SARCOIDOSIS & PROVING DISABILITY
WHAT IS SARCOIDOSIS?
Sarcoidosis is an inflammatory disease that causes the immune system to overreact and start attacking the body. The disease does this by forming granulomas. Granulomas are clumps of inflammatory cells. These granulomas, or small clusters of inflamed tissue, start to form throughout the body and imbed themselves in the body’s organs. For example, they can affect the lungs, liver, heart, or other major organs. Too many of these granulomas can interfere with the function of the organ and cause permanent scarring of organ tissue.
Sarcoidosis is a rare disease. There are 150,000 to 200,000 cases in the US per year. Out of those cases, almost 27,000 are new cases. People of African descent and those with Northern European descent are more likely to get sarcoidosis. Women are more likely to have the disease. Additionally, black women are three times more likely to have the illness than white women. Unfortunately, they also have a higher mortality rate.
Permanent scarring of organ tissue is called fibrosis. In 90% of cases, sarcoidosis affects the lungs. However, it can affect almost any organ in the body. Because it causes pain and inflammation, it can impact your ability to function on a daily basis. Therefore, it can prevent you from working.
In order to qualify for SSD benefits, you will need to prove your condition prevents you from working for one year or more. The SSA does not award benefits for medical conditions that will resolve prior to one year. For example, they do not award benefits for a broken leg, because that will heal within a few months. The burden of proving you deserve SSD benefits is on you.
WHAT ORGANS DOES SARCOIDOSIS AFFECT?
Beyond the lungs, the body organs or systems most affected by sarcoidosis are the skin, eyes, and musculoskeletal system. Also, other systems affected are the nervous system, heart, liver, and kidneys. Patients can have symptoms from a specific organ or they can have general overall symptoms. Also, some people have no symptoms at all.
For example, some patients with liver granulomas do not report any symptoms related to the liver. However, the severity of symptoms can depend on how long the illness has been going on. If granulomas have been forming and creating scar tissue, then symptoms may be worse.
LOFGREN’S SYNDROME
Some patients who experience sudden onset of disease have Lofgren’s syndrome, a form of sarcoidosis that affects the lymph nodes. Lofgren’s syndrome produces red nodules under the skin. Also, the patient normally has a fever and arthritis pain. Fortunately, for patients with Lofgren’s syndrome, the disease goes into spontaneous remission in more than 50% of patients within 3 years of diagnosis. It goes into remission in two thirds of patients within a decade and occurs again in fewer than 5% of patients.
What are sarcoidosis symptoms when it affects the eyes?
Approximately 25% of people with sarcoidosis have eye symptoms. The eye symptoms are inflammation of almost any part of the eye. For example, you could have inflammation of the membranes of the eyelids, cornea, outer coat of the eyeball, iris, retina, and the lens. The most common eye symptom is acute anterior uveitis (inflammation of a layer of the eye). This type of inflammation results in blurred vision, teary eyes, and light sensitivity. The disease can also cause glaucoma, cataracts, and blindness. Dry eyes are a very common with sarcoidosis.
What are sarcoidosis symptoms when it affects the heart?
Heart disease is present in 30% of patients with sarcoidosis. Any part of the heart’s structure may be affected by sarcoidosis granulomas. The most frequently reported heart problems include chest pain, cor pulmonale or enlargement of the right side of the heart, cardiomyopathy, and arrhythmias. Arrhythmias are the improper beating of the heart; either too fast or too slow. If your heat beats too fast it is tachycardia. It is bradycardia if your heart beats too slow. Learn more information about the heart and a heart attack.
WHAT ARE THE SYMPTOMS OF SARCOIDOSIS WHEN IT AFFECTS THE LIVER?
Sarcoidosis granulomas are present in the liver in 50% to 80% of patients. However, the patients usually do not notice the symptoms of liver involvement. However, there are rare cases where the liver disease progresses to portal hypertension or cirrhosis of the liver.
WHAT ARE THE SYMPTOMS OF SARCOIDOSIS WHEN IT AFFECTS THE KIDNEYS?
