy to become a hermit.

Ø Dealing with the MS fatigue has been very hard for someone like me, likened to a “heat-seeking missile” when focused on a task! If I were to give in to the fatigue, I would never get out of bed! Just the though of writing a check is hard and seems like it’ll take too much effort. As an example: On mornings when I shower, even though I sit in the shower, and do not “mess” with “doing” my hair, I have to sit for at least an hour to regain my energy before proceeding to the next task.
Ø The fatigue is such that you CANNOT ignore it. If I push my limits, the flu-like symptoms that I get are so bad that they are the “10” level on my pain scale, and NOTHING can take the ache in every muscle of the body away!
Ø Learning to “manage” the fatigue; to balance the insomnia; and to make sure that the bills get paid, the groceries picked up every now and then – all of this has become my full time “job”.
Ø I’ve learned through research that when the myelin has been impacted, the nerves have to work many multiple times to get the “message” to the muscles. Hence, trying to “cool the body down” takes away whatever little energy I have even faster. On hot days I become a mole – a cool dark room; lots of water, slow to no movements, and survive! (The new home has central air!)
Ø Depression and panic attacks, I learned, are real, and one cannot just “talk oneself” out of them. Dr. ZZZZZ prescribed Paxil in 20mg pills. These worked wonders up until I started taking the Avonex. Finding out that the MS was real; that I would be having to inject myself with Avonex on a weekly basis – Dr. ZZZZZ upped the Paxil level to the 40 mg pill level. I cannot express in words how devastating this disease is. No one can tell you what to expect; how the symptoms will progress; what to do to manage. AND, company STD and LTD plans are not easy to understand and manage!
Ø I set a goal to do something social once a week – even if it is just a face-to-face activity with friends.



Bottomline: As of Date of Completion, (the date of this update for Your Company LTD) my week day and week-end days have become pretty much the same. Up between 11 am and 1 pm. Then rest; shower, meal, 10 minute chores and rest. Now that I am in the new home with family, there is help with chores like groceries, laundry, changing the bed, house cleaning, and bill paying - (greatly appreciated!). Nap in the afternoon; music, some reading, some TV; dinner; lots of fruit, vegetables, and liquids. Between 11 pm and midnight, I usually go on the computer to answer email messages, and to assist folks with disabilities through “Ask the Expert, on About.com. Attempt to go to sleep about 2-5 am; toss and turn until the muscles stop aching and twitching enough to get to sleep. I have learned how to go to sleep with music, or to the drone of the television (alarm set for 30 minutes). Final note: As an indication of my mental capabilities change, I had to have my son proof read these documents, after I typed and proofed them myself up to 7 times. He found many errors – particularly the kind where the left-right hand word error could occur (i.e., seft instead of left; work instead of word;).



#4 LTD Key: Before and After Matrix

This Matrix is the Blank Matrix Template to be used to describe your “Before and After”.

DATE OF COMPLETION

The following matrix describes a “typical” day/week in the life of Your Name before the multiple symptoms of Multiple Sclerosis, and at this point of time: Date of Completion. This matrix will be (and has been) updated as needed. The last update was (whenever. Use this statement only when this is a follow-up document.)



Activity/
Timeframe

1996 until 4-13-00
(Similar work times 1990-1996)
Daily Activities as of
Date of Completion
Monday through
Friday, daily
activities











Weekends









Typical “Job” Duties






This is the completed example of a Before and After Matrix to use as a reference.

DATE OF COMPLETION

The following matrix describes a “typical” day/week in the life of Your Name before the multiple symptoms of Multiple Sclerosis, and at this point of time: Date of Completion. This matrix will be (and has been) updated as needed. The last update was (whenever. Use this statement only when this is a follow-up document.)

As of Date, I have changed my living arrangements. I purchased a home with my son and daughter-in-law. The home has a separate “mother-in-law” apartment. This arrangement allows me greater assistance in my day-to-day living, as indicated below.

