A stroke recently struck 53-year-old U.S. Senator Mark Kirk (R.–Ill.). Many have mentioned that strokes do not usually occur in people as young as Kirk.
According to a recent Associated Press article on strokes, up to 25% of strokes nationally occur in people younger than 65 years old. However, in Louisiana and other southeastern states, the figure is much worse. For example, in North Carolina, the article reports one facility measured 45% of strokes in young and middle-aged individuals.
While strokes are devastating at any age, when a younger or middle-aged person is affected with a stroke there is more chance of survival according to the article. But the recovery may take a long time. And you may experience loss of certain functionality.
As a result, you may need to apply for Social Security disability benefits for stroke. The residual effects of stroke often involve memory difficulties and problems with motor coordination and function, and for this reason, a stroke victim may have difficulty performing an occupation.
There are a few things to note when applying for disability benefits related to a stroke. Initial claims for disability benefits usually take several months before a decision is reached. However, stroke cases can take even longer because the evaluation is often delayed over a longer period of time to see if there is any improvement. The residual effects of a stroke can be nearly impossible to measure in the short time following a stroke. Doctors simply do not know enough to allow for a reliable projection as to how a stroke victim may recover from a stroke.
Your recovery can be influenced by factors such as age and the existence of other medical conditions and risk factors. Also, not all individuals will recover at the same rate. The Social Security Administration (SSA) needs to see how your recovery progresses before making a determination on your claim.
WHAT IS A STROKE?
A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen.
A stroke can be caused by an obstruction in the blood flow or the rupture of an artery that feeds the brain. You may suddenly lose the ability to speak, or have memory problems, or one side of your body can become paralyzed.
The two main types of stroke are ischemic stroke and hemorrhagic stroke. Both types of stroke result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.
Ischemic stroke – Ischemic stroke is the most common type of stroke and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke.
Hemorrhagic stroke – A hemorrhagic stroke occurs when a blood vessel on the brain’s surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).
The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Major strokes may lead to paralysis or death. Many patients are left with weakness on one side of the body, difficulty speaking, incontinence, and bladder problems.
WHAT ARE THE SYMPTOMS OF STROKE?
Within a few minutes of having a stroke brain cells begin to die and symptoms emerge. Recognition of the symptoms is important, as prompt treatment is crucial to recovery.
Common symptoms include:
- Trouble walking, loss of balance and coordination.
- Speech problems.
- Numbness, weakness, or paralysis.
- Blurred, blackened, or double vision.
- Sudden severe headache.
Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue.
A transient ischemic attack (TIA) may be a sign of an impending stroke – TIA is a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to those of strokes but last for a shorter period and do not leave noticeable permanent damage.
WHAT ARE THE EFFECTS OF STROKE?
Strokes can range in degree of severity, and the type of damage done depends on where in the brain they occur and how long they last. Strokes can cause death immediately, or cause little limitation. Some of the common and lasting effects caused by strokes include:
- Weakness, paralysis, numbness. This refers to limitations in movement or motor ability, such as weakness and paralysis in an arm and leg on the same side of the body as a result of the blockage.
- Speech and language problems. Strokes sometimes produce some degree of loss of ability to understand or express certain aspects of written or spoken language in various combinations (known as aphasia).
- Personality changes. Strokes may produce personality changes if it is large enough and in the right area of the brain.
- Vision problems. Usually to one eye only and can affect depth perception, peripheral vision, and cause other vision issues.
- Balance problems. Strokes can affect balance and ability to walk without producing any actual weakness. Strokes may also cause unilateral neglect, or where the brain does not recognize one of the limbs, which makes it functionally useless.
CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS FOR STROKE?
A stroke can cause symptoms, limitations and restrictions that can impact your ability to work. Social Security Disability benefits may be available to you if you have suffered a stroke and have residual symptoms.
If you are not engaging in gainful activity due to a stroke and the effect of residual symptoms, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.)
Generally, to establish a stroke as a medically determinable severe impairment, you should provide:
- Objective medical testing establishing the CVA (i.e., MRI or CT); and
- Treatment records detailing your initial hospitalization and ongoing therapy or residual effects.
At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing.
The SSA does have a listing for strokes. It is Listing 11.04, vascular insult to the brain. The listing for stroke is fairly short and requires the following:
- Stroke residuals will be evaluated at least 3 months following a stroke (meaning a case may be deferred).
- To be approved on the basis of the stroke listing, a claimant must demonstrate:
- 11.04A. Ineffective speech or communication that results from sensory or motor aphasia (the loss of ability to speak or comprehend due to brain illness or injury) OR
- 11.04B. Persistent, significant motor function disorganization in two extremities (this could be two legs, two arms, or an arm and a leg) that results in a sustained disturbance of gross and dexterous movements, or in gait and station.
These effects, if present, should be described in your medical records by your treating provider. It is important to note, that they must exist at least three months following the stroke and be expected to last at least 12 months total.
A knowledgeable social security attorney can help you determine if your residual effects meet the listing.
Even if your condition does not rise to the listing level, you may still be found disabled if the limitations resulting from the stroke prevent you from performing your past relevant work and other work available in the national economy. In such cases, you should consult with a disability attorney for help with proving your limitations.
As with any impairment, your level of impairment (or residual functionalality/RFC) will be determined by a review of your medical records, including treatment notes, admission and discharge summaries, lab and imaging studies, and also supporting statements from one’s treating physician(s). It is important to get these records into SSA as soon as possible for a complete evaluation of your disability claim.
The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.
TIPS FOR SSDI APPLICATION FOR STROKE
- Make sure that the medical records diagnosing the stroke are included. This may be an MRI, CT Scan, or other appropriate testing. It is important that you “know your medical records.”
- Make sure your medical records document ALL of your symptoms and limitations and the residual effects you experience. Your medical records should not just document your stroke, they should include your physical therapy, speech therapy or other therapy you have undergone. You need to let your doctor how often you feel symptoms, how severe each symptom is and how long each symptom lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms. Make sure any side effects of medication are noted in your records.
- Have someone assist you with your claim if your memory, concentration, etc. prevent you from completing the forms yourself.
- See a specialist. Treatment of stroke and recovery by a neurologist will carry more weight than the same diagnosis from a family physician or internist professional.
- Comply with your doctor’s orders and try what is recommended.
- See a mental health professional. If you are suffering from depression or anxiety as a result of the chronic problems and inability to participate in life, see a mental health professional to diagnose, treat, and document these conditions.
- See your doctor regularly and keep your appointments.
- If you can, provide evidence of a long work history.
- Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity, if applicable.
- Include information from non-medical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
- Keep a journal. Make regular notes about your impairment, level of function, and treatments.
- If you need assistance with your claim, contact an attorney who specializes in Social Security Disability. For a free case evaluation, call Loyd Bourgeois at 985-240-9773