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Strokes – Debilitating But Not Totally Disabling?

Published on July 1st, 2019

Surprisingly, the level of impairment needed to meet the Listing of Impairments for stroke patients is quite challenging, making it difficult for some to get Social Security disability benefits.

As with all medical conditions, disability is based upon the symptoms from a medical condition, and the proof as to how those symptoms impact a person’s ability to sustain work functions. Social Security relies upon the medical charts of treating physicians, therapists and counselors in conducting this evaluation.

With people who have suffered a stroke, an application may be approved if the evidence “meets or equals the Listings of Impairments” or it can be proven that the ongoing symptoms make sustained work activity impossible. The Listings of Impairments are part of Social Security’s regulations and outline medical findings which, if met or equaled, cause a presumption of being totally disabled.

Strokes fall under Section 11.04 “Vascular Insult to the Brain.” This is defined as brain cell death caused by blood flow issues to the brain. However, it is not the fact of a stroke that leads to total disability – it is the symptoms resulting from the occurrence that are the key.

To meet Listing 11.04A, there must be medical evidence of sensory or motor aphasia resulting in ineffective speech or communication for at least 3 consecutive months after the stroke. “Ineffective speech or communication” for this purpose means “…an extreme limitation in your ability to convey your message in simple spoken language….” This is a very high standard.
Section 11.04B requires an “extreme limitation” in the ability stand from a seated position, balance, or use the upper extremities for at least 3 months after the stroke. “Extreme” for this purpose is defined as needing a walker, two crutches, two canes or the inability to perform both fine and gross motor movements with either arm.

The third way to meet the Listing is 11.04C which requires a “marked limitation” in physical functioning (walker, one cane or one crutch) along with a marked limitation in mental functioning such as:
1. Understanding, remembering or applying information;
2. Interacting with others;
3. Concentrating, persisting, or maintaining pace; or
4. Adapting or managing oneself.

“Marked” for this section means a serious limitation that has lasted at least 3 consecutive months after the insult.
Many stroke patients will not be able to prove this level of impairment, but can still not work a full time job. The alternative approach is to prove that the ongoing chronic symptoms from the stroke make any full time work impossible. This analysis considers the claimant’s residual functional capacity, age, education and work skills. This is the theory where fatigue, weakness, and impaired concentration can be argued.

However, for any symptoms to be considered under this theory they must be consistently documented in the charts of the treating neurologist, mental health counselors and physical therapists. Those charts are the evidence and if the symptoms are not consistently documented during each visit, over a longitudinal period of time, then a Social Security Judge may not consider them to be serious problems.

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