SSDI for Amputees | The Disability Benefits Podcast #31

In this episode, we talk about getting your disability benefits as an amputee and how reaching Maximum Medical Improvement affects your case.

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Disclaimer: We are a non-attorney firm. Our company specializes in representation for Social Security disability claims and is not a law office. The information provided in this video is for general informational purposes only and does not constitute legal advice. For legal guidance specific to your situation, please consult a licensed attorney.

Transcript

SPEAKER_00 0:01

Will they will they tell you why they're unsubbing?

SPEAKER_01 0:04

Yeah, I don't know. They'll just ghost us.

SPEAKER_00 0:07

Let me practice.

SPEAKER_01 0:12

We're good. Okay. Well, I have a a medical question. Um this probably won't be a very long episode unless we get sidetracked and then who knows what happens.

SPEAKER_00 0:23

It happens. Yeah.

SPEAKER_01 0:24

But yeah, I have a medical question. So and we talked about this a little bit, but I want to talk about specific um scenarios. So when someone is getting treatment, we want them to get treatment all the time. I want to talk a little bit about sp specific diagnoses that really don't require ongoing treatment and what we would use instead of that or what we would recommend doing with treatment. And so a few of them stand out. For example, like if you're an amputee and you've been in an amputee for two years, I mean you don't really need to go to the unless you have other stuff going on. But for your amputations, there's not a whole lot of ongoing treatment for that. So usually we would sit, we would say, try to go to your doctor every couple of months, tell them what's going on, yada yada. But with an amputee, I mean, you know, I s I am still an amputee, and then five months later I'm still an amputee. And and so do we what do we tell those clients?

