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Disability Benefits for Stress

Stress

Stress can cause disability, aggravate other diseases (such as heart disease and mental health problems), and it appears to be a significant contributory factor to a declining life expectancy in the United States. This is particularly true in white working-class men, whose life expectancy has been steadily declining since 2015 (the first drop since 1993), largely due to an increased rate of suicide, alcohol, and drug addiction ... which many experts attribute to chronic stress.

Why working-class white men? Sociologists and doctors, such as Dr. Sanjay Gupta (in a film for HBO called “One Nation Under Stress”), point to chronic stress as an important factor in this cohort of middle-aged men, who feel a loss of control over their lives, uncertainty and unpredictability as to their future, and dashed expectations from a failed “American Dream” that, for them, has gone wrong.

Chronic stress often arises out of socioeconomic problems, and, in the case of teenagers, from the pervasive influence of social media and the ease with which it can be used for bullying. When it is  contnual, stress affects the mind and the body in many highly destructive ways.

Effects of Stress on the Brain

Dr. Gupta, himself a neurosurgeon, points out that neuroimaging studies show a loss of brain tissue in the pre-frontal cortex of the brain in patients under chronic stress. That's the area of the brain that is resopnsible for the exercise of good judgment and for what is often called "executive" decision-making, which may be why people under stress can have significant cognitive problems. They may find it hard or impossible to concerntrate or remember things. They may have problems relating to others, because the pre-frontal cortex is also the area of the brain that gives rise to feelinkgs of empathy toward others.

Effects of Stress on the Immune System

Stress activates the immune system (and not in a good way) and increases the level of immune chemicals in the blood called “pro-inflammatory cytokines,” that cause increased inflammation throughout the body. For example, the stress caused by being bullied as teenagers has been shown to increase the CRP (a blood marker of inflammation) levels in bullied victims.

Chronic stress has been linked to flares of rheumatoid arthritis, lupus, fibromyalgia, psoriasis, other autoimmune disorders, schizophrenia, and multiple sclerosis by causing increased inflammtion and because of its dysfunctional effects on the immune system.

Stress leads to accelerated cellular aging and a shortening of telomere length, all of which are factors associated with decreased longevity. Chronic inflammation also causes loss of immunological control over latent viruses, which can result in infection or mutations in genes and chromosomes that can be associated with lymphoma and leukemia. Simply put, over months and years of living with chronic stress, an overworked, over-tired immune system can no longer protect you as it degrades further and further from stress, but instead it begins to cause irreparable harm to multiple tissues and organs throughout the body.

[Reference: Morey JN, et al. “Current Directions in Stress and Human Immune Function.” Curr Opin Psychol. 2015 Oct 1; 5: 13–17.]

Effects of Stress on the Body's "Fight or Flight" Response

During stress, there are hormones that are released into the bloodstream, preparing the body for “fight or flight.” These hormones include cortisol and adrenalin, which are secreted into the blood stream by the adrenal glands. Their presence is good for the short-term (e.g., when you must run away from danger), but over the long-term, they can increase the blood pressure, aggravate bowel disorders, such as irritable bowel syndrome or inflammatory bowel disease, and they increase the risk of developing coronary artery disease, diabetes mellitus (Type 2), and other cardiovascular disorders. Id.

Effects of Stress on Psychological and Emotional Disorders

In addition to the physical effects of stress, the psychological and emotional effects of stress include anxiety, panic attacks, and depression, any or all of which may be disabling. Major depression affects close to 16% of the world-wide population. In the United States, at least 10% of the population suffers from major depression, and it may be more.

The cardinal symptoms of major depression include depressed mood, reduced motivation, hopelessness, anhedonia (diminished ability to experience pleasurable activity such as food, sex and social interactions), anergia, irritability, difficulty in concentrating, disrupted sleep, decreased appetite and cognition, and an increased risk of suicide.

Depression is associated with anxiety disorders, dementia, type 2 diabetes, coronary artery disease, Parkinson's disease, epilepsy, pain, cancer, aging, osteoporosis, and irritable bowel syndrome. [Reference: Yang L, et al. “The Effects of Psychological Stress on Depression.” Curr Neuropharmacol. 2015 Jul; 13(4): 494–504.]

Getting Disability Benefits for Stress

There is no specific “listing” for stress under the Social Security Act (SSA) guidelines. You cannot receive a long-term disability award for chronic stress, no matter how severe or for how long you have had it. However, you may be eligible for an award of disability benefits when stress leads to psychological, emotional, or mental disorders, such as depression, anxiety, panic attacks, post traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

Social Security typically evaluates stress under the criteria it uses for anxiety disorder. The essential medical documentation that is needed for disability benefits under a diagnosis of anxiety disorder include:

How long has the condition affected you?

What medication is prescribed and effects of the medication?

How does the condition impact you in your daily life? (substantial impact?)

How does the condition impact your ability to concentrate, follow directions, stay focused and on task? (substantial interference?)

How does the condition impact your ability to interact with others? (substantial interference?)

Have you required any hospitalizations for your condition?

Have you been fired or reprimanded from work for your condition?

SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).

SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.

SSA has its own forms that are used for Mental RFC here. These forms can be filled out by the treating source who can examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.

SSA "Listing" or "Blue Book" description for anxiety benefits can be found here (See 12.06)

Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med, that's what we do.

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