POLYMYOSITIS: HOW TO PROVE YOUR DISABILITY CLAIM

POLYMYOSITIS, DERMATOMYOSITIS, AND SSD BENEFITS

If you have polymyositis and you cannot work, then you should apply for SSD benefits on the SSA’s website. When you apply for Social Security Disability benefits, you must prove to the Social Security Administration (SSA) that your medical condition prevents you from working.

The SSA uses a set of medical rules called the “Listings.” It is also known as the “Blue Book.” If you meet the listing, then the SSA grants your case without further analysis. If your condition meets or equals a listing, then the SSA should approve your claim at step three of the evaluation process.

The listing that applies to Polymyositis and Dermatomyositis is Listing 14.05. These conditions can cause weakness, trouble swallowing, breathing problems, and systemic symptoms that make it impossible to work.

Understanding how the SSA evaluates this listing can make the difference in whether your win or lose your benefits. This article explains Listing 14.05 in detail. It also discusses how the SSA applies the listing. Finally, this article explains how to win SSD benefits outside of the listing.

WHAT ARE POLYMYOSITIS AND DERMATOMYOSITIS?

Polymyositis and dermatomyositis are chronic inflammatory muscle diseases that fall under autoimmune disorders. In polymyositis, the immune system attacks muscle fibers. This leads to progressive muscle weakness, especially in the muscles closest to the trunk. For example, it impacts the hips, thighs, shoulders, and neck.

Dermatomyositis has the same muscle involvement but also presents with a skin rash, often purple or reddish in color, that affects the eyelids, hands, chest, or back.

Both conditions can develop slowly over weeks or months. But in some cases they progress rapidly. Usually with these diseases there are “flares” when the immune system becomes particularly active. During a flare you may struggle with fatigue, difficulty walking, climbing stairs, lifting, or even raising your arms.

In severe cases, throat muscles are affected, leading to choking. Additionally, breathing muscles become weak, which makes it difficult to breathe properly.

THE CAUSES OF POLYMYOSITIS & DERMATOMYOSITIS

The causes of polymyositis and dermatomyositis are not completely understood. Researchers believe genetic risk and viral triggers play roles. It most often develops in adults between ages 30 and 60. Women are affected in greater numbers than men. The National Institutes of Health estimates only 1 to 10 new cases per million people each year.

Dermatomyositis is closely related but includes a distinct skin rash. The rash is often purple or red. Like polymyositis, the disease involves immune system attacks on muscle tissue. Its exact cause remains unclear but combines genetic, immune, and environmental factors.

Dermatomyositis is also linked to certain cancers, especially in adults. It occurs in both children and adults. Women develop dermatomyositis in greater numbers than men. However, the disease is very rare. There are 5 to 10 new cases per million people each year.

Treatment involves medications, physical therapy, and lifestyle changes. With treatment, some patients experience remission. Unfortunately, many people live with disability due to chronic weakness, pain, and fatigue.

HOW THE SSA EVALUATES AUTOIMMUNE DISORDERS

The SSA places polymyositis and dermatomyositis under the broader category of immune system disorders under Section 14.00 of the Listing. Autoimmune disorders affect multiple parts of the body, including muscles, joints, blood vessels, and internal organs. Because the symptoms vary widely, the SSA requires detailed medical records to establish the extent of the disease.

To meet Listing 14.05, the SSA requires specific medical findings that show either severe muscle involvement or systemic symptoms. Your symptoms must create marked limitations in function. Simply having a diagnosis of polymyositis is not enough to qualify.

Therefore, you must provide evidence from medical exams, lab tests, imaging, and clinical observations. You doctor can also write a letter of  support that discusses the criteria from the listing.

LISTING 14.05: POLYMYOSITIS AND DERMATOMYOSITIS

The exact language of Listing 14.05 includes several ways to meet the criteria. Each pathway focuses on different aspects of the disease, such as muscle weakness, swallowing difficulties, breathing problems, calcinosis, or repeated flares with systemic effects. Understanding each section is essential.

A. PROXIMAL LIMB-GIRDLE MUSCLE WEAKNESS

One of the most significant features of polymyositis and dermatomyositis is proximal limb-girdle muscle weakness. This means weakness in the muscles closest to the trunk, such as the shoulders and hips. Weakness in these areas affects mobility and independence.

To meet this part of the listing, the SSA requires not just evidence of muscle weakness but also proof that the weakness creates functional limitations. You would need to use an assistive devices that prevents the effective use of your arms or legs for work activities. The listing outlines three ways to qualify under this category:

• A medical need for a walker, two canes, two crutches, or a wheelchair that requires the use of both hands.

