Proving Disability For A Rare Medical Condition Like Cervical Dystonia

Cervical dystonia — also called spasmodic torticollis — is a rare medical condition where the neck muscles contract involuntarily, causing the head to twist or turn to one side, or to uncontrollably tilt forward or backward. The condition is quite painful.  Since the muscle contractions are involuntary, the condition is embarrassing and socially awkward. In general, the cause of dystonia is unknown. The condition is also relatively rare, afflicting only 30 persons out of every 100,000.

Even though it may be a rare medical condition of unknown causation, if the dystonia is severe enough and if the pain is severe enough, the condition might make a person eligible for Social Security Disability Insurance (“SSDI”) benefits if the dystonia prevents you from engaging in “gainful employment.” Being unable to work is the key criteria for SSDI eligibility. If you are unable to work because of severe dystonia, you will need the skilled and experienced New Orleans SSDI lawyers here at Ascend Disability Lawyers, LLC.

New Orleans SSDI Attorneys — Types of Dystonia

There are several types of dystonia. The most common type is called torticollis where “… the chin and nose rotate to one side and may stay in this position (tonic) or may turn to the side only intermittently and then released (clonic). A tremor of the head may also be seen.” The second most common type of dystonia is laterocollis where the “… head is pulled to one side and down to the shoulder [and] sometimes one shoulder lifts up.” The other two common types are anterocollis where the chin is pulled down towards the chest — which can cause problems with swallowing, speaking and vision — and retrocollis where the head is pulled back towards the spine. In general, with any form of dystonia, the person afflicted has “… difficulty maintaining the head in a central position and has even more difficulty turning the head to the other side.”

As one might imagine, dystonia can make working difficult. And, as noted, severe dystonia can be very painful.

New Orleans SSDI Attorneys: A Rare Medical Condition Not Disqualifying

Just because a medical condition is rare does not mean that SSDI benefits are unavailable for the condition. As required by federal regulations, in evaluating whether disability benefits are awardable, the Social Security Administration (“SSA”) must evaluate evidence with respect to five criteria (see 20 C.F.R. § 404.1520):

  1. Is the individual performing substantial gainful activity?
  2. Does he/she have a severe impairment?
  3. Does he/she have a severe impairment that meets or equals an impairment listed on the list of impairments?
  4. Can he/she perform his/her past relevant work?
  5. Based on age, education, and work experience, can he/she perform other work of the sort found in the national economy?

A rare medical condition is sometimes are not listed on the SSA List of Impairments. But, medical evidence can be provided that shows a rare medical condition “meets or equals” a listed impairment. Thus, criteria #3 is not problematic for those suffering from dystonia.

Legally speaking, the most difficult questions for those afflicted with dystonia are criteria #4 and #5. In one case, for example, the SSA held that the claimant, who suffered from dystonia and other conditions, satisfied the first four criteria, but not the last. Further, the SSA concluded that the claimant would not be able to perform work requiring lifting and carrying in excess of 10 pounds repetitively or that required the use of the upper extremities for strenuous pushing or pulling repetitively. This determination made the claimant unable to continue her then-current occupation. However, the SSA held that the dystonia did not prevent the applicant from performing sedentary work including various office-type jobs. As such, the SSA held that the claimant was not “disabled.” See Foote v. Chater, 67 F. 3d 1553 (Court of Appeals 11th Circuit 1995).

New Orleans SSDI Attorneys — Pain Is Often the Disabling Aspect of Dystonia

Moderate to mild dystonia might, in fact, allow an individual to engage in gainful employment as a sedentary office worker. However, as noted, severe pain is often associated with the condition. And that severe pain can be the disabling aspect of the condition.

In general, for the pain to be disabling, an underlying medical condition must be proven from which it can be further shown — by objective medical evidence — that the condition has an associated level of severe pain. In addition, it must be proven that the claimant is actually suffering from that level of severe pain.

In terms of evidence, the SSA administrative law judges (“ALJ”) will evaluate the following:

  • Testimony from the claimant about his/her subjective feelings of pain
  • Medical records
  • Reports and testimony from doctors
  • Reports and testimony from vocational experts
  • Any other relevant material

The ALJ will ultimately make a credibility finding. A good example can be found in the case of Rivers v. Astrue, 901 F. Supp. 2d 1317 (US Dist. Court, SD Alabama 2012). In that case, the claimant was a dump truck driver prior to applying for disability. Among various conditions, she claimed that she had severe pain in her back and neck from cervical dystonia and other limitations that prevented her from working. However, the ALJ, in that case, held her claims to not be credible. The ALJ agreed that she had impairments that limited her work, but not to the level claimed. Among the facts considered:

  • The medical evidence showed only mild degenerative desiccation of the relevant cervical discs
  • Claimant took pain medications that she testified allowed her to remain functional without side effects
  • Both doctors and vocational experts indicated claimant could engage in light duty work and sedentary work
  • Claimant admitted that she worked part-time (two to four hours a day) cleaning hotel rooms
  • The claimant was able to take care of her personal needs, shop for groceries, carry a gallon of milk, grip a cup of coffee, turn a doorknob, prepare a simple meal, bathe and dress, and perform some household chores like washing dishes, washing clothes, making her bed, etc.

Taken together, the ALJ found that the evidence showed that the claimant was not TOTALLY unable to work despite the pain associated with her dystonia. As such, the ALJ held her to be not disabled. On appeal, the US District Court affirmed.

New Orleans SSDI Attorneys: Contact Ascend Disability Lawyers, LLC Today

As can be seen, applying for and obtaining SSDI benefits for a rare medical condition can be confusing and intimidating. To navigate the legal complexities, you need the help and experience of the New Orleans SSDI lawyers at Ascend Disability Lawyers, LLC. We can help if you think you are eligible for SSDI benefits. We have years of experience helping New Orleans and Louisiana citizens file for and keep their SSDI benefits. Contact us via email or by our law offices directly.


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