Interstitial Cystitis in Disability Cases - Melvin A. Cook
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Interstitial Cystitis in Disability Cases

by Melvin Cook

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Social Security Ruling 15-1p

In 2015 the Social Security Administration promulgated just one new SSR (Social Security ruling). This relates to the disease of Interstitial Cystitis (IC).

This disease is defined as a complex genitourinary tract disorder characterized by recurring pain or discomfort in the bladder or pelvic region.

In accordance with medical guidelines, a physician should only make a diagnosis of Interstitial Cystitis after a medical history review and physical examination.

The physician should also conduct laboratory testing to rule out other diseases with similar symptoms.

Such procedures may include a cystoscopy (a procedure that allows your doctor to examine the lining of your bladder and the tube that carries urine out of your body ((the urethra)), biopsy of the bladder wall and urethra, distension of bladder under anesthesia, and, in men, culture of prostate secretions.

Treatment of IC mostly revolves around symptom control.

The severity and duration of IC symptoms may vary among individuals and over time.

Symptoms of IC may include pelvic pain and discomfort, frequent urination, sleep dysfunction, and chronic fatigue or tiredness, among others.

Medical signs that can support a diagnosis of IC include: fibrosis (bladder wall stiffening); diffuse glomerulations (pinpoint bleeding caused by recurrent irritations) on the bladder wall, and Hunner’s ulcers (patches of broken skin) on the bladder wall.

Laboratory findings can also support a diagnosis of IC, including: repeated sterile urine cultures while IC symptoms continue; positive potassium sensitivity testing (Parson’s test); and, antiproliferative factor (APF) accumulation in the urine.

As medicine advances, there may be other types of testing that can prove the existence of IC. Social Security may rely on such other types of testing if they are consistent with medically accepted clinical practice and other evidence in the case record.

In addition, persons with IC may exhibit mental health symptoms associated with their IC, such as anxiety or depression. When these are documented with mental status examinations or psychological testing, they may constitute medical signs or laboratory findings to help establish the existence of IC.

In order to document IC, Social Security relies on the following types of evidence: longitudinal medical history from acceptable medical sources (medical doctors or osteopaths, or licensed psychologists); medical evidence from other sources who are not considered acceptable medical sources, such as nurse practitioners, physician’s assistants, or physical therapists; evidence from non-medical sources such as family, friends, neighbors, clergy, past employers, vocational rehabilitation counselors and the like. Social Security will make every reasonable effort to develop the medical record by obtaining records for the twelve-month period preceding a disability application.

In evaluating a person’s statements about his or her IC symptoms, Social Security will first determine if medical signs and laboratory findings establish the existence of an impairment which can reasonably be expected to produce the symptoms complained of. Secondly, they will determine the intensity and persistence of the symptoms and the degree to which they limit a person’s functioning.

In determining whether a person’s IC is totally disabling, Social Security follows a five-step sequential analysis. First, the determine if a person has engaged in substantial gainful activity during the period of alleged disability. If the answer is yes, the person is found “not disabled.”

Second, Social Security determines if there is a severe medically determinable impairment (MDI) of IC. “Severe” means more than minimally limiting a person’s ability to do basic work activities.

If there is a severe MDI of IC, Social Security then determines whether or not it medical equals a listed impairment. IC is not a listed impairment. Therefore, Social Security must determine whether or not the person’s IC, either alone or in combination with other impairments such as mental illness, is medically equivalent to one of its listed impairments. If so, then the person is found “disabled.” If not, the analysis proceeds to step four.

At step four, Social Security determines the person’s residual functional capacity, or the maximum amount of work-like activities the person can do despite his or her impairment. Then they determine whether or not the person’s limitations prevent them from returning to their prior work. If not, the inquiry proceeds to step five.

At step five, Social Security determines whether the person, despite his or her limitations, can adjust to other work that exists in significant numbers in the national economy.

It is often helpful to consult an experience attorney in navigating the sometimes complex rules and regulations used by the Social Security administration.

This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.

Contact a Salt Lake City Attorney Committed to Protecting Your Rights

When it comes the family law and social security disability, each client and case is different. It is also important to select an attorney with the experience, skills and professionalism required to address your legal issues. To learn more, contact the Salt Lake City law offices of Melvin A. Cook and schedule an initial consultation to discuss your case.

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