Activity/
Timeframe

1996 until 4-13-00
(Similar work times 1990-1996)
Daily Activities as of
Date of Completion
Monday through
Friday, daily
activities
Ø Arise 6:00 am
Ø Leave for work 6:45 am
Ø Work from about 7:15 am until about 6:00 pm, straight through. Meals taken at desk or in a meeting.
Ø During the evening on work days, there always seemed to be an “event” of some sort. Keeping up with the kids; teaching at the Shipyard from 4:00 pm to 10:00 pm three nights a week for a 10-week session, 5 times; teaching at Portland State once or twice a quarter; professional meetings; Church-related meetings (Small Group Ministry; etc.). If no event, time on the computer/Internet, or catching up on reading for work.
Ø Sleep at about 10:00pm.
Ø Arise between 11:00am and 1:00pm.
Ø Prepare and eat a meal. Take medications; and perform stretch exercises. Every other day, take a shower in a specially equipped shower with a stool; safety bars; water direction assistance, etc. Taking a shower and recovering from same can take up to one and one-half hours.
Ø Nap between 4:00pm and 6:00pm.
Ø I lost the ability to drive effective September 1, 2002. My PCP (Primary Care Physician), Dr. ZZZZ and I decided that, because of the numbness of both of my legs, coupled with my increasing visual problems, it was no longer safe for me to drive.
Ø Evenings: reading, music, watching TV, and checking the Internet for information that could assist in my areas of interest.
Ø Between Midnight and about 2:00am I can be on the Internet, answering questions for others with disabilities on a volunteer basis. Typing takes much longer, now, as sometimes the wrong key is hit (i.e., when I want the e, the o comes; the p becomes a w; etc.)
Ø 2-3 hours per day devoted to “daily normal living” activities. These have been adequately discussed in the companion document entitled "Company LTD Claimant Questionnaire; Completion Date”.
Ø Paying bills is a big chore, as it taxes my cognitive and memory skills. Changing the sheets on the bed can take hours, as the activity can be accomplished in only 10 minute intervals.
Ø I begin to try and sleep between 2:00am and 5:00am. I toss and turn until muscles relax. The medication taken helps somewhat, but it still takes about 2 hours to be able to go to sleep.
Ø Sleep is interrupted each night about 4-5 times to go to the bathroom, and to get a sip of water because of the “choking” problems associated with what I now know is “mild Dysphagia”.
Ø As I now live in a daylight basement, the temperature can be regulated to keep cool. The new home has central air. This change will greatly assist in coping with heat in the summers.
Ø My feet are continually freezing; I can be in short sleeves and shorts, and have to wear socks!
Ø As my right leg is becoming as numb as the left, I am careful, and use my two forearm crutches when walking.

Weekends
Ø 4-6 hours of office work, either at the office, or at home.
Ø Socialize at least one night each weekend. This could be just with friends; with a Church social group (i.e., Presbyterian Mariner’s group); a movie, something.
Ø Church each Sunday morning.
Ø Part of each weekend shopping at one or more of the malls. I loved just walking in the mall, browsing, going to the music and bookstores, looking at people. Didn’t need to acquire anything, just looking.
Ø Grocery shopping.
Ø Cleaning home (two stories). During this timeframe, I also refurbished the entire house.
Ø I attempt to keep the volunteer and/or mentoring to only 4 days per week, late at night.
Ø Saturday and Sunday mornings are just the same as week-days.
Ø It takes the entire weekend to do laundry and cleaning, in 10 minute intervals.
Ø I’ve changed my habits to ordering books, music, and clothes over the TV and the Internet (Amazon.com).
Ø I have learned how to get groceries over the Internet. Safeway delivers to the home. Sunday night appears to be the best time to order.
Ø To ensure I do not fall, I sit in the shower, and have someone else do my toenails (the toes are so numb, the feet need care). (See the LTD Questionnaire for more information.)

Now that I am living with the kids, it will be easier to ensure that there is food in the house, and that the bills are paid. Also, I will be able to ensure that my medications are always available. This is a very important development in my life. For a week, I was not able to obtain my medications. It was quite a shock! I have learned to “manage” my symptoms to allow me to live as great a life as I can. However, without my medications, I felt that I had the worst case of influenza that I ever had! I ached in every muscle, including my earlobes; coupled with this, severe arthritis in every muscle and joint! For example, my hands cramped so badly, that I could not grip anything, and could not type on the computer, hold a toothbrush, or dial a phone. NEVER WANT TO EXPERIENCE THIS AGAIN!

Typical “Job” Duties
Ø In the late 1980’s, I was the VP-HR for the Pacific Northwest’s largest Savings and Loan.
Ø From there I went to a large Manufacturing company, as a Plant HR Director, and a corporate Benefits Director.
Ø My next job, in the mid-‘90’s was as VP-HR for an investment company.
Ø From 1994 - early 1996 I was a Senior Consultant with a Human Resources consulting company. One of my clients was 1234 Company, the Portland Shipyard (a privately owned, 100 million $/year company). I worked at the Shipyard from July 1996 until I joined Cascade as VP-HR in May of 1997. I retained that position until I went on LTD 4-13-00.
Ø As a “Type A” personality, my jobs always have required 55-60 hours of work per week. This time commitment increased at the Shipyard. We have anywhere from 500-2,500 employees at any one time, and from one day to the next. We have 11 unions. I supervised up to 25 employees, and started the first Human Resources Department that the Shipyard had ever had, in over 100 years of operations!
Ø I was responsible for, and/or did all the work for Employee Relations; Labor Relations; compensation; benefits; Workers Compensation (averaging 300-400 incidents per year). We had a Training Center, on site that was my responsibility. I also personally handled all of the Employment litigation. This meant representing Cascade in court and other legal/labor proceedings.
Ø Each day was crammed full of meetings, crises, activities, etc.
Ø The job required extensive patience, experience, maturity, tact, expertise, and the ability to remain calm in the middle of multiple crises.
Ø The day I knew that I had to cut back will remain always in my mind: I had a Craft Manager and his Union Business Agent and Shop Steward in my office, very agitated; I had the Safety Director and an employee out in the hallway; I had the Executive VP for Production on my cell phone; and I had the Owner on my land line (phone). All were talking (yelling) at me at once. Now, this was typical, but for the first time I froze; I could not multi-task effectively to provide the customer service to all of these clients in the manner that they deserved. My vision left (big black holes in my right eye; “heat waves” in my left – Optic Neuritis); my MS had reached the stage that I was too tired and too befuddled to effectively manage the work. I set in motion the process to lead to LTD.