Abnormalities can occur in the way the body handles calcium. For example, hypercalcemia (an excess of calcium in the blood) occurs in 2% to 10% of patients. Hypercalciuria (an excess amount of calcium in the urine) occurs in up to 21% of patients. Kidney stone formation, damage to the structure of the kidney itself, and kidney failure may also occur.
Another endocrine abnormality seen in sarcoidosis is hypopituitarism. The pituitary gland is at the base of the brain and secretes eight different hormones. The signs and symptoms of hypopituitarism vary, depending on which hormones are undersecreted. Occasionally, there is decreased secretion of all the hormones and this is called panhypopituitarism. Diabetes can also occur as a complication from sarcoidosis therapy.
WHAT ARE THE SYMPTOMS OF SARCOIDOSIS WHEN IT AFFECTS THE SPLEEN?
Cytopenias (deficiencies in the amounts of certain blood cells) are the most common “miscellaneous” symptom. Involvement of the spleen or bone marrow may lead to anemia and other blood abnormalities. These conditions usually are not important. Osteopenia is also common in sarcoidosis, as a result of the disease or as a side effect of prednisone therapy.
MENTAL SYMPTOMS ASSOCIATED WITH SARCOIDOSIS
Depression is a common issue for people with sarcoidosis. Other symptoms are fatigue and obstructive sleep apnea. Depression may occur in up to 2/3 of patients with sarcoidosis. It can cause much of the fatigue that people with sarcoidosis experience.
Sleep apnea is another reason that people with sarcoidosis can have fatigue. If you have sleep apnea, then you will probably experience daytime fatigue. Sarcoidosis of the sinuses or nose and weight gain from steroids increase the chances for obstructive sleep apnea.
Depression is a medical condition that qualifies for SSD benefits on its own. However, it can be combined with a physical condition to equal a listing. The combination of your mental and physical symptoms may keep you from working. The physical symptoms will prevent you from sitting and standing throughout the work day. But, the mental symptoms will impact your ability to focus, concentrate, and complete work projects.
OTHER COMMON SYMPTOMS OF SARCOIDOSIS
Sarcoidosis symptoms can vary greatly between different people. This is obviously due to which organs and tissues the granulomas affect. In some people, the symptoms are severe and for some they are mild. The most common initial symptoms are:
- Shortness of breath (dyspnea).
- Chronic cough.
- Reddish bumps or patches on the skin or under the skin.
- Enlarged lymph glands in the chest and lungs that produce shortness of breath.
- Fever, weight loss, fatigue, night sweats, and ill health.
Other disease symptoms include:
- Red and teary eyes or blurred vision.
- Swollen and painful joints.
- Enlarged lymph glands in the neck, armpits and groin.
- Pain in the hands, feet, or other bony areas due to cysts in the bones.
- Kidney stone formation.
- Development of arrhythmias and inflammation of the heart or heart failure.
- Nervous system effects include hearing loss, meningitis, seizures or mental disorders. For example, depression, dementia, and even psychosis.
SARCOIDOSIS TREATMENT
There is no cure for sarcoidosis. However, the disease may improve over time. Many people with sarcoidosis have mild symptoms and do not require any treatment at all. Treatment generally falls into two categories: 1) good health practices and 2) drug treatment. Good health practices include:
- Regular visits with your doctor.
- Eating a healthy diet with a variety of fresh fruits and vegetables.
- Drinking 8 to 10 8-ounce glasses of water a day.
- Getting 8 hours of sleep each night.
- Exercising regularly and keeping a health weight.
- Quitting smoking and excessive drinking.
- Avoiding exposure to dust, chemicals, fumes, gases, that can harm your lungs.
- Avoiding excessive amounts of calcium rich foods (such as dairy products).
STEROID TREATMENTS
Drug treatments are used to relieve symptoms. They also reduce the inflammation of the affected tissues and granuloma development. Also, they prevent the development of lung fibrosis and other irreversible organ damage. Steroids, for example, are effective in reducing inflammation and are usually the first drug your doctor will prescribe to treat your illness. Symptoms, such as cough and difficulty breath, generally improve with steroid therapy.
