In any disability claim, medical chart review is an important requirement. Muscular dystrophy is one such disability that is eligible for social security disability benefits from the SSA (Social Security Administration).
Muscular dystrophy (MD) refers to a group of genetic muscle diseases that causes irreversible damage to the muscles. It can affect the mouth, eyes, heart, and lungs. This condition can even cause mental impairments. There are more than 30 different types of muscular dystrophies and though there is no effective cure for this condition, therapy and medications can be used to address it.
Common Types of Muscular Dystrophy Requiring Medical Record Review
The most common types of muscular dystrophy are Duchenne muscular dystrophy or DMD, which is the type that commonly affects children; Becker muscular dystrophy; Myotonic muscular dystrophy, the most common form in adults; Congenital, Limb-girdle, Emery-Dreifuss, Facioscapulohumeral (FSHD), and Oculopharyngeal muscular dystrophies. This condition is diagnosed using various forms of tests: blood work, family history, physical examination, EMGsor muscle biopsy. Treatments provided include medications, orthotics/splints, or physical therapy.
If the symptoms of the claimant meet the requirements set by the SSA’s disability listing for MD (listing 11.13), the claimant will be approved for disability.
Already on the listing and approved for SSA’s Compassionate Allowance (CAL) program list are congenital myotonic dystrophy, Fukuyama congenital muscular dystrophy, Ullrich congenital muscular dystrophy, and Merosin-deficient congenital muscular dystrophy which is also known by the name LAMA2-deficient congenital muscular dystrophy. Recently, the SSA added Duchenne muscular dystrophy (DMD) to the CAL program list, thus speeding up the disability application process for adults with this genetic disorder.
Medical Evidence Required to Support the Diagnosis
Medical chart review is required to identify the type of muscular dystrophy and how it affects the patient in terms of disability. So, what does the SSA look for when reviewing the claimant’s medical records?
- Disorganization of Muscle Function: A review of the medical records should show that the claimant has severe and ongoing “disorganization” of his/her ability to use their muscles in two of their extremities, arms or legs, which causes chronic difficulty with their ability either to balance while standing or walking, to stand up from a seated position, or to use their arms effectively. The difficulty in using the muscles stems from issues such as:
- Paralysis or total inability to use a muscle
- Ataxia or lack of muscle coordination
- Tremors or involuntary muscle movement
- Paresis or partial paralysis
- Sensory disturbances
- Physical and mental limitations:
Muscular dystrophy can cause communicative, cognitive, or social problems. In such cases, claimants may qualify for disability benefits. The claimant must have “marked” physical problems along with significant limitations in any one of the following:
- Interacting with others
- Thinking, remembering, and following instructions
- Regulating emotions, adapting to changes, and taking care of oneself
- Completing tasks at a reasonable speed
To establish that the claimant’s MD meets the above requirements, their medical records must provide details of the diagnosis and treatment of the muscular dystrophy. The medical records required for review include:
- Muscle biopsies
- DNA or blood enzyme tests
- Nerve conduction studies
- Results of MRIs, CT scans, X-rays
- Physician notes and reports
- Physical therapy records and reports
- Medication lists and information regarding side effects
If the claimant can provide adequate information to the SSA at the beginning of the application process, the more quickly the claim will be approved.
Social Security Disability Benefits for Children with Muscular Dystrophy
Children with muscular dystrophy may also be eligible for social security disability benefits. SSA’s listing that applies to children is Listing 111.06 (Motor dysfunction due to any neurological disorder). To be eligible, the child must have ongoing, severe problems with at least two of his/her extremities (arms and legs) that interfere with their daily activities while also causing an extreme limitation in the child’s ability to stand up from a seated position, balance while walking or standing, or use their arms for writing, picking up things, eating or reaching for things.
A medical record review should reveal that the child has impairments in at least two extremities, or has persistent “disorganization of motor function”. In other words, medical evidence such as muscle spasms, weakness, tremors, lack of coordination, loss of sensation in two extremities, or involuntary movements must be documented in the child’s medical records.
The SSA will consider how the child’s MD affects his/her functioning when compared to other children of the same age without MD. Medical documentation of a neurological disability that is causing the muscle problems is required in this regard. Just as for adults, the SSA will review the test results such as muscle biopsies or blood tests in the child’s medical record that support the diagnosis. The treating doctor should have documented the type of muscle dystrophy the child has and its impact of his or her functioning.
How a Medical Record Review Company Can Assist Attorneys
Disability attorneys representing muscular dystrophy patients need to review the medical records to determine the validity of the claim. Performing the review process in-house could be tedious and time-consuming; it could also be difficult for the legal office staff to understand complex medical terminology in the medical records.
A well-prepared summary would include all the following details:
- Diagnosis or diagnoses
- Providers and dates of treatment
- Treatment plans that include diagnostic reports, prescriptions, and referrals
- Prognosis or the likelihood of improvement or recovery
- Permanent impairment, if any
- Ongoing medical needs
- Information regarding prior as well as unrelated medical treatment
- Definitions of medical terms can be included in a medical summary for quick reference
Since the review is done by trained and experienced professionals comprising legal nurse consultants and physicians, the attorney can benefit from accurate medical aspects related to the claim. They can therefore provide the right counsel to their clients. In case a claim is denied, and the case has to go for trial, the attorney can use the medical review report and summary to determine the legal validity of the claim.
Given the significance of medical chart review in a muscular dystrophy disability case, the pre-litigation support provided by a medical record review company is invaluable to attorneys handling such disability claims.