Compassionate Allowance: Jervell and Lange-Nielsen Syndrome

Jervell and Lange-Nielsen Syndrome (JLNS) is a congenital disorder the results in severe and progressive hearing loss and heart function compromise. This genetic disorder is so severely limiting that it is automatically medically qualified for Social Security Disability (SSD) benefits. It is typically detected in early childhood, but can be detected in adolescence and much more rarely, in adulthood.

Compassionate Allowance - Hepatorenal Syndrome

Hepatorenal Syndrome (HRS) can qualify you for Social Security Disability (SSD) benefits regardless of the type from which you suffer, but types II and III also qualify under the Social Security Administration’s (SSA) Compassionate Allowances (CAL) program, which ensure your application will be reviewed as quickly as possible and virtually guarantees you will be approved for disability benefits.

CAL Designation

While HRS is automatically qualified medically for disability benefits, you must still complete the full application process, including providing the SSA with the medical evidence necessary to make an evaluation of your diagnosis and the severity level of your condition.

What the CAL program does is ensure your application will be reviewed more quickly. Rather than waiting the typical four months of more for an eligibility decision, you will likely have a determination in just a few weeks. That is, provided the SSA has the medical evidence they need to make a decision.

Medical Evidence Requirements

The SSA’s program requirements dictate that every SSD application meets certain standards, even those that fall within the CAL program. The minimum evidence that your application and medical records must contain includes:

  • A thorough clinical history that documents the diagnosis and the progression of your HRS
  • Physical examination reports that describe the features of your condition, including:
    • the symptoms,
    • severity level,
    • the impact of the condition on your abilities,
    • treatment you have undergone,
    • and the prognosis

The specific test results the SSA needs to see at minimum include:

  • Lab test results that show your serum creatinine levels are consistently elevated at 2mg/dL or greater
  • OR

  • Urine output of less than 500 mL in 24 hours
  • OR

  • Urine sodium results that show sodium levels of greater than 10 miliequivalents (mEq) per liter

To substantiate the severity level of your condition, the SSA may also evaluate your medical records under the Blue Book listing in Section 5.05D. Additional medical documentation can help prove your eligibility as well.

To fully document the diagnosis of HRS, your medical records must also include test results and other evaluations that rule out other causes of kidney failure. Additionally, clinical evaluations and lab tests that document liver compromise, kidney function, and the presence of other HRS signs and symptoms can only strengthen your claim for benefits. These additional medical records are helpful in your application for SSD:

  • BUN and serum creatinine measurements
  • Urine specific gravity urinalysis results
  • Ultrasounds of the abdomen
  • Liver test showing the signs of liver disease that precede HRS

SSD Benefit Programs

There are two SSD programs for which you may qualify:

  • Social Security Disability Insurance (SSDI)
  • Supplemental Security Income (SSI)

HRS types II and III both meet the medical criteria for SSD benefits under SSDI and SSI. However, both of these disability programs also have technical and financial eligibility rules.

  • For SSDI, you must be unable to earn a substantial living and must have the required work credits from your previous employment.
  • For SSI, you must have very limited income and other financial resources or assets, but there is no work credit or work history requirement.

Applying for Benefits

To apply for benefits with Hepatorenal Syndrome, you can visit the SSA’s website, or call the main helpline at 1-800-772-1213 to schedule an appointment to file your application in person at your local office. Online application however, is usually the fastest way to file a claim.

Compassionate Allowance - Hepatopulmonary Syndrome

If you suffer from Hepatopulmonary Syndrome (HPS), then you are undoubtedly disabled, and the Social Security Administration (SSA) recognizes this. HPS automatically meets the SSA’s medical criteria for receiving Social Security Disability (SSD) benefits, though you must still submit an application and thoroughly document the diagnosis and severity level of your condition in order to be approved for benefits.

Disability Programs

The SSA has two programs for which you may qualify:

  • Social Security Disability Insurance (SSDI) – which provides benefits to qualified disabled workers, and on rare occasions, to their dependents.
  • Supplemental Security Income (SSI) – which is a need-based program for which there are strict income and financial resource limitations.

To receive benefits through either program, you must meet both the medical eligibility and the technical and financial criteria.

Medical Evidence and Required Documentation

When applying for benefits, you must ensure that your medical records meet the SSA’s evidentiary requirements for proving your diagnosis and the severity level of your HPS.

The minimum evidence that must be in your application and medical records includes:

  • A thorough clinical history that describes the diagnosis and progression of your liver disease.
  • Physical examination reports that detail the clinical features of your HPS, including the complications you experience.
  • Breathing function test and pulmonary exam results, including arterial blood gas studies and spirometry tests among others.
  • Imaging test results and reports, including x-rays, CTs, and transthoracic echocardiography (TTE)

To establish the diagnosis of HPS, a contrast enhanced ECG or echocardiogram that shows intrapulmonary vascular dilation is usually enough. However, an even stronger case can be built through the inclusion of the pulmonary and imaging test results mentioned above.

