The wild misconceptions surrounding Social Security Disability Insurance benefits never cease to amaze our Boston disability benefits lawyers.
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There are these misguided – yet common – notions that because there are more recipients, there must be fraud, or that because there are more applicants, it must somehow be quite easy to land this “free money.”

The truth could not be further from that. Our population is growing and aging – two factors that contribute significantly to the ballooning of disability rolls.

The fact is, people who are well-qualified often must wait months if not a year or more just to have their case reviewed. Even then, the vast majority of applicants are not approved. Those who continue on to the appeals process have somewhat better odds, but it is by no means a given.

In light of all of this, we can certainly see the need for reform. At a hearing before the House Ways and Means Social Security subcommittee, a retired administrative law judge testified that claimants should be made to come to hearings armed with more information regarding their disability.

As it stands, there is already an inordinate amount of information required for claimants at hearings.

The subcommittee has been hosting a series of hearings on the molasses-slow claim determination process. Managers for SSDI said they have attempted to streamline the process, particularly by setting special parameters for those who have severe and clear-cut disabilities (known as Compassionate Allowances). However, others moving through the process can take years.

At another of those subcommittee hearings, a policy specialist with the Center on Budget and Policy Priorities, indicated that Congress should boost financial support for the administrators of the SSDI program, as right now, the resources are scant for what they are expected to accomplish. As it now stands, congress treats the budget of the Social Security Administration as a form of discretionary spending. This is despite research showing that spending money at the front end can help to significantly reduce abuse and fraud and help to ensure that those who need the benefits most aren’t overlooked.

Another additional proposal is to amp up the requirements of those representing disability claimants. A decade ago, only about a tenth of claimants were represented by a third party, such as an SSDI attorney. Now, it’s about 80 percent.

With lax criteria for who can be a representative, it’s unfortunate that many claimants receive sub-par representation.

The original rules as they stand were written to accommodate claimants who were going forward on their own. But the administrative judge says more stringent requirements should be made of certain professionals, particularly attorneys, with regard to ensuring all the evidence is appropriately submitted and in a timely manner.

This is not a requirement that would concern us in the least, as these are the standards to which we already adhere.

You can ensure that your needs and interests will be held in the highest regard when you hire our experienced, caring SSDI lawyers to represent you.
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March is Traumatic Brain Injury Awareness Month, and it’s worth noting that Boston University School of Medicine researchers have been at the forefront of brain injury studies.
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Our Boston Social Security Disability Insurance attorneys have handled cases for countless clients on the personal injury side of our practice. While it’s true that the brain is a miraculous organ with this amazing propensity for resilience, it’s also incredibly vulnerable to damage.

Often when we’re talking about a traumatic brain injury, there is the assumption of a war injury or a football players who take regular hits to the head.

But in fact, there are many different ways that people incur serious and permanent brain injuries. One of the most common of those is motor vehicle accidents, where many victims often experience sudden and powerful blows to the head. Construction workers too are at high risk of head injuries, as they tend to be at a much higher risk for falls at elevated levels. Even children may risk permanent brain damage from an injury sustained in a playground fall or during recreational sports.

The Centers for Disease Control and Prevention, which are working to raise awareness about TBIs this month, indicate the following:

  • Males have the highest rate of traumatic brain injury;
  • Young children and elderly adults are at the highest risk for a fall-related traumatic brain injury;
  • Adolescents and young adults between the ages of 15 and 24 have the highest rate of motor vehicle crash-related brain injuries;
  • Adults older than 75 are more likely to be hospitalized for a brain injury and are more likely to immediately die from it than any other age group.

Traumatic brain injuries are a specific listing of disability impairment noted as “cerebral trauma.” This heading goes onto list conditions such as epilepsy, central nervous system vascular accident or organic mental disorders – all of which are subsets of TBI.

Epilepsy is a seizure disorder that can stem from a brain injury. In order to qualify, you would have to experience a certain type and frequency.

Central nervous system vascular accident refers to a series of conditions you might have following a stroke or other brain injury. This would include difficulty with language and communication and/or persistent and significant disruption regarding the use of your arms, legs, fingers, hands or in walking.

An organic mental disorder would be something that has resulted in significant emotional or cognitive changes stemming from the brain damage you or your loved one suffered.

