SYMPTOMS AS EVIDENCE
Disability is as a physical or mental condition that limits a person’s movements, senses, or activities. Social Security’s definition of disability is any physical or mental condition that keeps you from working for at least one year and the decision to award disability payments must be based on evidence.
Evidence is any testimony, writing or material object offered in proof of an alleged fact or proposition. Whether the claimant is disabled or has a severe impairment is a decision reserved to the Commissioner of Social Security POMDI24503.040 https://secure.ssa.gov/poms.nsf/lnx/0424503040. The disability determination should be based on all evidence, the complete record including claimant’s testimony. Symptoms and signs are often discussed together in decisions, yet they are distinct, different manifestation of disease and should be evaluated and treated differently in Social Security proceedings.
Medical diagnosis is based on symptoms, signs, and tests. A symptom is physical or mental problem a person experiences that may indicate a disease. It is a subjective manifestation of departure from the normal, a sensation experienced by the patient, never perceptible by others. A sign is an objective physical response, helps to notice and diagnose the disease. Pathognomonic symptoms and signs are so characteristic of a disease that they can be used to make a diagnosis. Ideally, symptoms will alert, signs direct and tests confirm the diagnosis. Many medical problems are far from this ideal, either symptoms or signs may be missing and/or no laboratory proof found. Diagnosis may be based solely on pattern recognition, the characteristic recurrence of symptoms or signs.
Unless the disability is proved under the Listings (described previously), an RFC (Residual Functional Capacity), what the claimant still can do despite his disability, has to be established. SSR 96-8p: Policy Interpretation Ruling: Titles II and XVI https://www.ssa.gov › rulings › SSR96-08-di-01
This Ruling directs the decisionmaker to carefully consider any evidence about symptoms because subjective description may indicate more severe limitations or restrictions that can be shown by medical evidence alone.
In conclusion, evidence of subjective symptoms may be crucial for establishing disability. Claimant’s testimony either during a hearing or as recorded by his/her medical providers should always be obtained.
The Listing of Impairments is an evidentiary compilation of signs and symptoms found at Appendix 1 of the Social Security disability regulations (20 C.F.R. Part 404, Subpart P, Appendix 1). This compilation is published in the “Blue Book”.
The Blue Book, formally titled Disability Evaluation Under Social Security, lists impairments the Social Security Administration (SSA) considers severe enough to prevent someone from working and lays out the medical criteria for determining if that person can receive disability benefits. This information is available on the Internet. https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm
The Social Security Administration (SSA) has its own rules for disability, laid out in a 5-step sequential evaluation process. The first 2 steps evaluate eligibility based on the applicant’s income and insurance status. Steps 3, 4 and 5 focus on medical issues. At step 3, the SSA assesses the applicant to see if they “meet” or “medically equal” one or more of the items in their “Listings”. Every requirement listed must be satisfied to “meet” a Listing. To “equal” a Listing, the severity of impairment must be so similar to a listed impairment that the claimant should be found disabled under that Listing.
If the claimant is found to be disabled at step 3, there is no further inquiry about their ability to work, they must be found disabled by law. However, for the majority of applicants, the disability evaluation continues. The inquiry is whether in spite of his/her disability the applicant is able to work at the substantial gainful level (SGA), as determined by Social Security.
In conclusion, the appropriate Listing should be always searched first before evaluating and arguing the medical records, symptoms and signs and difficulties in daily functioning that prevent gainful work.
Vaccines (July 23, 2021)
Vaccinations are traditionally used to prevent the devastating effects of those infectious diseases that defeat the immune system, the natural protection against invading foreign pathogens. Vaccines mimick the infection in a controlled way, provoke a protective immune response against the natural infection. The first immunization was used against smallpox over 200 years ago. Effective and safe vaccines are used word wide against a wide variety of infections: diphteria, tetatus, pertussis, measles, mumps, rubella, meningitis, hepatitis, rotavirus, influenza and many others. Some of the childhood vaccines are mandated in the US. Covid-19, the coronavirus causing the pandemic is new to humans, several approaches were tried word wide to develop a safe and effective vaccine. All Covid vaccines use part of the virus designed to induce a protective immune response but cannot cause infection. In the US, currently three vaccines are approved, two of them (the Pfizer and Moderna) use a messenger RNA technology as a direct approach to induce antibody production and the Jansen (Johnson & Johnson) vaccine uses as adenovirus vector.
One of the difficult legal question is whether Covid vaccines can be mandated nationwide as many childhood vaccines are. The Supreme Court’s decision Jacobson v. Massachusetts 197 US 11 (1905) has been the precedent used for the state’s right to mandate vaccinations over an individual’s right to refuse. All currently available COVID-19 vaccines are distributed under a Federal Drug Administration’s “emergency use authorization” power. The FDA may authorize unapproved medical products for use on an emergency basis to prevent life-threatening conditions caused by biological threats, provided certain criteria are met and there are no adequate, approved, and available alternatives. (12 U.S.C., § 21 U.S.C. § 360bbb-3(e).) One of these criteria is that individuals must be informed that they may refuse a vaccine made available under an emergency use authorization. (21 U.S.C. § 360bbb-3(e)(1)(A)(ii)(III).)
Certain medical conditions and sincere religious objections provide exceptions from mandatory vaccination. The medical conditions are notable for abnormalities of the immune system and diseases that can cause immunosuppression thus interfering with the immune response and may lead to complications. It is sufficient that a medical doctor indicate their patient is exempt.