The specific findings the SSA will be looking for in the physical examination reports include:

  • The presence of liver disease
  • Low blood oxygen levels due to impairment in the pulmonary system
  • Abnormalities in the intrapulmonary vessels

To establish the severity level necessary for disability qualification, the SSA may utilize the listing in its Blue Book, which appears in Section 5.05E. However, this listing essentially reports the same information found above regarding the tests and exam results required for approval of your application.

Compassionate Allowances

Hepatopulmonary Syndrome is part of the SSA’s Compassionate Allowances (CAL) program, which ensures that your application for benefits will be reviewed more quickly. The average application takes at least four months to go through the first review. Your application however, will be reviewed in just a matter of weeks, provided your medical records and other documentation are thorough.

Applying for Benefits

Although denials of HPS applications for disability benefits are rarely denied, they can be delayed by insufficient information or lack of appropriate medical records. You should collect as many of your medical records as possible before applying for this reason. Those records should be submitted along with your application in order to speed up the review and approval.

You can complete your application via the SSA’s website or you can schedule an appointment and complete your application at your local SSA office. To arrange an appointment, call 1-800-772-1213.

Compassionate Allowances - Hepatoblastoma

As a rare form of cancer that most often occurs in children, Hepatoblastoma (HB) is a condition the Social Security Administration (SSA) recognizes as qualified for Social Security Disability (SSD) benefits. It is additionally a condition that is included in the SSA’s Compassionate Allowances (CAL) program, which ensures any application filed with the diagnosis is reviewed more quickly than the average SSD application, which typically takes four or more months to proceed just through the initial review.

Compassionate Allowance - Hallervorden-Spatz Disease

As a rare genetic disorder, Hallervorden-Spatz disease is among the conditions the Social Security Administration (SSA) recognizes as automatically meeting the medical criteria for receiving disability benefits. This means that your child’s application for disability benefits will be reviewed more quickly, but it does not mean automatic approval for benefits. You must still complete the application process and ensure that there are appropriate medical records for satisfying the SSA’s evidentiary requirements.

Supplemental Security Income Benefits

Children typically receive benefits under the SSA’s Supplemental Security Income (SSI) program. Application for benefits on behalf of a minor child means the SSA must review:

  • your child’s medical records,
  • disability application,
  • and your financial records as well, because SSI is a need-based program.

When you apply for benefits for your son or daughter, you must meet with an SSA representative for an in-person interview. The representative will fill out your child’s application during that interview, utilizing the information you provide.

Children’s disability applications are completed by appointment only. To schedule your appointment, you should call 1-800-772-1213.

Compassionate Allowances

Hallervorden-Spatz disease is a condition that is included in the SSA’s Compassionate Allowances (CAL) program. CAL designation expedites the review and approval of disability applications filed for certain conditions. It does not however eliminate the need for medical evidence in your son or daughter’s application. It is only intended to get you an eligibility decision more quickly. Most disability applications take at least four months for a decision to be made. CAL applications often get reviewed in just a few weeks.

Medical Evidence Required

There is a genetic test for Hallervorden-Spatz disease, and if you are able to have this test completed, it can significantly decrease the required medical evidence your child’s application for benefits must contain. This is because the SSA knows the disease is severely disabling and progressive in nature.

The genetic test however is not widely available, which means your child’s records may need to include other evidence to confirm the diagnosis.

Additionally, some cases of Hallervorden-Spatz disease are not caused by a mutation in a single gene, which means the PANK2 test that is often utilized to confirm the diagnosis may not prove your child has Hallervorden-Spatz disease.

These facts mean other evidence may be necessary to prove the diagnosis in your child’s disability application. Other required documentation may include:

  • Physical findings showing the cluster of symptoms consistent with the diagnosis
  • AND

  • Neurological exams and imaging tests to support physical findings and to rule out other conditions that cause similar symptoms.

What to Expect

Though applicants with Hallervorden-Spatz disease are rarely denied benefits, a lack of appropriate medical records or other details in your child’s application can delay the review and approval process.

Collect as many of your child’s records as possible before applying and submit those records when you do apply. This will get you a decision more quickly.

Compassionate Allowances - Fryns Syndrome

As a rare genetic disorder that is usually fatal in early infancy, and which causes severe physical and intellectual impairments in those children who do survive, Fryns Syndrome automatically qualifies for Social Security Disability (SSD) benefits. You must however still submit an application and provide the Social Security Administration (SSA) with appropriate medical documentation.

Supplemental Security Income

Children most often qualify for disability benefits through the SSA’s Supplemental Security Income (SSI) program. This is a need-based program that sets strict income and other financial resource limitations as part of its basic eligibility criteria. Since you are responsible for providing for your child, a portion of your income and resources will also be considered when the SSA determines whether or not your son or daughter meets the SSI financial rules for eligibility.

Compassionate Allowances

Fryns Syndrome is part of the SSA’s Compassionate Allowances (CAL) program. CAL designation expedites claims filed for certain conditions in order to get benefits to those who need them most in the timeliest manner possible. Although CAL designed conditions are known disabilities and therefore automatically medically qualified for benefits, you must still support your son or daughters claim with the right medical records to avoid any delays in the process.