Even if you don’t meet any of these specific criteria, it’s very possible our SSDI lawyers can make a strong case for your entitlement to benefits on the basis of your inability to work. That is, we would argue that your residual functional capacity has been severely limited.

If you have suffered a traumatic brain injury, it’s highly likely you might not be able to return to your old job. But that’s not enough to prove disability. We have to take a step further by proving your disabilities are so severe that you are not likely to succeed in virtually any job for which you would otherwise be qualified.
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Addiction is a powerful and often fatal disease that affects more than 20 million people in this country each year.
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There is no question it is a clinical medical condition and yet, our Boston Social Security Disability Lawyers know that obtaining benefits for it can be quite difficult.

The administration has ruled that while beneficiaries can’t be denied solely on the basis of their addiction, they can be denied if the foundation of the claim is predicated on the addiction.

Potential effects of addiction include: anxiety, depression, paranoia, major organ damage (heart, kidney, liver, brain), seizures or strokes, respiratory problems. Any of these consequences may involve irreversible damage that would qualify a person for disability payments. Some of these conditions may be permanent, regardless of whether you are able to quit. And that’s ultimately what the administration is after.

Section 12.09 of the administration’s disability listing holds that the question has less to do with whether the disabling condition was caused by the condition and more to do with whether the condition would improve if the substance abuse was halted.

While it seems like a fairly straightforward explanation, in practice, administrative law judges and reviewers were too often finding it difficult to separate the addiction from the condition, as both were often innately intertwined.

That’s why effective later this month, the administration has announced the passage of Social Security Ruling 13-2p, replacing SSR 82-60 with regard to addiction evaluation.

Rather than expecting evaluators to arbitrarily determine whether a person’s addiction is material to the condition, the agency has spelled out a list of flow-chart guideline questions for reviewers seeking to make an accurate determination.

So the questioning starts with whether the individual in fact has a drug or alcohol addiction. If the answer is no, then the issue is moot.

If the person is deemed to have an addiction, the reviewer must decide whether, considering the entirety of the situation, the person would be considered disabled. If not, the claim would be denied.

If, however, the answer is yes, the question then becomes whether the addiction in and of itself is the only addiction. If it is, that’s the end of the road, and the claim will be denied.

If it’s not, the next question is whether the other impairment is disabling just by itself, even while the individual continues to abuse alcohol or drugs. If the answer is no, then that means the addiction is material to the claim and the claim will be denied.

However, if the answer is yes, the follow-up question is whether the addiction itself has caused or somehow affected this other disabling impairment. If not, the claim will be granted. Even if the answer is yes, the claim can still be approved if the impairment is irreversible regardless of whether the substance abuse stopped.

If the answer is yes, but it’s not clear to what extent, the final question is whether the condition COULD improve to the point of a non-disability if the person stopped abusing substances. If so, the claim is denied. If not, it will be granted.

The bottom line is that to obtain benefits on the basis of an addiction-related condition requires you to reach a high threshold, one that you are unlikely to prove without the assistance of a skilled SSDI attorney.
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Researchers in Boston are part of an international consortium that has recently discovered an underlying biological link between a handful of psychiatric illnesses, including schizophrenia, autism and depression.
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This breakthrough research gets us one step closer to determining which genetic variants cause these conditions, and how we may be able to better treat them.

In the meantime, our Boston Social Security Disability Insurance attorneys want to make sure that sufferers of schizophrenia – and these other conditions as well – know that they may be eligible to receive federal benefits. For many, this could very well be a way out of poverty, a ticket out of a potential cycle of homelessness, crime and institutions.

Of course, your eligibility may depend on how consistent you are in taking your doctor-prescribed medication. There is no cure for schizophrenia, but medical treatment programs have proven effective in quelling some of the most severe symptoms.

However, the disease itself may be a limitation to an individual taking their medication with any regularity. And as this new research shows, we have a long way to go in terms of eliminating the barriers that these individuals must endure in an effort to live happy, stable lives. When medication is not fully effective – or when that medication poses debilitating side effects on its own – disability benefits are an important consideration.

In some cases, schizophrenia may develop suddenly and without much warning. In other cases, there is a gradual decline in function that foreshadows the first major episode.