SPEAKER_00 1:23

Yeah, that's that's come up before. It's a good question. Uh and we've talked about a little bit before, but mostly it was some of the life like lifelong mental health conditions, like a learning disorder, autism, um, intellectual deficits, stuff like that, or like a traumatic brain injury. You know, you had you had a motorcycle wreck when you're 19, you're 50. No, you still had a motorcycle wreck with a traumatic brain injury when you're 19. So there's still going to be likely still going to be some uh residual problems. Um with an amputee with more physical limitations, we have to get it documented, first of all. So there were we would probably go back and get the records to when um the amputation happened. And what Social Security is really going to be looking at for an amputee specifically is if they're wearing a prostate prosthesis, if the prosthesis is fitting, that seems to be the big thing. Um it does take some time to um to get a prosthesis properly fit so it's not hurting um uh the the area where it fits to, stuff like that. And then there are going to be some instances where you you just you just can't. I mean there's not yeah, they can't fit you with one. Um and you're right. After that, you know, do you need to go to the health department, you know, every 90 days to say, yeah, you know, he's he still doesn't have a leg, or no, he still doesn't have an arm. Um, you know, it it sounds funny, but it's not, and no, the answer is no. I mean, if if it's there. However, we would need some kind of documentation from an ongoing source that you're having problems because of it. And sadly, the only way to provide that would be medical records. So, would you, you know, I'm gonna speak out of both sides of my mouth here. Would you need to go to the health department? You had an amputation two years ago, um, you got a prosthesis that fits okay, or you have a prosthesis and you tried and you tried to try it, and it's just not working, and therefore you're you're either hobbling around, or if it's an arm or a hand, um you're trying to learn how to work one-handed. Um, not work, but work your life from a one-handed standpoint. Um, really, the only acceptable records that Social Security would look at would be a medical provider. And a medical, and it seems kind of silly. Like I said, I I find myself speaking out of both sides of my house. No, you don't, that's stupid. You don't need to go to somebody to say, yep, there's they're still they still have an amputation. Okay, well, not for that reason you don't need to go, but you do need to go for you to say, just to document, listen, you know, I can't get from one end of my house to the other. You know, I have to hug a wall, or I can't make a simple meal meal anymore because you know, I'm missing an arm, um, especially if it was a dominant um uh arm. You know, I'm right-handed, and that's you know, I had a a right below elbow amputation. That's gonna cause some significant problems. Um just the um the the improvement from the time of the amputation until you get some therapy, and you know, again, once if they try to do a prosthetic and it just didn't happen, um, there's just gonna be a a pretty significant amount of time that passes. And eventually you're gonna be like, I don't I don't want to go to to the doctor for them to basically tell me, you know, hey, we told you, you know, nine months ago when you were in here that there's this we've done all we can. And of course, from Social Security standpoint, all they want is just that you uh some kind of documentation that you're still having problems. So I am, I'm I'm I'm giving two different answers. Do you medically need to do that to verify that the condition that you say you have exists? No, you know, if no, you don't. But do you need to go? Yeah, you probably still need to go. Um, just for them to document, you know, Mr. Smith came in today and you know, you know, we did a uh below elbow amputation on him in November of 2023, and blah blah blah blah blah blah blah blah. And he's still complaining of you know not having uh the ability to do just simple tasks, um, you know getting a bowl out of a cabinet, uh all sorts of stuff like that. So that would help. Another physical one that comes up is seizures and headaches, migraines. Um what what you s what we see normally in these is that um, especially if it's a traumatic onset of seizures, which that happens sometimes. You know, you're you live your life and you know, at 43 years old you have the first seizure, and then you know, two weeks later you have another one. What we find mostly is seizure disorders, they they they put you on an anti-convulsant, dilantin, tegritol, uh there's there's a ton of them. Yeah, capra is a big one. And um and the thing is is that 95% of cases with a seizure disorder, um, you're going to respond well to treatment. The only the only treatment that um Social Security is gonna be looking for in that, if you have a seizure disorder, is they want to know periodically what your blood levels are, because if the Kepra, the Tegrital, the Dilantin, whatever you're taking, if it is not at therapeutic levels, then they're not gonna allow your case. You're gonna say, well, if dude was taking the medicine like he's supposed to, and if it got up to therapeutic levels, but he's still having seizures, there's a so you're not really going in so much for treatment, because a lot of times what happens is you go to treatment and you go to the ER and you you amass a stupid bill, because every time you go to the ER, you amass a stupid bill, stupid expensive, and you just stop doing it. Yeah. You know, okay, you're you your your family's like, oh my goodness, look at him, he's zoning out again, or if it's like a grand mall uh seizure, which is the big one. Um, but you're you're flopping, you're actually on the floor, you know. Uh after they've seen that that happen a few times, what they're probably gonna do is this is they're probably gonna stick their hand in your mouth to make sure you don't swallow your tongue, and they're just gonna wait it out until you stop convulsing and stuff like that. Um they're not, you're not going to go to uh the ER every single time you have a seizure. You are not, after a while, gonna go to the ER every single time you have a migraine that, you know, they'll give you a shot usually of some, you know, something to to help you. It's usually some kind of uh narco narcotic, but um, and that helps you, but you've amassed a stupid expensive ER bill. Yeah. And if you're having them frequently enough, you're just I'm not gonna mess with it, you know. I I'll do what I normally do, which is I retreat into a quiet, dark, cool place, and I stay there until it goes away. And so back to our question Do you need medical evidence to show that you know you've continued to have three migraine headaches a week or five migraine headaches a month, or five seizures a month? No, you don't need medical records to show that, but with the seizures, you're gonna need to show some blood work periodically, that you are taking the anticonvulsants and they are at therapeutic levels, but you're still having seizures. And for migraines, we suggest that our clients do a diary. And I don't talking about writing a book or or you know becoming Shakespeare. I'm just saying a note a notebook, uh piece of paper, um, a small notebook that you have, just somewhere that you you always keep it. And you know, it's March 7th, uh had a seizure, you know, did the normal stuff to get rid of it. And then somewhere in that diary, the normal stuff, three hours laying down, eyes closed, lights off, curtains drawn, making sure nobody in the house is making any noise. He's doing that several times a month. Um and you have a diary of that, and we actually present it to Social Security. Well, listen, you know, they're they're not gonna go to the ER every time because it's it's it's not practical for one, and financially they just can't do it. Um if you're expecting them to go to the ER every time they have a seizure when they're having five of them a month, that's not gonna happen. It's not realistic for Social Security to expect that, and therefore we're not gonna play that game. It's not realistic for me. Uh, you know, I have five migraines a month, they they keep me out of pocket for three hours at a time. Sometimes the recovery takes as long as a day. Um I'll just take it, make a diary that it's not reasonable for you to expect me to go and amass a stupid expensive ER bill for them to give me a shot. Um I'm I'm gonna get the same kind of remedy, but I'm just not gonna get it as quickly as a shot, and I'm not gonna uh amass, you know, a $500 or more bill doing it several times a month. So again, I I find myself speaking out of both sides of my mouth. You always need medical records to prove a condition, but I don't expect it to be unreasonable. Um that's I I guess that's my my dual answer to the question.

