Social Security Ruling 19-4p on the evaluation of headaches in determining disability will appear in the Federal Register on Monday. You can read it today. Here is what appears to me to be the key language from the Ruling:
Primary headache disorder is not a listed impairment in the Listing of Impairments (listings); however, we may find that a primary headache disorder, alone or in combination with another impairment(s), medically equals a listing. Epilepsy (listing 11.02) is the most closely analogous listed impairment for an MDI [Medically Determinable Impairment] of a primary headache disorder. While uncommon, a person with a primary headache disorder may exhibit equivalent signs and limitations to those detailed in listing 11.02 (paragraph B or D for dyscognitive seizures), and we may find that his or her MDI(s) medically equals the listing or in combination with another impairment(s), medically equals a listing.
Epilepsy (listing 11.02) is the most closely analogous listed impairment for an MDI of a primary headache disorder. While uncommon, a person with a primary headache disorder may exhibit equivalent signs and limitations to those detailed in listing 11.02 (paragraph B or D for dyscognitive seizures), and we may find that his or her MDI(s) medically equals the listing.
Paragraph B of listing 11.02 requires dyscognitive seizures occurring at least once a week for at least 3 consecutive months despite adherence to prescribed treatment. To evaluate whether a primary headache disorder is equal in severity and duration to the criteria in 11.02B, we consider: a detailed description from an AMS [Acceptable Medical Source] of a typical headache event, including all associated phenomena (for example, premonitory symptoms, aura, duration, intensity, and accompanying symptoms); the frequency of headache events; adherence to prescribed treatment; side effects of treatment (for example, many medications used for treating a primary headache disorder can produce drowsiness, confusion, or inattention); and limitations in functioning that may be associated with the primary headache disorder or effects of its treatment, such as interference with activity during the day (for example, the need for a darkened and quiet room, having to lie down without moving, a sleep disturbance that affects daytime activities, or other related needs and limitations).
Paragraph D of listing 11.02 requires dyscognitive seizures occurring at least once every 2 weeks for at least 3 consecutive months despite adherence to prescribed treatment, and marked limitation in one area of functioning. To evaluate whether a primary headache disorder is equal in severity and duration to the criteria in 11.02D, we consider the same factors we consider for 11.02B and we also consider whether the overall effects of the primary headache disorder on functioning results in marked limitation in: physical functioning; understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; or adapting or managing oneself.
I'll just hang out here with my physician until I get a headache so that I can meet the SSR requirement that "An observation of a typical headache event, and a detailed description of the event including all associated phenomena, by an AMS."
ReplyDeleteYou think that's the key language? How many times have you seen FM non-MDI'd under 12-2p? How about under "How do we establish a primary headache disorder as an MDI?"
ReplyDelete"The evidence must document that the AMS who made the diagnosis reviewed the person's medical history, conducted a physical examination, and made the diagnosis of primary headache disorder only after excluding alternative medical and psychiatric causes of the person's symptoms."
How many neurologists or PCPs do anything other than diagnosing the subjective headache disorder and trying a new med? There are certainly some instances, but more often than not, IME, a claimant says they have migraines and the provider diagnoses them with migraines before starting a Triptan or Topamax.
How many claimants who now say they have migraines every day and parrot all of the symptoms they got off the internet are going to now parrot this disease? I hate how the SSRs are making it easy for a 25 year old with 3 kids at home to qualify, just because they can make more money being "disabled" with all the other freebies that comes along with it.
ReplyDelete@9:28: SSDI and SSI are not that easy to get onto, "parroting" symptoms to a doctor is not medical evidence. And yes, * here comes the sarcasm* we all know all the SSA recipients are only on the program for all the "freebies"... like, uh...what are you talking about? Free hats? A free mug upon 3 successful visits to a field office?! There are no "freebies" on SSA. Pay a lawyer to fight for you, and then tell me how much a "freebie" SSA is, and how many "freebies" they offer.
ReplyDeleteYeah, what freebies are you talking about? And it's hard as hell for a 25 year old to get disability for any but the most obvious reasons. The last young claimant I had with a serious circulatory problem died before we could get to a hearing.
ReplyDeleteMost very young claimants haven't earned enough to be entitled to a substantial benefit. Then, whatever it is, they have to stretch that for a month. Most don't have the financial literacy to make that work very well. There sure is a crappy attitude towards 'the least among us.' I don't know what it is, but it's sure not christian.
Thank you. I submitted a request for a headaches listing. I have had numerous clients suffer from horrendous headaches. I once had a client document every daily headache for 3 years. Kudos to the SSA.
ReplyDeleteSSA understandably doesn't like these headache cases because there is little that can be shown objectively on any test to prove that a person has most types of headaches, much less how often they occur and how limiting they are. People with legitimate, severely disabling chronic migraines will typically show absolutely nothing abnormal on any diagnostic test of their head. That is the nature of the condition. How then, to decide these cases?
ReplyDeleteIt's good to have some guidance, but I am always concerned when rules call for much more information to be in medical records than doctors would ever normally put there in the regular course of treating a patient. If this rule is interpreted to require medical documentation which does not occur in the regular course of treating patients, then many with legitimate claims will be arbitrarily denied. I'm not sure what the solution is, but there is definitely a problem.