Early on, sufferers might seem somewhat eccentric, reclusive or unmotivated. They may appear to lack emotions or be increasingly forgetful or say odd things or express a general indifference to life. They may find themselves suffering from insomnia, depression or inappropriate expressions of both joy and grief.

Part of the problem for many schizophrenia sufferers is that when they first begin to experience these symptoms, they try to mask it with substance abuse, which not only compound the issue but make it tougher to get a true diagnosis and treatment. Sometimes, those with schizophrenia may be wrongly diagnosed with other disorders. Often, it takes six months or more to even get an accurate diagnosis.

This ends up not only straining relationships, as close loved ones struggle to understand or help, but it is truly an impairment on every day functioning. Persons with schizophrenia may find they have trouble completing even basic tasks such as eating, bathing or running simple errands. They are also at a heightened risk of suicide.

Once the disease becomes more developed, it is usually manifested through delusions, hallucinations, disorganized speech or behavior or a lack of interest or enthusiasm about the world around them.

The Social Security Administration, under Section 12.03 Schizophrenic, paranoid or other psychotic disorders, holds that in order to qualify for benefits, these episodes must be severe, debilitating and frequent.

If an individual has been coping with this disease on their own for at least two years or if they have shown an inability throughout the last year to function outside of some highly-supported living arrangement (either an institution or with watchful parents, etc.) then he or she would qualify.
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Up until about two years ago, a person who experienced repeated episodes of hypoglycemia (low blood sugar, usually due to diabetes) might have been eligible for disability benefits on that basis alone. bloodglucosemeasure.jpg

However, our Boston Social Security Disability Lawyers know that as of July 2011, all endocrine disorders – including hypoglycemia – were removed from the Social Security Administration’s formal listing of impairments. The idea behind this thinking was that there have been great strides in medical advancements for those battling endocrine disorders, and that disability wasn’t necessarily a foregone conclusion anymore.

While existing patients who were receiving disability benefits under endocrine listings were allowed to hang onto those benefits, they have still been subject to the periodic reviews conducted by the administration and, absent those listings, they may have a harder time hanging onto them.

Plus, new patients with the disorder are going to have a harder time securing benefits for ailments such as hypoglycemia than those in years past.

In both scenarios, we highly recommend hiring an experienced disability lawyer. Even if your condition no longer meets a specific listing, side effects from endocrine disorders can be severe and therefore produce significant functional limitations with regard to your ability to work.

Let’s look specifically at hypoglycemia. This is a condition in which your body’s sugar/glucose is either used up too quickly or it’s released into your system too slowly or you have too much insulin being released into your system. Insulin is the hormone that regulates your blood sugar.

Most commonly, you’re going to see hypoglycemia in people who have developed diabetes. Those who don’t have diabetes may have the conditions as a result of heavy alcohol consumption, pancreatic cancer, thyroid dysfunctions, a heart, kidney or liver failure, a body-wide infection or as a side effect to weigh loss surgery.

When your sugar gets too low, you could experience a range of symptoms, including double vision, pounding heartbeat, anxiety or nervousness, headaches, hunger, shakes, sweats, tingling, weakness, insomnia or difficulty focusing. If your sugar gets below a certain point, you might faint, suffer a seizure or even go into a coma. In some cases, it may cause permanent brain damage.

It’s true that most people with this condition have been given the tools to monitor and control it. However, if you are following your doctor’s prescribed regiment and are still suffering repeated bouts of severe low blood sugar, you might be eligible for disability under other sections of the SSA’s blue book guide.

For example, someone who suffers repeated seizures due to hypoglycemia would now be evaluated under Section 11.00 Neurological impairments. In these cases, the degree and frequency will be major factors in the disability determination. If controlling those seizures requires a large level of medication that carries its own debilitating side effects, those should be noted as well.

In cases where an individual has suffered an altered mental status as a result of one or repeated hypoglycemic episodes, his impairment would be evaluated under Section 12.00 Mental Disorders.

If you have taken measures to control your hypoglycemia and have found it has not improved and further is impeding your ability to work, we can help.
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Individuals and families of those who have been diagnosed with Down syndrome may be somewhat familiar with federal benefits through the Supplemental Security Income program, which is often extended to parents and caregivers of disabled persons under age 18.