SPEAKER_01 11:17

Yeah, I mean we can't we're not gonna be able to work a case without any kind of evidence. Right. So it doesn't necessarily need to be this intense, you know, every month with a specialist, and every month with this guy, and every month with this provider. But we have to have some piece of evidence. And I would imagine the ADL is also super important for those type of cases. Absolutely. Um, if you're an amputee, use your example of say it's their dominant um limb, their dominant arm or hand. Um Social Security will send the client an ADL activity of daily living, and that's your opportunity to talk about I have trouble doing laundry because of this amputation, and I have trouble doing uh washing dishes and folding laundry and sweeping, and I can't go to the grocery store by myself, stuff like that. That as I would imagine that's extremely important for all cases, but especially something like an amputation.

SPEAKER_00 12:08

Absolutely. Yeah, I mean uh upper extremity involvement, um the the ADL, you're going to have problems doing things that people with both limbs, both upper extremities still have. Um and there's gonna be a long and arduous uh learning curve. You know, if you're 50 something years old and you've had both limbs all 50 years, and all of a sudden, for whatever reason, um you have to have um you know one of them removed, there's the drama, but then there's that learning period of doing things one-handed. Um lower limb. There's that learning period of balancing, of learning what you can't do. Um certain things that you know there's the obvious things like okay, well, they're gonna have difficulties walking, you know, getting around, stuff like that. Yeah, try to get in and out of a car without both legs. Yeah. If you're watching this video, just try to do that. If you're watching this video, and I won't get gross and crude, if you're watching this video, tomorrow morning, try to do your morning hygiene ritual showering, bathing, cleaning, brushing your teeth. Try to do all that with your non-dominant arm, and your dominant arm you don't get to use it all. Try to do that. And you will see how absolutely horribly hard it is.

SPEAKER_01 13:43

Yeah.

SPEAKER_00 13:43

And it's not something that you overcome in a week or a month. It's, you know, you're you're basically your body's been doing something for decades, and all of a sudden you're you're telling it I can't do that anymore, you're gonna have to do it a different way. Um we are really f fantastically adaptable creatures, but we don't adapt quickly.

SPEAKER_01 14:03

Yeah, and take some time.

SPEAKER_00 14:04

Yeah.

SPEAKER_01 14:05

Yeah, that makes sense. So I'll give another example. This one's more of like a category, not a specific condition. All right. Um well, I'll use a specific condition and then I'll go into what I was gonna say. So we'll use um we'll use degenerative disc disease, degenerative disc disease, because that's very popular, or arthritis or herniated disc. Um so their back is hurting, they're having trouble walking, standing, stooping, squatting, you know, all of those words, uh lifting things. I ask the client after that when I'm doing when I'm screening this person, I'll ask them, what are they doing for treatment? Because the question is, okay, you have this wrong with your back. Are you going the um pain meds route? Are you go are you gonna do an operation? Are you getting the um the shots? Are you like what are you doing? What's the what are we working with here? Every once in a while, this doesn't happen super frequently, but every once in a while I'll talk to someone who uh who tells me that they're at um maximum medical improvement. And that's an actual medical term, so I don't want to I don't want to speak too much about it because I'm not a doctor, but MMI maximum maximum medical improvement. If they get to that point, that is their doctor telling them essentially. Look, man, there's not really anything else we can do.

SPEAKER_00 15:18

Yeah, we see that mostly um in worker comp settlements, you know, MMI maximum medical improvement. Um it is not a term that Social Security other judges care about, by the way. Um what they do care about is somewhere in the medical records it says that or it says it in a different way. You know, Mr. Smith has come in, you know, we've we've tried, you know, what they call radical treatment, which would be cutting you, you know, surgery. We've tried conservative treatment, which is usually physical therapy, exercises. Umgoing maintenance therapy is usually the medication. Um and that does include the shots, the epidural steroid injections. Um But yeah, the somewhere somewhere along the line they're gonna say we've done what we what we can for him. So what with you're gonna follow up with the question of are you I interrupted you, so yeah.

