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Lyme Disease and Social Security Disability Benefits

Lyme disease is a tick borne disease first identified in the United States in 1978. This condition causes a multitude of disorders which seem to be transmitted via bacteria, although Borrelia Burgdorferi Sensu Stricto is the most common bacteria identified in cases found in the United States.

Symptoms of Lyme Disease

Conditions can come and go and can include depression, headaches, fever, fatigue and a circular rash. Individuals who are aware they are suffering from Lyme disease can generally eliminate the infection by taking the appropriate antibiotics, although treatment needs to be done early.

Individuals who fail to get proper treatment may suffer from more extreme symptoms including heart, joint and central nervous system issues, which can be severely debilitating.

Awarding Disability benefits for Lyme Disease

The Social Security Administration maintains a handbook which outlines conditions, disabilities and diseases they believe are disabling. This handbook is called the “Disability Evaluation under Social Security,” but it is more commonly referred to as the “Blue Book.”

The SSA Blue Book lists all of the major body systems and the criteria that a claimant must meet to be automatically considered disabled from a specific listing or impairment. The listed disabilities or diseases are considered so severe by the Social Security Administration that they would automatically keep claimants from performing substantial work. All of the conditions listed are expected to last for a period of at least 12 months.

There is no specific Social Security listing for Lyme disease, although a disability claim for Lyme disease could be evaluated under Listing 14.09D Inflammatory Arthritis. This is, however, not a precise listing for Lyme disease.

Most disability claimants who suffer from severe Lyme disease symptoms will have to win their claim through a medical vocational allowance.

Medical Vocational Allowance Process for Lyme Disease

What if the claimant’s Lyme disease symptoms do not match the Blue Book symptoms? If a claimant’s condition does not meet a listing, they will have to win disability benefits through what the SSA terms a medical vocational allowance. Unfortunately, winning disability benefits under a medical vocational allowance is a bit more complicated and time consuming than meeting a listing.

To start the evaluation process the disability determination office reviewed the claimant’s medical records and uses a form called a residual functional capacity form to document the claimant’s physical and mental limitations. The RFC form is used to determine if the claimant’s residual functional capacity is so limited that they are unable to work their present job, past job or retrain for new work based on their age, education, and job skills. This disability approval process is called a medical vocational allowance.

Proving Disability for Lyme Disease

How does a claimant win SSDI or SSI disability through a medical vocational allowance? the claimant needs strong medical evidence to prove they cannot work their current job, any relevant job they have had in the past and they cannot be retrained for new work (given their age, work history, transferable job skills, residual capacity to work or education).

Functional mental and physical limitations should be documented in the claimant’s medical records. A claimant can also have their doctor complete a RFC or Residual Capacity Form. This form differs somewhat from the RFC form used by the SSA and can be downloaded from various sites on the internet. The RFC form identifies the following limitations or abilities of the claimant:

• How much a claimant can lift and how often (light RFC, Medium RFC, or heavy RFC)
• How long a claimant can sit or stand
• If a claimant can crouch, stoop, grasp objects
• If a claimant can reach forward or overhead
• Whether claimant can maintain persistence and pace
• Whether a claimant can get along with co-workers
• Whether a claimant can maintain a normal work schedule
• Whether a claimant can follow directions

Winning benefits for Lyme disease can be tough. Good medical documentation including doctor’s notes, laboratory tests, and an RFC form can help eliminate subjective analysis of the claimant’s Lyme disease claim and improve their chances for winning either SSI or SSDI.