However, once that child becomes an adult, our Boston Social Security Disability Insurance attorneys understand he or she may need to apply separately for SSDI benefits. They may still qualify for SSI benefits as well, but the SSDI benefits will allow them to further hold some measure of autonomy.

Down syndrome is characterized by the presence of an extra copy of a certain chromosome. It’s one of the most common birth defects, and it causes impediments in the way both the body and brain develop.

There are two basic types of Down syndrome: Mosaic and Non-Mosaic. In non-Mosaic individuals, that extra chromosome copy appears in every single cell in the body. In Mosaic patients, that extra chromosome may be noted only in a portion of the body’s cells.

Either way, the individual may face significant impairments to work ability, though a person with a diagnosis of non-Mosaic Down syndrome – which are 98 percent of Down syndrome patients – will receive a seemingly automatic approval of SSDI benefits. However, those with Mosaic Down syndrome may have a somewhat more uphill battle.

In children with this condition, mental and social development is often impaired. Common development problems include impulsive behavior, poor judgment, slower learning and short attention spans. They may also experience poor muscle and skeletal development that may make it difficult to find some form of sustainable employment.

Even for someone with Mosaic down syndrome, all of these would factor into the increased probability of SSDI benefits.

Other problems that those with Down Syndrome in general may expect to experience are:

  • Birth defects, particularly relating to the heart;
  • Severe vision problems;
  • Gastrointestinal dysfunction;
  • Hearing problems, often prompted by regular ear infections;
  • Dementia;
  • Sleep apnea;
  • Chronic constipation;
  • Hip dislocation or impairment;
  • Teeth that appear later than usual and in locations that could cause problems with proper chewing;
  • Hypothyroidism.

Down syndrome may affect a person with varying degrees, from moderate to severe.

A person with non-Mosaic Down Syndrome is not going to have to prove the degree to which they have been affected, but someone with Mosaic Down syndrome applying for SSDI benefits will need some help building a case for it.

That will include any and all information about cognitive performance, physical impairments such as hearing or vision loss, thyroid issues, muscle weaknesses and breathing or heart disorders. Any one of these side effects of the condition may be enough to singularly qualify a Mosaic Down syndrome patient for benefits, so that combined with the original diagnosis could be sufficient to win your claim. Obviously, though, the more information you can cull together, the better.

Having an experienced SSDI attorney by your side to help you do it only serves to improve your chances.
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If your spouse was able to secure Social Security Disability Insurance benefits, you know he was able to overcome perhaps one of the greatest obstacles of all time, as the process is rigorous, time-consuming and difficult. selfportrait2.jpg

But our Boston SSDI attorneys understand that it doesn’t always end there. Many widows and widowers of deceased disability benefits recipients are more frequently having to cope with the question of whether they can continue to receive those payments now that their spouse is gone.

The answer is: It depends.

You would do well to contact an experienced SSDI attorney to help you handle your request for continued benefits, as it will depend on a number of factors. Plus, we understand that in the wake of the loss of your spouse, this is really not something you want to have to worry about. Still, it’s an important consideration because it affects your ability to be able to pay off your bills and, in some cases, support your children.

When an SSDI recipient passes away, his benefits may go to his dependents. This includes his spouse, children and sometimes even his elderly parents.

The criteria for being able to collect SSDI benefits as a surviving spouse are:

  • You are responsible for the care of the SSDI recipients’ dependent child under 16. This would make you eligible for 75 percent of your spouse’s benefits.
  • You are at least 50 years-old and you are disabled and that disability began either before your spouse died or within seven years of your spouse’s death. In this case you will receive about 70 percent of your departed spouse’s benefits.
  • You are a minimum of 60, but you haven’t yet reached retirement age. In these cases, you may be eligible for between 70 and 99 percent of your spouse’s benefits.
  • You are of full retirement age. In this case, you may expect to receive100 percent of your spouse’s SSDI benefits.

However, nothing with government is ever straightforward. As such, there are important exceptions that could impact your eligibility.

To begin, if you have remarried before you turned 60 years-old, you won’t be able to receive your deceased spouse’s benefits. However, if you get married again after age 60 (or after age 50, yet you yourself are disabled) your benefits won’t be affected.

Secondly, if you are entitled to your own retirement benefits, you will be allowed to choose between that and your former spouse’s SSDI benefits – whichever one happens to be more.