Ø The computer work is great, as I can work for 15-30 minutes, take a break, read some, and get back to it – correcting all of my typing errors! Also, I have a large computer screen to assist in the visual problems. I find that by changing my “up close” reading/typing with my watching TV or looking out my back yard window at the garden helps with the vision.
Ø I do Internet searches for information.
Ø The Volunteer work falls into the following categories:
1. MS Chapter Committees. I am on the Government Relations and the Employment Committees of the Portland, OR MS Chapter. This work requires occasional meetings (I participate via a telephone conference call now, without a car); reading and responding to emails; keeping up to date, primarily through the Internet, about what’s going on in the employment world.
2. Volunteer “Expert” on disability and other related issues. I am a volunteer expert; I receive about 2 or so questions every week. Most of the time they can be easily answered. Some, like the one I am working on now, require research and 2 or three times to respond. To date, I have assisted up to 98 folks.
3. Because of my helping others, and because I have been on Avonex (weekly IM [inter-muscular] injections) for 4 years, I have been interviewed for an article in the Spring 2003 edition of the BIOGEN magazine entitled “The Avonex Alliance”. In this article, I have been interviewed as a Mentor; I recommend that others use matrixes like this to assist their doctors in their care.
4. My long term goal is to work with Insurance companies to change the nature of STD and LTD plans to provide company discounts to companies who hire the disabled and the retired; to work with all disability organizations to form a coalition and work together for their constituents, and not to compete with each other for funds; to get the local, state and federal governments to offer tax breaks to companies to hire the disabled and the retired; and, to allow the disabled and the retired to work longer and continue to feel valued in whatever they do.
5. As the honorary “Executive Vice President” for A Company., I have the opportunity to add value to work as a “mentor”; as an experienced person who has “been there, done that”. Often, I can assist Executives and Managers over the phone with employee relations issues. I have no financial interest in the company; I do, however, receive satisfaction in that I am still a contributing adult, and not just an “ill person”!



In general, I’m listening to my body, and trying to do what is right for me. I have enclosed the last two physical “updates” that I provide to my Doctors with each visit.



The other significant change is that I was granted SSDI coverage, as you know. This was a significant success, in that I have been told that I am still the only person in the my area who was granted coverage the first time, in under 30 days! The 2001 issue of this matrix, along with other documents were of significant value in obtaining this coverage.
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Sunday, January 01, 2006

The Physician Key:Linking Your Symptoms to Disability

The Physician Key:Linking Your Symptoms to Disability










Introduction
You have read the Disability Overview Key, and you now have:
· A better understanding that the purpose of obtaining disability insurance benefits is to create a financial safety net for you and your family;
· A better understanding of the disability insurance options that may be available for you particularly, LTD and SSDI;
· An understanding that your primary role in this process is to gather all of the evidence necessary to prove that the symptoms of your disease render you disabled, and therefore, qualified for the particular disability insurance(s) for which you want to apply; and,
· Considered the option of selecting an Attorney to do the work for you at a significant cost, or own the process by doing the work yourself using disease-specific experiential assistance.
Having decided to do the work yourself, and having completed the Current Situation Checklist, you now need to understand how to get your Doctor(s) to understand how best to help you. This is the purpose of this document: The Physician Key.
The value of The Physician Key is threefold:
1. By reading the information contained herein, you will gain a better understanding of the fact that disability insurance proof evidence is NOT necessarily about a disease and its symptoms. It IS about the SPECIFIC AND DETAILED impact that those symptoms have on you; specifically, on your ability to perform the Normal Daily Living (NDL) activities of your life – both on the job and at home.
2. The information contained herein is segmented so that you can copy and create separate documents to use as templates for use in communicating to your Doctor(s).
3. To maximize the help you can receive from your Doctor(s), it is important to provide them with as much information as they need to better help you. DO NOT ASSUME THAT YOUR DOCTOR CAN EVEN FIND YOUR FILE OR TAKE THE TIME TO GATHER THE EVIDENCE ON HIS/HER OWN. If your want help, DO THE WORK FOR THEM; they will greatly appreciate it. Remember, most Doctors have never been educated about disability insurance themselves and by educating them, you are assisting them to help you.