SPEAKER_01 16:16

No, that's well that's that's what I was gonna primarily talk about is just MMI and how we how we go about that. Because but you know, back pain or or I mean it could be anything, it could be any kind of diagnosis, but to me having your doctor literally tell you that we've done all we can, that seems like that client is gonna stop going to the doctor. Sure.

SPEAKER_00 16:35

Yeah.

SPEAKER_01 16:36

Um probably probably the most common thing we see after that is just like pain management for degenerative disc disease, something just uh instead of curing it, we're just trying to put up with it, like maintenance. Yeah, like you were saying. Trevor Burrus, Jr.

SPEAKER_00 16:48

And you're absolutely right. And and you know, we went to you know, our first example, you know, an amputation, you know, that's pretty drastic. But you're you're right. Things that are more common, which degenerative disc disease is um any kind of back disorder is I think it's number one as far as allegations in disability claims nationwide. Um but you're exactly right. You gotta think about that. If you're if you were from the outside looking in and you're like, you know, what what what has this person done to address the the the he's got a herniated disc. What has he done with that? And again, Social Security, what they're looking for is, you know, they'll they'll almost always start out with very conservative things. Oh, you need to do these exercises at home, and hopefully it'll, you know, it'll loosen up your back to where you won't be hurting so much. Um but then you come in, you know, two months later, and you know, it's the back problem is still really bad, it's shooting down my leg all the way into my toes or whatever. And so they're like, Well, let's give you you know an ESI, an epidural steroid injection, and that's literally it's a shot in the back, and it's you know supposed to kind of numb the area. Um you come back in two months later, and they're like, you know, you're probably a surgical surgical candidate if you want to do that, but it's up to you. And you're like, Well, yeah, I'm you know, I can barely get out of bed every morning, let's do something. And you have surgery, and you know, here's the bad news, guys. I speak from personal experience here. Surgery works for the first five or six months, you're gonna feel like a new person, and thank goodness they did that. They got it all squared away. I'm good, I'm good. Wait, wait a minute. Feeling a little bit stiff today, and eight months later, you're at the same point. That's what I hear from 90% of my clients when it comes goes to uh surgery, specifically a laminectomy. So you and your doctor talk about it, and it might work for you because it does work for some people, but for the majority of cases, especially for folks in their 50s or older, and they have that, um, they'll say the same thing. For a few months I felt like a new person. I was a superman, I was able to do everything. Then it kind of got bad again, and now it's as bad as it ever was, or sometimes it's worse. So let's say you do that. So you've gone down from exercises, then you had the ESIs, the injections, and now you've had the surgery, and several months later you're like, it's still there, it's still shooting down into my leg, which indicates that there's some neurological involvement, it's hitting a nerve somewhere. What are you gonna do? You're not gonna do another surgery because now you're mad because you know the surgery that you had didn't work. Um they're just they're just gonna prescribe stout pain medication for you. It's and it's almost always gonna be an opioid, and it's gonna work, but you're gonna be loopy, and they're probably gonna say you can't drive or operate heavy machinery on this. Um there are gonna be some restrictions. And I say everything and I went through the list like I went through because that is exactly how Social Security will look at that specific disorder. Well, really any kind of disorder. Did you start with a conservative treatment and then you you move to kind of a more, you know, a more uh in-depth treatment? You d you went all the way to what they call radical treatment, which is surgery, they cut you. Um and then after that, if that didn't work, you're just you're kind of on a maintenance program there. They're gonna they're gonna give you pills. Or they might have you come in every month for a shot. I mean, uh and it's it's all pain relief at that point.

SPEAKER_01 20:44

Yeah, and and that is valid treatment. That's valid medical records records. If if it if a client gets to the point where they're not trying to have any other surgery and they've tried everything, like you said, and they're walking with a prescribed cane and they're on heavy narcotics and they just see their pain management doctor every one to three months, that's fine. We just we would put that pain management doctor or provider as a medical source, and that's valid.

