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.
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 day to day basis. Therefore, it can prevent you from working.
WHAT ORGANS DOES SARCOIDOSIS AFFECT?
Beyond the lungs, the body organs or systems most affected by sarcoidosis are the skin, eyes, musculoskeletal system, 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 liver-related symptoms. 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, symptoms may be worse.
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 recurrence occurs in fewer than 5% of patients.
What are the 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 (sclera), iris, retina, and the lens. The most common eye-related 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 very common in long-standing 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.
What are 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 to portal hypertension or cirrhosis of the liver.
What are 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 occur as a complication of sarcoidosis therapy.
What are 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 of clinical significance. Bone thinning (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 symptoms for people with sarcoidosis. Other symptoms are fatigue and obstructive sleep apnea. Depression may occur in up to 2/3 of patients with sarcoidosis, and 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 you will probably experience daytime sleepiness or sleep that is not refreshing. Sarcoidosis of the sinuses or nose and weight gain from steroids increase the chances for obstructive sleep apnea.
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 characteristics include:
- Red and teary eyes or blurred vision.
- Swollen and painful joints.
- Enlarged lymph glands in the neck, armpits and groin.
- Nasal stuffiness.
- Pain in the hands, feet, or other bony areas due to the formation of 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.
There is no cure for sarcoidosis, but the disease may get better over time. Many people with sarcoidosis have mild symptoms and do not require any treatment at all. Treatment generally falls into two categories: 1) maintaining good health practices and 2) drug treatment. Good health practices include:
- Getting regular check-ups with your health care provider.
- Eating a well-balanced 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, and toxic inhalants that can harm your lungs.
- Avoiding excessive amounts of calcium-rich foods (such as dairy products).
Drug treatments are used to relieve symptoms, reduce the inflammation of the affected tissues, reduce the impact of granuloma development, and prevent the development of lung fibrosis and other irreversible organ damage. Corticosteroids, for example, like prednisone, are effective in reducing inflammation and are typically the first drugs your doctor will prescribe to treat your sarcoidosis. Symptoms, such as cough and shortness of 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 corticosteroid treatment. It is up to you and your doctor to determine if steroid treatment is a good fit for you. Common side- effects of steroid treatment include excessive weight gain, insomnia, glaucoma, cataracts, depression, and possibly diabetes.
RESOURCES FOR THOSE WITH SARCOIDOSIS
- Cleveland Clinic Respiratory Institute The Sarcoidosis Center of Excellence https://my.clevelandclinic.org/departments/respiratory/depts/sarcoidosis
- Foundation for Sarcoidosis Research https://www.stopsarcoidosis.org/
- National Sarcoidosis Resource Center https://www.nsrc-global.net/
- Sarcoidosis Network Foundation https://www.sarcoid-network.org/
- National Heart, Lung, and Blood Institute (NHLBI) https://www.nhlbi.nih.gov/
- American Academy of Dermatology https://www.aad.org/
- Arthritis Foundation https://www.arthritis.org/
- American Liver Foundation https://liverfoundation.org/
- National Eye Institute https://www.nei.nih.gov/
- American Lung Association https://www.lung.org/
- National Institute of Arthritis and Musculoskeletal and Skin Diseases https://www.niams.nih.gov/
- Ocular Immunology and Uveitis Foundation Massachusetts Eye Research and Surgery Institute https://uveitis.org/
CAN YOU QUALIFY FOR SOCIAL SECURITY DISABILITY BENEFITS WITH SARCOIDOSIS?
Sarcoidosis is a relatively rare disorder. But, the symptoms from sarcoidosis can make it very difficult for the people who have it to continue working. If you have been diagnosed with sarcoidosis and you have worked in the past and paid taxes, then you can file a claim for Social Security disability benefits. You will also have to be off work for 12 months or more. The disability benefits from the SSA can help you make ends meet while you can’t work.
QUALIFYING FOR DISABILITY BENEFITS UNDER EQUALLING THE LISTING
In order to qualify for disability 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 documentation showing that you equal the criteria for another listing. For example, if you have sarcoidosis with lung involvement, then you can qualify by equalling the criteria under listing 3.02 for COPD.
TESTS YOU NEED TO OBTAIN FOR LISTING 3.02
Listing 3.02 for COPD states you must submit one of these tests in order to qualify for disability benefits:
- a spirometry test documenting 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 impairment must be severe. It is possible for you to equal other listings. For example, your sarcoidosis may equal a listing for a heart condition, if you have heart involvement. Or, you may have another organ that has fibrosis and you may equal a listing for kidney involvement or skin symptoms. However, there is another way to win benefits. You can also qualify for disability benefits through a judge applying the Medical Vocational Allowance.
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 for your impairment to 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, she will have to do so by using a Medical Vocational Allowance. This requires the judge to determine your residual functional capacity (RFC). Your RFC is the physical capacity that is left to you after taking into account all of your physical limitations.
It will be helpful to have your doctor document your residual functional capacity. You should have him or her fill out this Residual Functional Capacity evaluation. The doctor will have to provide detailed 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 employment history, your age, and the RFC evaluation. They will try to find some kind of work that you can do with the skills and limitations that you have. If they can’t find any type of work that you can reasonably be expected to do then you will be eligible for disability benefits.
THE MEDICAL EXPERT AT YOUR HEARING
The medical expert at the hearing is called to testify by the administrative law judge. The SSA pays the medical expert’s fee. However, the doctor is supposed to give objective testimony. This means that the doctor is not supposed to be in 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 ALJ’s to find that a claimant meets or equals a listed impairment. For example, in the past, a judge could determine after reading your medical records, that your physical or mental impairment meets or equals a listing. That is no longer the case.