This Physician Key is segmented into the following components:
o An overall explanation for the Doctor(s);
o An example of a letter from you to your Doctor(s) specifically asking them for what you need;
o A disease-specific (Multiple Sclerosis) medical history document that you complete to better remind your Doctor(s) about your symptoms and their specific impact on you;
o An example of a successful medical history document
o A blank copy of what the disability insurance industry calls a Physical Capacity Evaluation document (PCE) or a Residual Functional Capacity (RFC) assessment that allows your Doctor(s) to quantify the effect your disease symptoms have on you.

A Message to Your Doctor
Your patient is in the process of attempting to qualify for disability benefits from either an insurance carrier or the Social Security Administration. They will need specific details when documenting their symptom’s impact on a Functional Capacity Evaluation (PCE) form. Note: this process might also be called a Residual Functional Capacity [RFC] assessment. It is used extensively by the Social Security Administration (reference form #SSA-4734.)
The patient has provided the following explanation so that you can better assist them in completing the necessary forms. The patient also has taken the first step in completing the form documenting symptoms as they impact daily functions. If you have a difference in opinion about your patient’s perception, please resolve the differences with the patient before completing the form.
Defining Disability
Doctors with patients who have been injured or have Social Security disability and/or long term disability claims are usually asked to provide evidence. But what do the Social Security people mean by "disability?" And what kind of evidence do they need from doctors?
There is no universal definition of "disability." It depends on who is defining it – the Veterans Administration, Worker's Compensation, Americans with Disability Act, Social Security Administration, etc.
A functional capacity evaluation can be an essential tool in determining whether a patient is disabled for purposes of Social Security and Long Term disability benefits. It is one of the primary reasons for SPECIFICALLY documenting the impairment a disease or illness has on a patient’s normal daily living (NDL).
An individual will be determined to be disabled if his or her impairment meets or equals the requirements of the Listing of Impairments found in the Social Security Blue Book. This is a list of physical and mental illnesses that the Social Security Administration (SSA) considers to be so severe that they warrant an automatic finding of disability.
However, if an impairment does not meet or equal the Listing Requirements, the patient will be determined disabled only if s/he is unable to perform work s/he did in the past 15 years and s/he is unable to do any other type of work considering residual functional capacity, age, education, and work experience. It is important to know that the proof of impairment – the documentation of this impairment – is the responsibility of the patient and his/her supporting medical team.
An individual's residual functional capacity means what an individual can do despite the limitations of the individual's impairment. The tool used to determine a patient's RFC is the functional capacity evaluation, which assesses a patient's capacity to do work-related physical and mental tasks on a regular and continuing basis--which means eight hours a day, five days a week.
A useful functional capacity evaluation needs to assess three important areas:
· physical abilities,
· mental limitations, and
· other non-exertional impairments and restrictions
All of a patient's impairments that are supported by medical records, even those that are not sever, should be addressed in the functional capacity evaluation since the combination of impairments may adversely affect the patient's ability to work.
Physical Abilities
This section of the functional capacity evaluation should describe the patient's limitations regarding physical activities. All potential activities that might be required for a work situation should be addressed: sitting, standing, walking, lifting, carrying, bending, squatting, crawling, climbing, reaching, stooping, kneeling, and so on. The patient's ability to do particular types of repetitive motions should also be considered. Please bee sure to note any necessary restrictions on the patient's physical activities. For example, can the patient lift up to 10 pounds? Over 50 pounds? And how often can the patient engage in such activity? Never? Occasionally? Frequently?
Mental Limitations
This part of the functional capacity evaluation should fully describe any of the patient's limitations in understanding, remembering, and following through on instructions. Also, be sure to note any limitations the patient has with respect to responding appropriately to common work situations, such as the ability to handle work pressures, receive supervision, or relate to co-workers.
Non-Exertional Impairments
This part of the evaluation should include information on other factors such as a patient's pain, environmental restrictions, the need for rest breaks, and any side effects of medication. When describing pain, be sure to note any objective signs of pain, the degree of pain, and the frequency of pain experienced by the patient. The evaluation should also explain whether the patient will need unscheduled breaks because of pain.
Any applicable environmental restrictions should be included in the functional capacity evaluation, as well. Must the patient avoid exposure to dust, fumes, or smoke? Can the patient tolerate heights?
The evaluation should address the patient's need for rest breaks, time off, and effects of the patient's medication. Is it likely that the patient will miss days of work because of pain or the side effects of medication? All such limitations should be fully described as they will affect the patient's ability to do work.
It is very important that you are very specific about the occupational limitations (including additional information not requested on the forms, if necessary). Also, it is important that NO ONE assume that a symptom or illness will automatically equate to functional impairment. You cannot depend on common sense to tell you who is disabled under the Social Security law. For example: with Multiple Sclerosis patients, an MRI that shows lesions does not necessarily equate to physical impairment, without the Doctor providing the actual link examples for that specific patient. SSA evaluators do not necessarily assume an MRI, which shows demyelinating disease, equals vocationally limiting fatigue, for example, unless a medical professional makes and explains the connection.
Here are some more examples:
1. A 48 year-old construction worker has done heavy, unskilled labor since age 16. He has a 4th grade education and a "low/normal" I.Q. He can read only basic things, like inventory lists and simple instructions. His heart condition limits him to sedentary work. He is not disabled under Social Security law unless he has an additional limitation.
2. A 38 year-old machine operator has done unskilled, medium exertion factory work since graduating from high school. A cardiovascular impairment limits him to sedentary work, and a permanent injury of the right hand limits him to work not requiring bi-manual dexterity. He is disabled under Social Security law.
3. A 61 year-old truck driver has been driving trucks all his life. But during a downturn in the trucking industry ten yeas ago he worked 18 months at a sedentary office job for his brother-in-law. Now a pulmonary impairment limits him to sedentary work. He is not disabled under Social Security law because he is still capable of doing the office job.
The Social Security Administration (SSA) defines disability as:
"Inability to perform substantial gainful activity by reason of a medically determinable physical or mental impairment, or combination of impairments, which has lasted or is expected to last at least 12 consecutive months, or end in death, taking into account the individual's age, education and work history."
The ultimate decision regarding a patient's residual functional capacity rests with the SSA, or with an LTD Insurance company, which may request a functional capacity evaluation to be performed by its own medical consultants. However, the importance of a functional capacity evaluation done by the treating physician or other health care professional cannot be underestimated. After all, it is that person who is most knowledgeable about the patient's condition and any resulting occupational limitations. The treating health care professional's functional capacity evaluation can greatly assist a patient in obtaining much-needed disability benefits.
Thank you very much for taking the time to assist your patient in this difficult process.
Sample Letter to Doctor