Also, widow benefits for those under 50 who had been receiving the benefits due to care of a minor child will usually find those benefits cut off by the time the child turns 16. The exception would be if the child is disabled as well.

You’ll want to consider as well that if you are working, your SSDI survivor benefits are probably going to be reduced, but it will largely depend on how old you are and how much you earn.

And finally, in order to be eligible to receive these benefits, the government usually requires that your marriage have lasted for a minimum of nine months. There have however been exceptions made in cases where a person died a violent or unexpected death, such as in a car accident.
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There has recently been some great news on the breast cancer research front, where the Massachussetts-based firm ImmunoGen Inc. was given the FDA green light for its cancer treatment using a drug called Herceptin.behindtheshutter.jpg

Our Boston Social Security Disability Lawyers understand that this experimental drug, also known as T-DM1, is going to marketed as Kadcyla to patients with HER2-positive mestatic breast cancer who have already gotten prior treatment with a combination of chemotherapy and Herceptin.

It’s pricy, though – approximately $9,800 a month for now. Still, many hail the decision to approve the life-saving drug. The main complaint, according to the Boston Business Journal, was that it had taken seven years to approve in the first place – far too late for far too many breast cancer patients.

Breast cancer is the second most common type of cancer in the world, and sometimes, if untreated, may be deadly. Prognosis may be positive, however, for those who catch the progression fast enough.

But a diagnosis of breast cancer is not enough to secure SSDI benefits. To understand who is eligible, first let’s give a little background of the way we measure the severity of the disease. We rate breast cancer stages on a scale of Stage 0 to Stage 4. The higher the number, the more advanced the cancer is.

Stage 0 cancer involves non-invasive cancers. In this stage, cancers or abnormal pre-cancerous cells haven’t yet spread from the part of the breast where they first formed.

Stage 1 breast cancer involves cancerous cells – up to 2 centimeters – that have begun to invade nearby tissues, excluding lymph nodes.

Stage 2 cancer is divided into 2A or 2B. In 2A breast cancer, doctors are unable to find cancer cells in the breast, but they are able to find it in the lymph nodes located under the arms. In 2B, the tumor is at least five centimeters, but hasn’t spread to the lymph nodes under the arm or is less than 5 centimeters, but it has spread to the lymph nodes under the arm.

Stage 3 breast cancer is divided in 3A, 3B and 3C. Stage 3A breast cancer means there is no actual breast tumor and it’s all located in the underarm lymph nodes and has spread to the nearby breast bone and is sticking to other areas as well. Stage 3B breast cancer means that the tumor – any size – has spread to the breast skin, chest wall both and that it may be invading other axillary lymph nodes well. Stage 3C breast cancer means that the tumor has spread to the breast skin and chest wall and lymph nodes above and below the collar bone, as well as the lymph nodes under the arms and/or near the breast bone.

And then there is Stage 4 breast cancer. This is where the cancer has invaded other vital organs in the body, such as the brain, lungs, bones or liver.

Women who have been diagnosed with stage 4 breast cancer or cancer that is inoperable have been given an expedited means to disability benefits through a compassionate allowance.

In less serious cases, the administration is going to evaluate your breast cancer disability claim under Section 13.10, breast cancer. In order to meet the listing criteria, the administration requres that the cancer be locally advanced (or with inflammatory cancer, it can be a tumor of any size with extension directly to the skin or chest wall or internal mammary lymph nodes) or one with mestastases to the nearby bones or to 10 or more lymph nodes. Alternatively, if the breast cancer is recurrent, you would qualify for disability benefits.

The explanation is quite technical, but if you have questions about whether your condition likely qualifies you for disability benefits, we are happy to answer your questions.
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The anxiety roller coaster of a young mother in Boston was recently chronicled by CNN in its investigation into whether anxiety medications where truly the best answer for parents suffering from severe bouts of depression and anxiety. faceinthedark2.jpg

Our Boston Social Security Disability Insurance lawyers know that while this mom has learned to cope by taking five-minute “breathers” in the laundry room, not everyone with an anxiety disorder is able to make that method work. Many are debilitated by the extreme levels of anxiety, which are manifested in severe panic attacks, obsessions or compulsions or stress that can result in major difficulties in maintaining everyday life activities, relationships and basic function.