• Being unable to use one arm for work related activities while also needing a one handed device such as a cane or a wheelchair that requires one hand.

• Being unable to use both arms for fine and gross motor activities, meaning you cannot independently initiate, sustain, and complete basic tasks with your arms

For example, if you cannot climb stairs without a walker, then you satisfy this requirement if the medical records document your limitations. Physical therapy notes and neurologic testing are especially valuable evidence.

B. IMPAIRED SWALLOWING

Polymyositis and dermatomyositis can affect the muscles involved in swallowing, leading to dysphagia. Dysphagia can cause aspiration. This occurs when food or liquid enters the airway and lungs. It creates a risk of pneumonia.

The listing requires trouble swallowing with aspiration due to muscle weakness. This must be found in the medical record. For example, you can submit swallowing studies, clinical exams, or reports from a speech therapist. If you choke on food, require thickened liquids, or you have been in the hospital for aspiration pneumonia, then you may meet this requirement.

C. IMPAIRED RESPIRATION

Another serious issue is weakness in the intercostal and diaphragmatic muscles, which are essential for breathing. When these muscles are weak, you may experience shortness of breath, decreased lung capacity, and reliance on respiratory support.

The SSA recognizes that impaired breathing due to muscle weakness is a condition that qualifies under Listing 14.05. Evidence might include pulmonary function tests, physician note that state you have reduced diaphragmatic movement, or a medical need for mechanical ventilation or oxygen therapy. Those who cannot sustain activity without significant breathing issues are likely to meet or equal this section of the listing.

D. DIFFUSE CALCINOSIS

Diffuse calcinosis refers to abnormal deposits of calcium in the skin, muscles, or connective tissue. This issue is more common in dermatomyositis and can lead to painful nodules, limited joint movement, and even intestinal problems.

Under the listing, diffuse calcinosis with limitation of joint mobility or intestinal motility qualifies. Medical imaging, reports from surgery, and other records often provide the necessary evidence. The impact of calcinosis can be profound. It can make it difficult to move your joints, perform activities, or maintain nutrition.

E. REPEATED MANIFESTATIONS WITH SYSTEMIC SYMPTOMS

If you do not meet one of the specific physical criteria, then you may still qualify under part E of Listing 14.05. This section applies to individuals who experience repeated manifestations of polymyositis or dermatomyositis that produce systemic symptoms and marked issues in the ability to function.

The SSA requires records showing you have at least two constitutional symptoms, such as severe fatigue, fever, malaise, or weight loss. These symptoms must be combined with one of the following at a marked level: limits in activities of daily living, trouble with social function, or being unable to complete tasks in a timely manner due to problems with concentration, persistence, or pace.

This section recognizes that autoimmune conditions often cause widespread fatigue and cognitive issues, making it impossible to sustain work activity, even if you do not have muscle weakness or organ damage. People who regularly experience flares that keep them in bed, prevent them from caring for themselves, or cause missed work may meet this section of the listing.

PROVING YOUR CLAIM WITH MEDICAL EVIDENCE

Winning a disability claim for polymyositis requires strong and consistent medical records. Going to the doctor two or three times a year isn’t enough. You must seek treatment and go to the doctor months.

 The SSA does not approve claims based on symptoms alone. Your medical records must clearly describe your diagnosis, treatment, response to medication, and ongoing limitations.

 The SSA looks for evidence such as:

• Elevated muscle enzyme levels, including creatine kinase.

• Abnormal findings on EMG or muscle biopsy.

• MRI scans showing muscle inflammation.

• Swallowing studies or pulmonary function tests.

• Documentation of flares, hospital stays, or medication side effects.

Keeping a detailed record of your symptoms, including fatigue and weakness, can also support your claim. Statements from your treating doctor that describe why you cannot work can also help.

Visit your doctor at least once a month. Go to a mental health counselor every two weeks. If you have support from your treating doctor, then it will help you win benefits. If you cannot afford a doctor, then find a doctor by using our resources for free or low cost medical treatment.

WHAT TO DO WHEN YOU DO NOT MEET A LISTING

Not every person with the disease will meet the exact criteria of Listing 14.05. However, you may still qualify for benefits if your condition is severe enough to prevent you from working. In that situation, the SSA will consider whether you “equal” a listing. Next, they will decide whether your residual functional capacity (RFC) rules out all work.

Equaling a listing means that your symptoms and limitations are equivalent to the listing criteria, even if they do not match exactly. For example, if you have significant weakness and fatigue that prevents walking without assistance, but your records do not specifically mention limb-girdle weakness, your attorney may argue that your illness equals Listing 14.05.