Date

XXXX Fax # NOTE: You can use their addresses if you are writing to
ZZZZ Fax # them, instead of faxing the information.
A.

Dear Dr. ZZZZZ and Dr. XXXX:

I am in the process of working with the Social Security Administration (SSA) to qualify for Disability Insurance benefits. (or, I am in the process of working with my long term disability (LTD) company to quality for LTD insurance benefits.) My appointment is scheduled for Tuesday, MONTH 17, 2222. I am taking the liberty of faxing this information to you and request that you fax back to me (111-111-1111) the requested information no later than Deadline Date.
Your assistance is needed in this process as follows:
1. Attached is a document that explains what I need from you, why I need the information and how to make the direct links between my illness symptoms and their impact on my life.
2. Attached is a copy of a Residual Functional Capacity Questionnaire for you to complete on me, based on your findings. I have completed my own, as I see myself impacted, and have attached it for your information.
3. A letter to the SSA, (or to the LTD Insurance Company) on your letterhead, stating that you have been treating me since (appropriate date for Dr. XXXX; appropriate date for Dr. ZZZZZ).
4. Your prognosis about my condition. (Dr. ZZZZZ is calling it chronic progressive. If your opinions are consistent, it will help the decision makers.)

5. Your prognosis about my ability to return to any type of work (never).
6. A statement about my overall physical condition. For example: I also am providing you by fax, a copy of how I believe that each bodily system is impacted by MS that I am providing to SSA/LTD. A statement could look like this:
Patient Name’s Multiple Sclerosis symptoms have been steadily increasing in magnitude since conclusive diagnosis through MRI and spinal tap in (appropriate date). The impact of these symptoms on the patient’s daily activities are adequately described in my chart notes, and in the patient’s diary notes.
Due to the magnitude, scope, and complexity of this patient’s condition, it is unreasonable at this time to expect that s/he will be able to work at any time in the near or distant future. At best, medication can only decrease the rate of increase of this chronic disease. In my opinion, this patient would be a liability to any employer, and would be unable to sustain gainful employment of any sort, due to her physical, mental, emotional, and psychological limitations.”
You may add that you had to cut the patient back in work hours from a “full time” of 60-40 hours per week to a “part time of 30 hours” in date, and to no more than 32 hours since Date.

