Myelodysplastic Syndromes and Disability Benefits

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Myelodysplastic Syndromes and Disability Benefits: What You Need to Know

As the name suggests, myelodysplastic syndromes (MDS) are not a single disease. They are a group of illnesses that prevent your bone marrow from producing a sufficient number of healthy blood cells. Instead of developing normally, your blood cells die in the marrow or soon after being released into the bloodstream.

Over time, the defective blood cells created by myelodysplastic syndromes may cause symptoms such as fatigue, anemia, shortness of breath, tendency to bruise and bleed easily, frequent infections and petechiae (red spots beneath the skin).

Treatment includes blood cell transfusions, bone marrow stem cell transplants, and medications intended to increase the number of healthy blood cells in your system.

MDS can grow more severe over time, and even develop into an aggressive leukemia known as acute myelogenous leukemia (AML). A confirmed diagnosis also makes you eligible for Social Security disability benefits, as MDS is recognized as a disabling condition.

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Medically Qualifying with Myelodysplastic Syndromes

Myelodysplastic syndromes (MDS) is listed in the Blue Book, which is the SSA catalog of disabling conditions. It is specifically referenced in Listing 7:10- Disorders of Bone Marrow Failure. To medically qualify, the following conditions must be applicable in your case.

• Bone marrow failure complications that require a minimum of three hospitalizations occurring within a 12-month period and at least 30 days apart. Each incident must last for at least 48 hours (may include time spent in the emergency ward before hospitalization)

  OR

• Myelodysplastic syndromes requiring lifelong red blood cell transfusions at least once every six weeks to keep you alive If you receive a bone marrow stem cell transplant, the SSA will consider you disabled for at least 12 consecutive months from the date the transplant took place. Your application for disability benefits must be accompanied by the following information from your doctor:
• The methods of diagnosis: must be peripheral blood smears accompanied by bone marrow aspiration OR bone marrow biopsy
• The treatments you have received (medications, bone marrow stem cell transplants, red blood cell transfusions)
• Records of hospitalization due to MDS complications

Your doctor will also complete a residual functional capacity (RFC) form that documents the ways that MDS has limited your ability to function and work.

If the SSA determines that your MDS symptoms do not qualify you for a listing, you may still be awarded disability benefits under a medical vocational allowance system.

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Technical Qualifications for Social Security Disability Benefits

The Social Security Administration (SSA) oversees two disability programs. Social Security Disability Insurance (SSDI) is a disability program that is based on credits. You earn credit based on your work history. To be fully insured and eligible to receive SSDI, you must have earned 40 credits and 20 of those credits must have been earned during the last 10 years and ending during the year that you become disabled. However, you may be able to qualify with fewer credits if you are younger.

As of 2020, you earn one credit for every $1,410 of self-employment income or wages that you earn. After you have earned $5,640 that year, you have earned your maximum four credits for the year. The number of credits that you need to qualify for SSDI benefits depends on the age at which you become disabled. Children do not qualify for SSDI because they have no work history. The older that you are, the more credits you will need to have earned to qualify for SSDI.

On the other hand, SSI is a needs-based disability program. To qualify for SSI, you must meet specific financial criteria involving your income and resources. The income limit for SSI is based on the federal benefit rate (FBR). The FBR represents both the maximum federal SSI monthly payment as well as the SSI income limit.

As of 2019, the FBR is $771 monthly for an individual and $1,157 per month for couples. Children are considered to have access to a portion of their parents’ income and resources, so a process called deeming is used to determine eligibility.

To qualify for SSDI or SSI, your condition must meet very specific criteria. The SSA requires supporting documentation and hard medical evidence that confirms that you meet the medical requirements to be considered disabled per SSA guidelines. You must meet the medical criteria in addition to the SSDI credits or SSI financial requirements.

The SSA uses a medical guide, which is called the Blue Book, to determine if you are disabled per the SSA criteria. If you cannot meet the criteria of a listing, a residual functional capacity (RFC) form completed by your physician could help you with your claim. The RFC will detail all restrictions and limitations, detailing what you can and cannot do. Using these details the disability examiner can determine what kind of work you can do, if you can work at all.

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What To Do If Your Claim Is Denied

Most disability claims are denied during the initial review. When your claim is denied, you will be sent written notification from the disability examiner. Disability Determination Services (DDS) will detail in the letter why your claim was denied and the deadline for filing an appeal, which is also called a request for reconsideration. The chances of a claim being approved during the request for reconsideration are very small, but with the supporting details it can be approved.

By going by the details of the letter, you can determine what the disability examiner needs to reconsider your claim. You can gather additional information or have additional medical tests done so you can show the severity of your condition, and it may be the pivotal details that are needed to get your claim approved and be awarded disability benefits.

You should make sure your claim is filed by the deadline. If you don’t meet the deadline, your appeal will be denied, and you will have to file a new claim and start the process all over again. A disability lawyer will help you get your claim on the right track and gather the supporting documentation that your claim needs to succeed.

A disability attorney will be able to determine the best way to proceed with your claim and ensure that all deadlines are met. If your claim is denied again during the reconsideration you will receive a denial letter once again. At that point, you will request a hearing before an administrative law judge.

Your chances of having your claim approved increase greatly when it gets to the hearing level. An attorney will help you get prepared for the hearing. A lawyer will know what kinds of questions that you may be asked and will be able to help you get prepared for questioning by the judge.

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How An Attorney Can Help Your Claim

A claimant who is represented by an attorney is much more likely to have a claim approved. An attorney is familiar with the claims process and how the SSA makes its decisions. An attorney will also be able to gather the supporting evidence and documentation that your claim needs to succeed. An attorney will make sure all deadlines are met and that all your paperwork is filed properly.

A lawyer will understand the technical wording in the medical guide that the SSA uses to determine if a claimant qualifies for disability. Disability claims can be complicated, and a lawyer will be able to determine what information your case needs to proceed and get you approved for benefits. You will also need to prepare for questioning and now how to respond to the information requests.

When you retain an attorney to represent you through the disability claims process, you will not have to pay anything out of pocket or upfront. Instead, the attorney will take your case on the contingency basis, which means that he or she will not be paid until you win your claim and you are approved for disability benefits. At that time, your lawyer will receive 25 percent of your back pay not to exceed $6,000.

If you are applying for disability benefits, or if your claim has already been denied and you need to appeal the decision, you should consult with a Social Security Disability lawyer. Complete the Free Case Evaluation Form on this page to share the details with an attorney who represents disabled workers in you area.

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Getting Help with Your Myelodysplastic Syndromes Claim

Don’t be discouraged if your application for disability benefits is rejected the first time you apply, as this is practically routine even for conditions that meet a Blue Book listing. Instead, be prepared to request reconsideration and even file an appeal.

A Social Security disability attorney will help increase your chances of a successful application by protecting you from errors that hurt your chances of acceptance, ensuring that your application is filed early, and presenting a strong case for you. When you have a professional who is knowledgeable about the Social Security disability system and knows what it takes to win, peace of mind will follow.

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