However, steroid treatment only controls the disease, it does not cure it. Results of some long-term studies indicate patients can expect about a 10% improvement in symptoms up to five years after stopping steroid treatment. It is up to you and your doctor to determine if steroid treatment is a good fit for you. Common problems with steroid treatment include excessive weight gain, insomnia, glaucoma, depression, and possibly diabetes.
RESOURCES FOR THOSE WITH SARCOIDOSIS
- National Heart, Lung, and Blood Institute (NHLBI)
- American Academy of Dermatology
- Arthritis Foundation
- American Liver Foundation
- National Eye Institute
- American Lung Association
- National Institute of Arthritis and Musculoskeletal and Skin Diseases
- Ocular Immunology and Uveitis Foundation Massachusetts Eye Research and Surgery Institute
CAN YOU QUALIFY FOR SSD BENEFITS WITH SARCOIDOSIS?
Sarcoidosis is a relatively rare disorder. But, the symptoms from sarcoidosis make it very difficult for those who have it to continue working. If you have sarcoidosis and have worked and paid taxes, then you can file a claim for Social Security benefits. You will also have to be unable to work for 12 months or more. SSDI benefits can help you make ends meet while you can’t work. If you can never return to work, then the SSA pays monthly benefits until you reach full retirement age.
QUALIFYING FOR SSD BENEFITS BY EQUALING THE LISTING
In order to qualify for benefits you will have to prove, through medical evidence, that you cannot work due to sarcoidosis. There is not an SSA listing for sarcoidosis, so you cannot meet a listing. However, you can submit medical evidence showing that you equal the medical rules for another listing. For example, if you have sarcoidosis with lung involvement, then you can equal the rules under listing 3.02 for COPD.
If you need information about COPD, then learn about COPD SSD benefits. Likewise, learn about lung symptoms when you have asthma. If you have lung issues with sarcoidosis, then you will need to get a chest X-ray to show fibrosis.
TESTS YOU NEED TO OBTAIN TO EQUAL LISTING 3.02
Listing 3.02 for COPD states you must submit one of these tests in order to qualify for SSDI benefits:
- a spirometry test that documents your FEV1 value (your forced expiratory volume in one second, meaning the amount of air you can exhale in one second) or (FVC) forced vital capacity
- a DLCO test (which measures how much oxygen passes into the blood)
- an ABG test (which measures the partial pressure of oxygen, PaO2, and carbon dioxide, PaCO2, in the blood), or
- an oxygen saturation test (SpO2).
The listing for lung involvement is difficult to equal because your breathing condition must be severe. It is possible for you to equal another listing. For example, your sarcoidosis may equal a listing for a heart condition, if you have heart involvement. Or, you may have another organ with fibrosis and you may equal a listing for kidney or skin symptoms. However, there is another way to win benefits. You can also qualify for SSDI and SSI benefits when a judge applies the Medical Vocational Guidelines.
IF YOU HAVE SARCOIDOSIS, THEN THE JUDGE MIGHT USE A MEDICAL VOCATIONAL ALLOWANCE TO GRANT BENEFITS
Because the SSA does not have a listing for sarcoidosis, there is no way your condition can meet a listing. It may also be difficult for your symptoms to equal a listing. Therefore, if the judge is going to grant your case, then she will have to use the Medical Vocational Allowance. This requires the judge to determine your residual functional capacity (RFC). Your RFC is the physical function that is left to you after taking into account all of your physical limits.
It will be helpful to have your doctor document your RFC. You should have your doctor fill out this Residual Functional Capacity evaluation. Your doctor will have to provide information about your condition and how it limits your ability to work. Then submit your claim for benefits, any medical evidence that you have, and the RFC evaluation to the SSA.
The SSA will look at factors like your past work history, your age, and the RFC evaluation. They will try to find some kind of work that you can do with your skills. If they can’t find any type of work that you can do then you should win benefits. The judge can use the Medical Vocational Guidelines, the GRID Rules, to grant your case. Find out how the GRID Rules can help you win SSD benefits.
