Social Security Disability Claims and ALS Lou Gehrig’s Disease

By: Pitt Dickey – Attorney

Preface: Social Security Disability operates under federal law, so this information applies across the United States. That said, each Social Security office and court system has its own procedures. This column focuses on how Social Security District Offices and the Office of Hearings and Appeals evaluate disability claims.
– Pitt Dickey

This column examines the Social Security Administration's (SSA) rules for evaluating claims from people diagnosed with Amyotrophic Lateral Sclerosis (ALS), commonly called Lou Gehrig's Disease.

In August 2003, the SSA adopted new rules to speed up approval of ALS disability claims. Both the SSA and Congress recognized the severity of ALS and changed the law to get benefits to patients faster.

ALS is a progressive nerve disease. The SSA describes it as "a progressive invariably fatal neurological disease that attacks the nerve cells (motor neurons) responsible for controlling voluntary muscles."

It typically appears in people ages 40 to 60. As the disease progresses, all voluntary muscles are affected. People with ALS eventually lose the ability to move their arms and legs, and to swallow, speak, and breathe.

Most people with ALS die from respiratory failure, usually within 3 to 5 years of symptom onset. There is no cure.

The new rules expedite claims based on a medical diagnosis of ALS confirmed by history, neurological findings, and electrophysical and neuroimaging tests to rule out other conditions causing similar symptoms.

Electrophysiological studies (electromyography or nerve conduction studies) can support the diagnosis but may be negative or inconclusive. A negative test does not rule out ALS.

The diagnosis must be supported by medical documentation: a relevant medical history, neurological findings consistent with ALS, and results of any electrophysiological and neuroimaging tests.

The SSA receives relatively few ALS disability applications. In 2002, it received 1,384 ALS claims and approved 96% at the initial review stage. In North Carolina, initial decisions come from the Disability Determination Section in Raleigh.

Most non-ALS claims are typically denied twice—at the initial and reconsideration levels. Only after two denials can an applicant request a hearing before an Administrative Law Judge. The 96% approval rate for ALS claims at the initial stage reflects how seriously the SSA takes these cases.

Congress also changed Medicare rules for ALS patients. For most disability recipients, there is a 24-month waiting period before Medicare coverage begins. In 2000, Congress eliminated this waiting period for ALS patients who receive Disability Insurance Benefits.

For SSI cases, the SSA can begin payments to someone diagnosed with ALS up to 6 months before making a formal determination that the patient meets the disability listing. This is called "presumptive disability"—the SSA has reviewed medical records confirming an ALS diagnosis and starts payments while the formal decision is pending.

The SSA cannot make presumptive payments in Disability Insurance cases. If the SSA later determines the presumptive decision was wrong, the patient does not have to repay the six months of SSI payments.

People diagnosed with ALS should apply at their local Social Security office.

Under the new rules, most ALS cases should not require an attorney.

For more information on ALS, contact the Jim "Catfish" Hunter Chapter of the ALS Association at 1425-113 Rock Quarry Road, Raleigh, NC 27607, or call 800-568-4347.

Pitt Dickey has practiced law in Fayetteville since 1978 and has handled Social Security disability claims for over twenty years. He practices with Smith, Dickey, Smith, Hasty & Dempster, P.A., located at 555 Executive Place. He can be reached at 910-485-8020 or through the firm website at www.smithdickey.com.

Copyright © 2023 Pitt Dickey – Used with permission

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years. He practices with the firm of Smith, Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place and can be reached at 910-485-8020 or at . Or at the firm web site of www.smithdickey.com .

Copyright © 2023 Pitt Dickey – Used with permission