From The City:
The illness was supposed to last for three weeks, doctors told her.
But weeks four through six of COVID-19 were the worst for Holly MacDonald. Her low-grade fever morphed into an all-around fatigue. She began having trouble speaking.
And when she stood up, her legs and feet turned purple.
“I’d walk too far and then I’d need to be in bed for three days,” said MacDonald, who is 29 and lives in Crown Heights. She had to take administrative leave from her job at a nonprofit where she builds social-media campaigns.
A month after getting sick in early March, MacDonald was back in the ER, frustrated as she tried to convince her doctors she was mired in her second month of what, she’d been told, was a three-week respiratory virus.
She’s still not fully recovered. MacDonald is one of upwards of 70,000 New Yorkers struggling with unexplained long-term symptoms of COVID-19, according to a range of estimates provided by several New York City-area doctors and hospitals contacted by THE CITY.
“The hidden number could be more,” said Dr. Zijian Chen, who directs Mount Sinai’s Center for Post-COVID Care. “We’re looking at patients who are still testing positive day to day, so this is a population that’s going to continue to grow.” ...
In some cases, patients say, their doctors don’t believe them. ...
These “long-COVID” cases, as the Mount Sinai center describes them, appear to occur randomly — there’s no demographic category that is more likely than another to be struck.
Patients come in reporting fatigue, shortness of breath and difficulty thinking clearly. In some cases, the symptoms arrived months after the worst of COVID illnesses were over. ...
Note the part about "their doctors don't believe them." If physicians can't explain the reasons for a patient's symptoms, they tend to dismiss the symptoms as if they were imaginary. A few examples: post-polio syndrome, sero-negative rheumatoid arthritis, multiple sclerosis, interstitial cystitis, irritable bowel syndrome, fibromyalgia, complex regional pain syndrome, etc. Of course, by now many of these are taken seriously and some were taken seriously all along, such as MS, but there's no good way to tell from medical tests how badly the disease is affecting the sufferer. Social Security has historically just turned down disability claims filed by people with such problems for the most part. I expect the same for claimants with chronic health problems related to Covid-19. I hope the volume is small because I hope that given a little more time most people with these post-Covid-19 symptoms will get better but I'm really expecting a good number of these cases.. We'll see.
Been wondering if/when we would be receiving guidance on COVID-related claims and how to analyze them. I think the denials will be more of a problem at the initial/recon levels compared to the hearing level. DDS isn't going to pay it without a definitive impairment.
ReplyDeletePersonally, I'm fully aware of the long-term effects of the disease in some people (because I'm not a moron who thinks it's a hoax or whatever) and will give the claimants the benefit of the doubt on their symptoms provided there's an actual positive COVID test in the file. Can't speak for the rest of the ALJ's but the judges in my office are pretty reasonable people.
I understand exactly what the issue is here, but my question is, what would you have SSA or any other "insurance" provider do without medical evidence to substantiate a claim?
ReplyDelete@9:53
ReplyDeleteThank you.
@10:34
Publish a new SSR allowing claims for the condition based on a generally consistent set of symptoms, as SSA did for fibromyalgia and chronic fatigue syndrome with SSRs 12-2p and 14-1p.
Also, a report of symptoms is evidence. Maybe not objective, maybe not even particularly strong, but if supported by sufficient evidence, I would expect that should be enough to qualify for benefits. It's literally enough to qualify for any mental disorder, because even psychological testing is based on the claimant's responses to testing. And like those tests, plenty of techniques can be employed to weed out false claims through detection of malingering.
Seems to describe most of my fibromyalgia cases. Some doctors (and ALJs) simply do not believe it exists.
ReplyDeleteBut the real side effect of the coronavirus will be psych problems. Many people who lose their jobs never seem to recover. It happened back in 2008. Will probably see more of those cases. Will make it tougher for the SSA to arbitrarily turn down these cases.
Some cases won't have a positive COVID-19 test result in file. Some people could have a relatively mild bout with COVID-19 and develop these long-term symptoms later. Some people may not be able to get a COVID-19 test. And there apparently is a window of time during which a test will show positive & later tests may not show COVID-19. Even a positive antibody test may not last. This may well have to be diagnosed, in some instances, based on chronic symptoms.
ReplyDeleteIt's hard to award benefits when a requirement is that the disability will last 12 months or longer (or result in death) when the virus hasn't even been around 12 months. People with very debilitating heart attacks, strokes and cancer are denied because they may recover within 12 months and those are things we know quite a bit about. Not knowing what will happen in 6 months or a year is not a reason to pay someone. If Social Security was a short term disability program that would be a different story.
ReplyDelete@9:53 AM
ReplyDeletePlease, for the love of all that is holy, do NOT deny claims based on the absence of a positive COVID-19 test. That would not be consistent with the law or the medicine. In many cases, particularly in earlier days before the United States (belatedly) found its footing, doctors have had to make diagnoses without the aide of a test. Testing is NOT the only way to confirm a diagnosis. Nor is it always the best way to confirm a diagnosis. Additionally, many of the tests out there extraordinarily high false-negative rates. So again, unless you want to appear ignorant, callous and unfit for your position, please change course.
9:53 -- Glad you will give the claimant's benefit of the doubt if there is a positive covid test but ask that you will be as gracious to those who were unable to get covid testing due to the shortage of tests in spring.
ReplyDeleteHere is your chance, you can roll out the old reliable statements, for conditions that cannot be tested and measured. I see the old list of favorites:
ReplyDelete"I am unable to get through the grocery store without fatigue, I have to use the cart for support"
Who can forget the olden golden moldy "I am unable to stand and cook at the stove, I have to microwave all my meal..."
And I am sure there will be some new spin on the "I cannot go out in public without anxiety, even seeing people without a mask on TV causes me anxiety."
The one case I had with COVID had pre existing and disabling conditions that were of listing level severity for over. four months.. We tried to allow but the federal reviewing component returned it to us saying it MIGHT not last twelve months. That said they are usually very inconsistent so tomorrow might return a denial with COVID with even less severity saying we should have allowed
ReplyDelete9:53... A person would not be denied on the basis of a COVID test being negative because SSA looks at how the condition effects function, persistence and long term results. What I fear is that if Obama care is eliminated and insurance companies can again deny for pre existing conditions, ten years down the road some insurance company will deny coverage for a new neurological or cardiac condition saying that it resulted from the prior COVID infection
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