THE MEDICAL EXPERT AT YOUR HEARING
The medical expert at the hearing is called to testify by the SSA judge. The SSA pays the medical expert. However, the doctor is supposed to give objective testimony. This means the doctor is not to favor of one side or the other. Even though the SSA is paying his fee.
The medical expert can testify that you equal a listing. Over the years, the SSA has made it hard for the ALJs to find that a medical condition meets or equals a listing. For example, in the past, a judge could find that your physical or mental condition met a listing. That is no longer the case. Now, the judge has to have a medical expert testify that your condition meets a listing.
THE ALJ’S OPTIONS
In order for a judge to find that your medical condition “equals” a listing, the SSA requires the judge to hire a medical expert. The medical expert will testify at your hearing whether your disability “equals” a listing. If the ALJ does not have a medical expert at the hearing, then she will not be able to find that your condition equals a listing on her own. Instead, she has three options:
- 1) call a medical expert to testify about the SSA listing
- 2) send questions to the medical expert after the hearing or
- 3) bypass finding that you meet or equal a listing and move to a finding that you cannot work by using expert testimony.
STEP FOUR OF THE SSA REVIEW PROCESS
At step four of the SSA review process, the ALJ determines your RFC. You have probably never heard of this before. However, it is very important to being paid benefits. The RFC finding is what the judge thinks you can do during the course of a work day. But, what are they? The SSA defines your RFC by your ability to sit, stand, walk, lift, carry, push, and pull.
Your medical condition and symptoms, such as pain, may limit your ability to meet the demands of certain jobs. These limits may be exertional, nonexertional, or a combination of both. Limitations are defined as exertional if they affect your ability to meet the strength demands of jobs. Learn about the five step SSA review process to qualify for SSD benefits.
EXERTIONAL IMPAIRMENTS
The SSA’s definition of an exertional limit is related to the US Department of Labor’s definitions of job levels. The levels are seated, light, medium, heavy, and very heavy. Each level is defined in terms of the strength demands for sitting, standing, walking, lifting, carrying, pushing, and pulling. SSA’s rules explain how they classify jobs by strength levels. The levels of jobs are in the Dictionary of Occupational Titles (DOT) published by the Department of Labor. The DOT determines the work demands of all jobs which exists in the national economy.
NON-EXERTIONAL IMPAIRMENTS
The harder question is – what are “non-exertional” impairments? The SSA defines it as follows: limitations or restrictions which affect your ability to meet the demands of jobs other than the strength demands. That means demands other than sitting, standing, walking, lifting, carrying, pushing or pulling. If it doesn’t involve that list of activities, then it falls under the non-exertional definition.
Some examples of non-exertional limitations include the following:
- (i) You are nervous, anxious, or depressed;
- (ii) You have ongoing trouble with attention or concentration;
- (iii) You have difficulty understanding or remembering detailed instructions;
- (iv) You have trouble seeing or hearing;
- (v) You have difficulty with the physical features of certain work places. For example, you cannot tolerate dust or fumes.
The law requires the judge to look at all of your physical and mental conditions to determine your RFC.
THE VOCATIONAL EXPERT AT YOUR HEARING
Once the ALJ determines your RFC, that RFC is used in hearing questions. A vocational expert (VE), called to the hearing by the judge, answers questions based on the judge’s questions. For example, the judge may ask if a person can work if they have fatigue from sarcoidosis and needs to lay down 2 hours a day. The answer is no. But there are other questions the judge may ask. Can a person who can lift 20 pounds work? The answer is yes. These are the kind of questions the judge will ask to the VE.
One of the reasons to hire an attorney with experience is so they can questions the VE for you. Your attorney can prepare questions for the VE that include all of your symptoms. This is important in order to prove that you cannot work at any job in the national economy.