The following SSA criteria for your information comes from their Blue Book, used to evaluate candidates for SSDI:
· Disability Evaluation Under Social Security also known as The Blue Book,
· Medical criteria for evaluating Social Security disability claims

Medical Evidence from Treating Sources
Currently, many disability claims are decided on the basis of medical evidence from treating sources. SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed longitudinal picture of the claimant’s impairments and may bring a unique perspective to the medical evidence that cannot be obtained from the medical findings alone or from reports of individual examinations or brief hospitalizations. Therefore, timely, accurate, and adequate medical reports from treating sources accelerate the processing of the claim because they can greatly reduce or eliminate the need for additional medical evidence to complete the claim.”

Finally, Dr. ZZZZZ, as my Primary Physician, could you please have a copy of all information in my medical file pertaining to the diagnosis of Multiple Sclerosis, including the old data dating back to the 1980’s. The information should include, but not be limited to: Doctor notes; chart notes; lab results; x-ray results; MRI results; Spinal Tap results; the chart notes from the Physical and Occupational therapists that I saw through Dr. PPPPP. (Note: I have Dr. PPPPP’s first write-up on me.)
I do not need this info by my SSA appointment date. However, as soon as possible would be nice. If someone could call me on OWN PHONE # I’ll come by in person and pick up the information.

B. THANK YOU BOTH FOR YOUR CONTINUED SUPPORT AND HELP!

MULTIPLE SCLEROSIS HISTORY Form
This form is provided as a way of reminding you of the key components of your illness. These components will serve as the starting point for completing all of your disability documents. They also often describe the reasons why your illness impairs your normal daily activities, both on-the-job, and at home.

1. NAME:___________________________ DATE:___________

2. SSN:_______________________

3. Age when you first experienced MS symptoms:________________

4. Year or age when you were diagnosed with MS:________________

5. In general, how has the course of your multiple sclerosis gone?

_______a few attacks with good recovery afterwards.
_______a number of attacks with at least some recovery.
_______slow progression with long periods of stability.
_______fairly steady progression without much recovery

6. What symptoms do you currently have related to MS?


SYMPTOM
EXPLANATION

Visual blurring or difficulty seeing colors


Double vision or jerky vision


Difficulties with concentration or memory


Depression


Facial pain


Loss of balance control


Rocking or spinning feeling


Difficulties with swallowing


Weak cough


Tremors


Tingling or feelings of numbness


Loss of feeling


Loss of strength in arms


Loss of strength in legs


Spasms or jerking in arms or legs


Difficulties with bowel


Difficulties with bladder


Spastic or uncontrolled movements


Headaches


Changes in sexual function


Easy fatigue


Heat sensitivity


7. Have you ever experienced:
_______ Skin breakdown (bed sore, decubitus ulcer)
_______seizure

8. Have you ever had:
_______Occupational therapy for__________________________
_______Physical therapy for_______________________________
_______Speech therapy for_______________________________

9. Do you have any type of regular exercise program or activity? ___No ___Yes; explain____________________________

10. Please describe your current activity level:


Activity level

Getting around on foot, but may have some limiting fatigue.

Getting around on foot, but using some assistive equipment (including braces, canes, crutches, walker, walls and furniture)

Able to take a few steps, but mainly relying on wheelchair or scooter

Able to move back and forth from wheelchair or scooter without help, but using wheelchair or scooter for all mobility

Using wheelchair or scooter, but need help with transfers

Spending much of time in bed

11. How often do you fall?__________________________________

12. Do you presently drive? ____Yes ____No
If no, date lost license:___________________
If yes, is your car equipped with hand controls? ____Yes ___No

13. Do you have a disabled parking permit? ____Yes ____No

14. Do you currently work outside the home? ____Yes ___No

15. Do you currently work inside the home (on activities other that “traditional” housework)? ____Yes ___No

16. If “yes” to either questions #14 and #15, are you working full time? ___Yes ___NO; Part time? ___Yes ___No

17. If “no”, are you on short term disability? ___Yes ___No
Long term disability? ___Yes ___No

18. Are you on Social Security Disability Insurance? ___Yes ___No

19. Are you retired? ___No ___Yes When:__________

20. Please indicate what assistive equipment that you currently use:


Assistive Equipment

Assistive Equipment

C. Brace

Reacher

Cane

Computer

Crutches

Cooling vest

Walker

Air conditioner

Wheelchair

Standing frame

Electric wheelchair

Bathroom grab bars

Power scooter

Bath chair or bench

Transfer board

Hand held shower

Toilet Assist seat

“Canadian” cane (arm assist)

21. Do you follow a special diet? ____No _____Yes If yes, does it work, and please describe briefly: _______________________________________________________________

Actually Completed MS Medical History form as an Example

MULTIPLE SCLEROSIS HISTORY

Actual example completed by Carolyn Magura; 45 years with MS; on LTD and SSDI; author of these examples.