SPEAKER_00 21:08

Yeah, but let's say, you know, back to our question. Let's say all that happened and it all happened two or three years ago. Okay. When you had the back injury or it got so bad that you couldn't work anymore, you went in, they gave you exercises to do, uh-uh. You went in, they gave you epidural steroid injections, and you had that for you know two or three months. Uh-uh. You went in, you begged them, cut on me, please, please, please do something. My pain is excruciating. You had that. And here we are two or three years later. Um, what happened after the surgery? Well, it's gonna be documented because they're gonna they're gonna bring you back. Your surgeon is always gonna bring you back. How did it do? Um, and two two months later, you're they're gonna feel like they're the best surgeons on planet earth. Yeah, we we solved this man's problem. That he's been dealing with for years and years and years, and blah blah blah. And then the wind is gonna go out of those sails because five months later, their client or their patient is gonna be coming in and saying, I'm having the same problems, and I think it's getting worse. And um, so all that happens like two, two, three years ago. Are there gonna be medical records? Maybe. There may just be like, you know, every six months or so they show up to the doctor, and he, you know, are you doing any any better? No. Okay. I'm rewriting you a script, and you're, you know, here's a 90-day supply of LORTEB or Oxycodone or whatever. Um, and pain management's gonna be the same way. Pain man pain management. Um there's not really gonna be a whole lot of treatment involved, as in let's try this and let's try this. It's pain management, it's just here's here is the pills that we're gonna give you. By the way, every time you show up, you've got to pee in a cup because we've got to make sure that you know we're giving you this medication, it better show up in your urine. Because if it doesn't, um you're not one, either you're not taking the medication the way you're supposed to, and that can be really problematic for you with Social Security. They they're gonna wonder where where's the medication going to, you know, especially if if some of the uh pain management companies make you bring in your bottle and you have three three tablets in it left, and that's where it should be, and then they take your blood and they're showing either no none of that medication or just a trace of that medication. Now they're like, you're giving it away or you're selling it or something like that. And it just it can turn into a absolute mess. Again, speaking from experience, you know, I've seen this with many, many of my clients. Um so pain management, it it is a natural progression, but if you're looking for pain management records to show treatment, the only treatment is that they're they're gonna make sure that you're you're taking a medication as you're supposed to, and they do that with a urinalysis. Um, and they're gonna ask you, you know, uh on a scale from zero to ten, you know, for the last since we've seen you last, last three months or so, what's your pain level been like? It's an eight. Okay, you just they still need it, and they'll write you the script or whatever. Um, you're not gonna get a whole lot of you know range of motion here. You know, we're gonna do a straight leg raise, straight leg leg raise, a straight leg raise. They do two of them. They do one of them where you're um lying on your back and they lift your leg up, and if it hurts, they they say, okay, well, they got to 45 degrees, and his they're just looking at your face basically to see if you're wincing in pain, or they got to 90 degrees, you should be able to get to 90 degrees. Or you're sitting um at the edge of the exam table and they lift your leg and you know, well, yeah, he got he got to 90 degrees, and you know, he was he was wincing, so so they do that, and that's just shows neurological involvement, but you're not gonna see a lot of that in pain management. So, you know, my long, long answer to your short question is you have to go somewhere to basically report that you're having the can the limitations. The ADL is gonna be great, and you brought up the the just the general ADL, the activity is a daily living form. If you have a seizure disorder, most states have a seizure questionnaire. You know, if you have uh other things that we haven't talked about in the podcast that are a little bit more specific. Um, chronic fatigue syndrome. You have chronic fatigue syndrome, there's a chronic fatigue form that, or a questionnaire that they send out. Um they do the pain questionnaire is universal. I think every state has that. They're gonna send that out if you're alleging problems with pain. Um, so you have these things, and they go they do go a long way. The the migraine headache diary goes a long way, believe it or not. That's kind of Mickey Mouse. I'm just writing it with my hand on notebook paper. Yeah, you are. And you're keeping a diary of every time that happens. And somebody looking at that is like, oh my goodness, look at this. In the month of March last year, you you had six migraines, and they they pretty much every one of them took you out of pocket uh all day. Yeah, that's that's kinda the way it is. That's disabling.

SPEAKER_01 26:25

Yeah.

SPEAKER_00 26:26

So Okay.

SPEAKER_01 26:28

Well, I think that's a good place to end it unless you have anything else to add. Nope. Alrighty. If you have a question about your disability case, drop it in the comment section below and we will do our best to answer it in the next episode.