IF YOU HAVE SARCOIDOSIS, THEN FILE AN APPLICATION FOR SSDI BENEFITS
The best way to file a claim for SSD benefits is to apply in person. Make an appointment at your local branch of the SSA. Bring all of your medical records and tests with your, including your RFC evaluation, to the appointment. A staff member at the SSA will help you fill out and submit your claim for SSDI and SSI benefits.
Pulmonary sarcoidosis may cause shortness of breath, fatigue, and loss of stamina. Your doctor must document these symptoms in your medical records. These symptoms may restrict your ability to walk and stand during an eight hour workday. They may also limit your ability to lift, which can effect the kinds of jobs you can perform. If you cannot sit or stand for long periods, that may support your claim for SSD and SSI benefits.
You can apply for Social Security Disability benefits (SSDI), if you have enough work credits. SSDI benefits come with Medicare. Medicare benefits are health insurance. Learn about Medicare benefits. By contrast, Supplemental Security Income benefits (SSI) come with Medicaid. Medicaid is also health insurance. However, it covers different visits and procedures. Also, to receive SSI and Medicaid, you must meet the income and asset rules. Learn about Medicaid benefits.
HIRE US TO WIN YOUR SARCOIDOSIS CLAIM
We will use our skills to help you through the appeal process. It is our goal to win your case. But, it also our goal to make it easier for you. We offer a free review of your case. Even if we don’t accept your case, we will still try to help you.
It also doesn’t cost you any upfront money to hire us. Why? Because you only pay us an attorney fee if we win your case. This means if we win, then you pay us out of your back benefits. If you do not win, then you do not pay an attorney fee. How much is the fee? It is 25% of your back benefit. Also, the fee is currently capped at $9200. You do not pay more than the cap. And, 25% is usually less than the cap. You will pay whatever amount is less.
If there are costs in your case, then you pay for those costs. But the costs are usually less than $100. You must also pay to obtain a copy of your medical records. The cost of your medical records is whatever your doctor charges for them. You owe costs whether we win or lose your case. But, to hire most lawyers, you have to pay a fee upfront. However, you can’t do that because you don’t have a job. We understand that. Which is why you only pay an attorney fee to us if we win your SSDI and SSI case.
MORE ABOUT THE LAWYERS AND STAFF AT OUR LAW FIRM
At Cannon Disability Law, we can help you apply for benefits for sarcoidosis. Also, we can help you appeal an SSA denial. Likewise, we can represent you in court. We will help you be a witness in your case. If necessary, we can also appeal your case to the Appeals Council. Additionally, we file appeals in Federal Court. Finally, we can represent you where you live. For example, we can represent you if need a Social Security attorney in Utah or Nevada. Also, we can help you if you live in Idaho, Colorado, or California. Learn about California SSDI and SSI benefits.
Additionally, your ability to receive Medicaid and Medicare depends upon your success with your SSD claim. Learn about Medicaid benefits. Additionally, you can read information about Medicare benefits. Even your future retirement benefits are at risk if you do not win benefits. In order to fight the SSA, you need a lawyer who knows what they are doing.
OUR LAW FIRM HAS THE EXPERIENCE YOU NEED TO WIN BENEFITS
Ms. Cannon’s firm is one of the best Social Security law firms in the country. Additionally, her firm is one of the best Social Security firms in Las Vegas, Nevada. Her firm represents clients throughout the western United States. Learn more about Utah SSDI and SSI benefits. Nevada SSD benefit information is also available.
In the last 30 years, our law firm has won over 20,000 SSDI and SSI hearings for our clients. Additionally, we have won over $100 million in ongoing and past due SSDI and SSI benefits for our clients. We have years of experience filing for benefits. We also appeal SSA’s decisions and help people win their case in court. Legal experience wins benefits. Call us now for a free review of your case.
During our 30 years in business, we have seen the Social Security Administration change their rules. Over time, it has become far more difficult to win Social Security cases. Also, the medical evidence required to meet SSA’s rules are harder to meet. Individuals who come to the hearing without an attorney do not usually win benefits. You should hire an attorney with experience to help you win SSDI and SSI benefits. Contact us today and see if we can help you win your sarcoidosis case.