D. This form is provided as a way of reminding you of the key components of your illness. These components will serve as the starting point for completing all of your disability documents. They also often describe the reasons why your illness impairs your normal daily living activities -–both on-the-job, and at home.


· NAME:___Carolyn Magura___________ DATE:_22-22-22

· SSN:_123-45-6789

· Year of age when you feel that you first experienced MS symptoms:_______15___________

· Year or age when you were diagnosed as having MS:___1986 “diagnosis of exclusion”; 1997 actual confirmation diagnosis

· In general, how has the course of your multiple sclerosis gone?
_______a few attacks with good recovery afterwards.
_______a number of attacks with at least some recovery afterwards.
_______slow progression with long periods of stability.
___X___fairly steady progression without much or any let up.

· What symptoms do you now have related to MS?


SYMPTOM
EXPLANATION
X
Visual blurring or difficulty seeing colors
Problems with “horizonal scanning”; brings on dizziness and nausea; weekly visual blackouts
X
Double vision or jerky vision
Wavy lines; holes of vision; right peripheral vision narrowing
X
Slowed thinking or difficulties with concentration or memory
Problems with “holes” in memory and speech; phone in freezer; not able to multi-task
X
Depression
On medication for 6+ years
X
Facial pain
And numbness of right side(about 25%); in 1993, mis-diagnosed with Bell’s Palsy on right side of face for 6 months
X
Loss of balance control
Consistently fall if not holding onto something
X
Rocking or spinning feeling
Any large visual situation, where the eyes need to move lead to dizziness and nausea.
X
Difficulties with swallowing
Had problems with swallowing; after testing, diagnosed with dysphasia.
X
Weak cough
Feel as though the chest is always “slightly full”, making a “deep breath” hard; comes with a weak cough. Has led to two (so far) major problems with pneumonia, going into bronchial asthma.
X
Tremors
In arms, fingers, legs, torso, feet, and head. Can no longer write by hand legibly.
X
Tingling or feelings of numbness

Also, heightened sensitivity in other areas; left foot and leg up to mid-thigh; right foot and up to mid-calf; scalp; fingers; arms; torso.
X
Loss of feeling
25% of right side of face; torso; feet; left leg; other areas at periodic times
X
Loss of strength in arms
Arms and fingers; also, problems with info from the brain going to the correct finger (i.e., e instead of I; w instead of p, etc. when typing).
X
Loss of strength in legs
Left leg very little strength; left foot drop, requiring support; right foot loosing strength.
X
Spasms or jerking in arms or legs
Causes MAJOR problems each night trying to get to sleep; when at rest, arms and legs jerk and spasm. Taking medication to lessen impact.
X
Difficulties with bowel
Sphincter muscles no longer close; problems when diet not strictly regulated, with loose bowels and too hard bowels. Wear protection 24/7
X
Difficulties with bladder
Problems with both incontinence and with inability to urinate. VERY FRUSTRATING!
X
Spasticity when move
Torso clinches like a charlie horse when I turn or twist
X
Headaches
Focused headaches, and aches in EVERY MUSCLE OF THE BODY. Medication to alleviate symptoms.
X
Changes in sexual function
Problems with loss of feeling.
X
Easy fatigue
MS is the only illness that I have found that combines insomnia with fatigue! When the twitching finally stops, and sleep kicks in, it is impossible to get up! Any activity taking longer than 10 minutes results in the need for rest/sleep. The fatigue is so bad that just the thought of activity is tiring.
X
Heat sensitivity
Heat only exacerbates the fatigue. Heat is to be avoided! BUT, even with 100 degree temp, feet are cold! Cooling vest and wool socks – what a look!

· Have you ever experienced…
___No_Skin breakdown (bed sore, decubitus ulcer)
___No_seizure

· Have you ever had:
___No__Occupational therapy
for__________________________
__Yes__Physical therapy
for___walking canes; foot brace; bathroom help; to be fitted for a scooter__
__Yes__Speech therapy
for_____help in sowllowing____

· Do you have any type of regular exercise program or activity? ___No _X_Yes; explain___stretching, balancing, and strength exercise program from Physical Therapy___

· Please describe your current activity level:


Activity level

Getting around on foot, but may have some limiting fatigue.
X
Getting around on foot, but using some assistive equipment (including braces, canes, crutches, walker, walls and furniture)

Able to take a few steps, but mainly relying on wheelchair or scooter

Able to move back and forth from wheelchair or scooter without help, but using wheelchair or scooter for all mobility

Using wheelchair or scooter, but need help with transfers

Spending much of time in bed

· How often do you fall?___frequently, if I do not have an assist of some sort_____

· Do you presently drive? ____Yes __X__No
If no, date lost license:__September 30th, 2002____
If yes, is your car equipped with hand controls? ____Yes ___No