If you neither meet nor equal the listing, the SSA moves to step four and five of the disability process. At these steps, the SSA will consider your ability to lift, carry, stand, walk, and sit. They will also consider your ability to use your hands, concentrate, and interact with others. Many people with polymyositis are limited by their severe symptoms. Their fatigue, pain, or flares prevent them from performing all work.

THE IMPORTANCE OF MEDICAL OPINIONS

Because polymyositis and dermatomyositis are complex conditions, the opinions of treating doctors carry significant weight. A detailed medical source statement that explains why you cannot sustain employment can be critical. Physicians should address your ability to lift, stand, walk, sit, use your arms, and maintain concentration. They should also document the frequency of flares, medication side effects, and hospital stays.

In many cases, your case can benefit from a functional capacity evaluation (FCE) done by a doctor or physical therapist. This type of testing demonstrates whether or not you can meet the physical demands of work.

HOW AN SSD ATTORNEY CAN HELP

Applying for Social Security Disability benefits is a complicated process, especially for rare conditions like polymyositis and dermatomyositis. Many claims are denied initially because the SSA does not fully understand how severe the condition is. Hiring an experienced SSD attorney can make the difference between approval and denial.

An attorney can gather your medical evidence. Also, they can work with your doctors to obtain helpful opinions. They can present legal arguments that your condition meets or equals Listing 14.05. If your claim goes to hearing, then your attorney can question the experts to strengthen your case.

At our SSD law firm, we have decades of experience helping clients with severe medical conditions, like polymyositis. We understand the unique challenges you face and know how to present your case to the SSA.

HIRE US TO HELP YOU WIN BENEFITS

It is always our goal to win benefits for our clients. Your future ability to pay your bills, for yourself and your family, relies upon the result of your SSD case. Additionally, your ability to receive Medicaid and also Medicare depends upon whether you win your case. Learn how to obtain Medicaid benefits.

You can also learn about Medicare benefits. Medicare benefits are a form of health insurance that helps pay your medical bills.

You need to hire an SSD attorney with experience. We bring 30 years of legal experience to your case. For example, Dianna Cannon has been helping people win their benefits for over thirty years. Brett Bunkall and Andria Summers also have many years of legal experience. Additionally, our staff has years of legal experience helping clients collect records and win benefits.

One thing you may not know is that we are able to help you with your case no matter where you live. For example, we represent clients in Utah and Nevada. Learn how to win Utah SSDI benefits.

Likewise, learn about Nevada SSDI and SSI benefits. We also have clients in Idaho, Colorado, and California. Learn about California SSD benefits. You can trust that our lawyers and staff will do the job to win your SSD and SSI benefits. We want to be your legal team. Contact us now.

WE WORK FOR FREE ON YOUR CASE

We work for free on your SSD case, until you win benefits. In fact, you only pay an attorney fee if you win benefits.

If we do not win benefits for your polymyositis, then you do not pay an attorney fee. But, how much is the fee? The fee is 25% of your back benefit. However, the fee is capped by the SSA. You pay whatever amount is less. And, the 25% fee is the more likely fee. Because 25% of your back benefit is usually less than the cap on fees. Again, you pay the lesser of the two amounts.

If there are costs in your case, then you pay for those costs. Costs are minimal. They are usually less than $100. Typically, the only cost you will pay for is a copy of your medical records. And, we only charge you if the doctor charges us.

You will owe costs whether we win or lose your case. In order to hire most lawyers, you have to pay an upfront fee. We don’t work like that. You don’t have a job. So how can we expect you to pay? We can’t. That is why you only pay if you win SSD benefits.

THE TOP SSD ATTORNEYS CAN HELP YOU 

We will use our legal skills to help you through the Social Security benefits process. It is our goal to win your case and to make it easier for you. We offer a free review of your case. And, there is no pressure to become a client when you call.

Polymyositis and dermatomyositis are severe conditions that can cause profound muscle weakness, breathing problems, and systemic symptoms. To meet listing 14.05, you must have strong medical records.

Even if you do not meet the listing, you may still qualify for benefits if your condition equals the listing.  You can also qualify if your polymyositis prevents you from working a 40 hour work week. It is best to hire an SSD lawyer to help you present these arguments. Living with chronic pain is hard enough. You don’t have to fight the SSA alone.

If you are struggling with polymyositis or dermatomyositis and can no longer work, do not give up. Contact us for a free review of your case. We can help you gather the medical evidence and fight for the benefits you deserve.