What’s more, anxiety disorders are increasingly common. The Centers for Disease Control reports that some 40 million American adults are coping with anxiety disorders. Of course, not every single one of those will qualify for disability benefits, but there are some extreme cases where that may be the only option.

CNN reports that parents are more vulnerable to anxiety disorders and when they are diagnosed, they tend to be more severe. It makes sense that if you are already someone who is prone to depression or obsessive compulsion, the added emotional, physical and mental strain of rearing a child could increase those risks.

One mother revealed waking up every night at midnight and suffering from panic attacks so severe she truly believes she will die – every single night.

There is also the risk for new mothers of crippling postpartum depression. Proving eligibility for SSDI of postpartum depression can be difficult because although it is often quite serious, proving that it lasts more than a year can be tough.

Anxiety disorders, on the other hand, can last years if not decades, even when an individual is faithful about seeking and following treatment plans.

Section 12.06 of Social Security Disability’s impairment listings addresses anxiety-related disorders. Essentially, these conditions are defined as the medically-documented finding of one of the following:

  • General, persistent anxiety (accompanied by motor tension, autonomic hyperactivity, vigilance or scanning, apprehensive expectation);
  • An irrational, persistent fear of a certain object, situation or activity;
  • Severe, recurrent panic attacks that bring about an unpredictable and instantaneous apprehension, terror fear or sense of doom at least once a week;
  • Obsessions or compulsions that are recurrent and a source of marked distress;
  • Intrusive and recurrent recollections of some traumatic experience that causes a significant source of distress.

In addition to this, the administration requires that this condition be the source of some serious restriction of daily living activities, social functioning, concentration, ability to function outside of one’s home.

The CDC reports that anxiety disorders primarily affect women, and rates tend to be higher in developed countries.

Specific anxiety disorders include generalized anxiety disorder, post-traumatic stress disorder, separation anxiety disorder, and certain phobias.
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Every time Laura Willmott stared into the mirror, she saw a young woman who was grossly overweight and needed to become more disciplined in shedding the pounds. faceinthedark.jpg

In reality, Wilmott was only 99 pounds, her skewed personal perception a symptom of her illness, anorexia nervosa. The British 18-year-old recently died after collapsing from cardiac arrest, after spending the last five years starving herself.

Our Boston Social Security Disability Insurance attorneys know that anyone who is familiar with this heartbreaking disease knows that it takes every ounce of energy to fight. Although it manifests itself in the severe reduction of food intake, the Mayo Clinic purports it is more about a distortion of coping with emotional problems.

As such, the disability impairment listing for this disease falls under section 12.00 mental disorders, specifically, section 12.07, somatoform disorders.

(Note: For those under 18, it is possible to obtain Supplemental Security Income for anorexia nervosa, but primarily our focus in this article is adult sufferers.)

A somatoform disorder is one in which there are clear physical symptoms, but there is no demonstrable organic findings or physiological causes for it. In order to qualify, the person has to have had a history of multiple physical symptoms over the course of several years – beginning before age 30 – that would have caused an intense frequency of medication, doctor visits or significantly-altered life patterns. Alternatively, there would have to a be a non-organic disturbance of vision or speech or hearing or use of a limb or movement or sensation or an unrealistic belief that he or she is overweight that would result in at least two of the following:

  • Major restrictions in daily living activities;
  • Major difficulties in keeping up with social functioning;
  • Major problems maintaining concentration and persistence;
  • Repeated episodes of the condition worsening, each for an extended period of time.

Short-term effects of eating disorders might include a yellowing or dryness of the skin, emaciation, abdominal pain and constipation, dizziness and fatigue, anemia and lowered blood pressure, depression and social withdrawal. Long-term, the stresses to one’s body caused by eating disorders can result in a weakening of the bones and damage to major organs, including your kidneys, heart and brain.

Adults who are working to recover from anorexia or other eating disorders may be especially emotionally fragile. They can’t afford not to obtain benefits, but at the same time, the process of applying would be difficult and emotionally-draining for anyone. That’s where having an experienced Boston SSDI lawyer can be invaluable. We will help you gather all the necessary information – psychiatric testing and reports, lab tests, extensive individual reports, medical doctor evaluations, etc. – to help bolster your chances of a successful claim.

We want you to focus on recovery. Let us handle the rest.
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