Stroke (Cerebrovascular Accident or CVA)
Stroke is the fifth leading cause of death in the United States, killing about 140,000 Americans each year—that's 1 of every 20 deaths.
A stroke occurs when a clot blocks the blood supply to the brain ("thrombotic") or when a blood vessel in the brain bursts ("hemorrhagic").
Someone in the United States has a stroke every 40 seconds. Every four minutes, someone dies of stroke.
Every year, about 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes; 185,000 are recurrent strokes.
Stroke is an important cause of disability. Stroke reduces mobility in more than half of stroke survivors age 65 and over.
Stroke costs the nation $34 billion annually, including the cost of health care services, medications, and lost productivity.
You can't control some stroke risk factors, like heredity, age, gender, and ethnicity. Some medical conditions—including high blood pressure, high cholesterol, heart disease, diabetes, overweight or obesity, and previous stroke or transient ischemic attack (TIA)—can also raise your stroke risk. Avoiding smoking and drinking too much alcohol, eating a balanced diet, and getting exercise are all choices you can make to reduce your risk.
Sudden numbness or weakness of the face, arm, or leg—especially on one side of the body.
Sudden confusion, trouble speaking or understanding.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance or coordination.
Sudden severe headache with no known cause.
Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving or removing the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and drugs that break up or dissolve blood clots, called thrombolytics.
Although stroke is a disease of the brain, it can affect the entire body. A common disability that results from stroke is complete paralysis on one side of the body, called hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or hemiparesis. Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Stroke survivors often have problems understanding or forming speech. A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions. Many stroke patients experience depression. Stroke survivors may also have numbness or strange sensations. The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures.
Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years
Of course, some patients who suffer a stroke have only mild neurological deficits and may still be able to work, while other patients may suffer debilitating strokes that leave them unable to perform any kind of work, including sedentary ("desk job") work. If you are disabled and applying to Social Security for benefits (SSDI) and/or if you have an employer-based long-term disablity policy (ERISA), you must work with your doctor (neurologist) to document in the medical record your diagnosis, treatment, physical findings, MRI findings, and specifically what functions you are unable to perform because of your stroke.
Your physical or exertional limitations may include, for example, being unable to sit 6 or more hours in an 8 hour day, lift/carry 10 lbs or more, stand/walk 2 hours or more, and so forth. These limitations must be documented with specificity in the medical record. Or, you may have cognitive dysfunction from your stroke that has affected your "executive function," causing permanent imapirment in your ability to think, remember, concentrate, or stay on task.These mental impairments must also be documented in your medical record.
In some cases, you may require formal neuropsychological testing that your doctor can arrange for you to have to more objectively document your cognitive dysfunction.
Essential Medical Documentation of Stroke Needed for Disability Benefits:
- How long has the condition affected you?
- What medication is prescribed and effects of the medication?
- Do you have difficulty with your memory?
- 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 Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.