THE ALJ’S OPTIONS
Now, in order for a judge to find that your impairments “equal” a listing, the SSA requires the judge to hire a medical expert to testify that your disability “equals” a listing. If the ALJ does not have a medical expert at the hearing, she will not be able to make an “equalling” finding on her own. Instead, she has three options:
- 1) call a medical expert to testify about the listings at the hearing
- 2) send interrogatory questions to the medical expert after the hearing or
- 3) bypass finding that you meet or equal a listing and move to a finding of disability by using a vocational expert.
STEP FOUR OF THE DISABILITY REVIEW PROCESS AT YOUR HEARING
At step four of the disability review process, the ALJ determines your residual functional capacity (RFC). You have probably never heard of this before. However, it is very important to a finding of disability. The RFC finding is what the judge thinks you can do considering your exertional impairments. What are exertional impairments? They are what they sound like – the things that impair you when you exert yourself. The SSA defines exertional impairments as follows:
Your impairments and related symptoms, such as pain, may cause limitations of function or restrictions which limit your ability to meet certain demands of jobs. These limitations may be exertional, nonexertional, or a combination of both. Limitations are classified as exertional if they affect your ability to meet the strength demands of jobs.
The classification of a limitation as exertional is related to the United States Department of Labor’s classification of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of the strength demands for sitting, standing, walking, lifting, carrying, pushing, and pulling. Sections 404.1567 and 404.1569 explain how we use the classification of jobs by exertional levels (strength demands) which is contained in the Dictionary of Occupational Titles published by the Department of Labor, to determine the exertional requirements of work which exists in the national economy.
The harder question is – what are “non-exertional” impairments? The SSA defines “non-exertional” impairment as follows: Limitations or restrictions which affect your ability to meet the demands of jobs other than the strength demands, that is, demands other than sitting, standing, walking, lifting, carrying, pushing or pulling, are considered non-exertional.
Some examples of non-exertional limitations include the following:
- (i) You have difficulty functioning because you are nervous, anxious, or depressed;
- (ii) You have difficulty maintaining attention or concentrating;
- (iii) You have difficulty understanding or remembering detailed instructions;
- (iv) You have difficulty in seeing or hearing;
- (v) You have difficulty tolerating some physical feature(s) of certain work settings, e.g., you cannot tolerate dust or fumes.
The law requires the judge to look at all of your exertional and non-exertional impairments to determine your RFC.
THE VOCATIONAL EXPERT AT YOUR HEARING
Once the ALJ determines your RFC, that RFC is used in hypothetical questions. A vocational expert, called to the hearing by the judge, answers questions based on the hypothetical 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 in a hypothetical to the vocational expert.
An attorney can cross-examine the vocational expert. Also, your attorney or representative can prepare questions for the VE that include all of your impairments. 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 DISABILITY BENEFITS
The best way to file a claim for disability benefits with an RFC is to apply in person. Make an appointment at your local branch of the SSA. Bring all of your documentation and your RFC evaluation with you to the appointment. A staff member at the SSA will help you fill out and submit your claim for disability benefits.
Pulmonary sarcoidosis may cause shortness of breath, fatigue, tiredness, and loss of stamina. Your doctor must document these impairments in your medical records. These impairments may restrict your ability to walk and stand during an eight hour workday. They may also restrict your ability to lift, which can effect the kinds of jobs you can perform. If you cannot sit or stand for extended periods, that may support your claim for disability benefits.
HIRE CANNON DISABILITY LAW FOR HELP WITH YOUR SARCOIDOSIS CLAIM
We will use our skills to help you through the disability process. It is our goal to win your case. But, it also our goal to make it easier for you. We offer a free consultation. Even if we don’t accept representation in 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 is a contingency fee. It means if we win, you pay us out of your back benefits. If you do not win, you do not pay an attorney fee. How much is the fee? It is 25% of your back benefit. Also, the fee is capped at $6000. You never pay more than the cap. And, 25% is usually less than the $6000 cap. You will pay the lesser amount.
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 SSD and SSI case.
MORE ABOUT THE REPRESENTATIVES AT CANNON DISABILITY LAW
At Cannon Disability Law, we can help you apply for benefits. 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 disability attorney in Utah or Nevada. Also, we can help you if you live in Idaho, Colorado, or California.
Additionally, your ability to receive Medicaid and Medicare depends upon whether or not you are successful with your disability claim. Even your future retirement benefits are at risk if you do not win benefits. In order to fight government agencies like the SSA, you need a lawyer.
CANNON DISABILITY LAW HAS THE EXPERIENCE YOU NEED TO WIN BENEFITS
Ms. Cannon’s firm is one of the best disability firms in Utah and Nevada. Additionally, her firm is listed as one of the best Social Security Disability firms in Las Vegas, Nevada. Her firm represents claimant’s throughout the western United States. Learn more about Utah SSD benefits here. Nevada Disability Information can also be found on this website.
In the last 30 years, Cannon Disability Law has won over 20,000 disability hearings for our clients. Additionally, we have won over $100 million in ongoing and past-due SSD and SSI disability benefits for our clients. During the time we have been in business, we have seen the Social Security Administration change their policies. Over time, it has become far more difficult to win Social Security cases. Also, the medical evidence and listing requirements are harder to meet. Individuals who come to the hearing without representation are typically not successful in winning benefits. You should hire an attorney with experience in disability law.