· Do you have a disabled parking permit? X Yes ____No

· Do you currently work outside the home? ____Yes _X_No

· Do you currently work inside the home (on activities other that “traditional” housework)? __X_Yes ___No

If “yes” to either questions #14 and #15, are you working full time? ___Yes X NO; Part time? _X -volunteer_Yes ___No

If “no”, are you on short term disability? ___Yes _X_No
Long term disability? _X_Yes ___No

· Are you on Social Security Disability Insurance? __X_Yes ___No

· Are you retired? __X_No ___Yes When:__________

· Please indicate what assistive equipment that you currently use:


Assistive Equipment

Assistive Equipment
X
E. Brace
X
Reacher
X
Cane
X
Computer

Crutches
X
Cooling vest
X
Walker
X
Air conditioner

Wheelchair

Standing frame

Electric wheelchair
X
Bathroom grab bars
X
Power scooter
X
Bath chair or bench

transferboard
X
Hand held shower
X
Toilet Assist seat
X
“Canadian” cane (arm assist)

· Do you follow a special diet? ____No ___X__Yes If yes, does it work, and please describe: __As a result of the swollowing problems, I drink liquids with every meal; I also do not eat anything small that could get caught or that could go into the lungs; so, I use mashed potatoes or some other food to “collect” food for eating.

F.


PCE/RFC Form PHYSICAL CAPACITIES EVALUATION FORM

RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT FORM
Patient: SS #:
Date Of Birth:
Dear Doctor:
Please answer the following questions with regard to your patient's claim for Social Security disability benefits or Supplemental Security Income (SSI) and/or with regard to your patient’s claim for Long Term Disability (LTD). Please base your answers on how your patient's medical conditions affect his or her ability to function.
1.Nature, frequency and length of contact:2.Please describe patient's symptoms (including patient's reports of pain, dizziness, etc.):3.State all clinical findings and laboratory/test results (or enclose copy of same): Please link findings to specific limitations.4.Diagnosis:5.Treatment and response (including list of medications and their effect and side-effects):6.Prognosis:7.Has the patient's impairment lasted, or can it be expected to last, at least twelve months?Yes _____ No _____
8.Can the patient continuously stand for at least 6 of 8 hours?Yes _____ No _____ How long CAN the patient stand? ____________
9.Can the patient continuously sit upright for at least 6 of 8 hours?Yes ______ No ______ How long CAN the patient sit upright? ______
10.If the answer to either number 8 or number 9 is NO, why is the patient unable to sit or stand?11.Does the patient have to lie down during the day? Yes ______ No ______ If yes, please explain why:12.How many city blocks can the patient walk without stopping?
Please check the frequency that the patient can perform the following activities:
Rarely Freq. Const.
0-33% 34-67% 68-100%
Reach Above shoulder ______ ______ _______
At waist level ______ ______ _______
Below waist level ______ ______ _______
Handling (gross motor) ______ ______ _______
Fingering (fine motor) ______ ______ _______
Feeling ______ ______ _______
14. How many pounds can the patient frequently lift over an 8 hour period?_____ Less than 5 _____5-10 _____11-20 _____21-50 _____over 50

15. How many pounds can the patient frequently carry?____ Less than 5 _____5-10 _____11-20 _____21-50 _____over 50

16. Does the patient have any problems performing such functions as grasping, pulling, pushing, or doing fine manipulations with his or her hands? PLEASE BE SPECIFIC.17.Does the patient have any problems with the following movements? (Please indicate any applicable range of motion studies):Bending ______________________________________Squatting ______________________________________Kneeling ______________________________________Turning any parts of the body ________________________
18. Is the patient able to travel alone? Yes _____ No ______Why?

19. Are there any other factors affecting the patient's ability to work (e.g. exposure to fumes, gases; ability to tolerate heights; restriction of exposure to moving machinery)?
20. If your patient complains of any pain, please indicate the nature and severity of the complaints and your opinion of the patient's credibility with respect to his or her complaints:
If there is an objective basis for the patient's pain, give specific details for this basis (i.e. degenerative changes in the spine):21. Considering your diagnosis of the patient's condition and his/her prognosis, is the patient capable of returning to his/her past job?
Yes _____ No _____ State why or why not:
22. Considering the same factors, is there any work the patient is capable of? State why or why not:
Please note whether the above restrictions are:

____ Not likely to change.

____Temporary From:_________To:____________


Date patient can return to work:______________

_______Without Restrictions

_______With Restrictions as noted above


Please enclose copies of your clinical records on this patient. Use the space below for any additional comments you may have:

Date Report Completed:
______________________________
Signature of Physician:
______________________________
Physician Name:
______________________________
Address:
______________________________
Telephone:
______________________________
Specialty:
______________________________