Medical Evidence and Required Documentation

The SSA is obligated to document key criteria for every application approved for benefits. This means there are certain pieces of information they must be able to verify before they can approve any claim, even those filed on CAL designated conditions like Fryns Syndrome.

The minimum evidence that your child’s application and medical records must contain includes:

  • A thorough clinical history that documents signs and symptoms consistent with the diagnosis of Fryns Syndrome , as there is no genetic test for making the diagnosis
  • Heart, lung, and kidney function tests to document any impairment in these body systems
  • In older children, intellectual and psychological testing is required

The specific tests that the SSA typically wants to see include:

  • Chest and abdominal x-rays
  • Ultrasounds of the cranium
  • Echocardiogram results
  • An ultrasound of the kidneys

The report of physical findings may include any or all of the following, based on the signs present in your child:

  • A hernia in the diaphragm at birth that required emergency surgery
  • The facial features characteristic of infants with Fryns Syndrome
  • Kidney dysplasia
  • Cloudy corneas
  • An underdeveloped heart
  • Underdeveloped fingers and toes
  • Brain abnormities
  • Abnormalities in the urinary and/or gastrointestinal systems

Applying for Benefits

While it is unusual that CAL conditions are denied for medical reasons, it is possible for CAL claims to be delayed due to a lack of sufficient medical records. Keep this in mind when preparing to file for disability benefits for your son or daughter. Collect as many records as you can prior to starting the application.

When applying for benefits for a minor child, you must schedule an appointment and complete the application via an interview at your local SSA office.

Compassionate Allowance - Fatal Familial Insomnia

As an exceptionally rare genetic disorder, Fatal Familial Insomnia (FFI) is automatically qualified for Social Security Disability (SSD) benefits. However, you must still submit an application and support your claim with appropriate medical documentation.

There are two disability programs for which you may qualify with FFI:

FFI is also included in the Compassionate Allowances (CAL) program, which has special review and approval procedures in order to get applications for certain conditions through the Social Security Administration’s (SSA) procedural requirements and approved for benefits more quickly.

Medical Evidence and Required Documentation

The SSA must determine certain things in order to approve your application, even under the CAL program. This means you must complete the full application process and submit thorough medical records along with your application.

To support the definitive diagnosis of FFI, your medical records should include evidence from:

  • An Electroencephalography (ECG)
  • An MRI of the brain
  • A Sleep apnea test
  • Genetic evaluation that documents the presence of mutations in the PRNP gene

To substantiate the severity level of your condition, which is required for all disability claims, your medical records must also show that you suffer any or all of the following symptoms:

  • Difficulty sleeping
  • High pulse and high blood pressure
  • Excessive sweating
  • Declining coordination and motor skills

The minimum evidence that your application and medical records must contain in order for you to be approved for disability benefits includes:

  • A thorough clinical history taken by your doctor that includes symptoms you suffer
  • Lab tests, including the PRNP genetic test that documents the presence of mutations

Applying for Benefits

Though it is very uncommon for CAL conditions to be denied benefits, you must still complete the full application and ensure your medical records meet the SSA’s requirements. Collect as many of those records as possible prior to submitting your claim and ensure you turn them in to the SSA at or just after submitting your application for benefits.

Additionally, you should know that there are multiple ways to apply for benefits, including scheduling an appointment with the local SSA office. However, the fastest way to initiate a claim is to fill out your application online via the SSA’s website.

CAL conditions are generally reviewed within just a few short weeks. The more thorough the information is that you provide to the SSA, the faster you will have a decision on your claim.

Compassionate Allowance - Endometrial Stromal Sarcoma

As an exceedingly rare and form of uterine cancer that spreads rapidly and often recurs following treatment, Endometrial Stromal Sarcoma (ESS) is designated as qualified for Social Security Disability (SSD) benefits under the Social Security Administration’s (SSA’s) Compassionate Allowances (CAL) program.

CAL provides expedited review and approval processes for any application filed on a diagnosis that falls under the program’s guidelines. The purpose of the program is to significantly reduce the wait for benefits for those who need them most.

Documentation Requirements

While ESS is qualified for expedited processing under CAL guidelines, you must still prove the severity level of your condition through the medical records and other documentation your application contains.

The SSA has specific information they look for to prove your diagnosis and to substantiate the severity level of your condition.

Only ESS in its advanced stages qualifies under the CAL program. Grade III or IV or high grade ESS must be the diagnosis on your application for benefits. Undifferentiated Uterine Sarcoma is also an acceptable formal diagnosis for evaluation under the ESS CAL listing.

Documentation required for supporting a definitive diagnosis of ESS includes any or all of the clinical diagnostic and physical findings:

  • Cellular evaluation results, from cells collected during endometrial biopsies, D&C procedures, or hysteroscopies
  • Pelvic MRI and/or CT scan results showing the presence of masses in the abdomen
  • Vaginal bleeding or spotting in postmenopausal women
  • Abnormal bleeding in premenopausal women
  • Anemia resulting from persistent and chronic loss of blood
  • Enlargement of the uterus
  • Abdominal and/or pelvic pain
  • Vaginal cramping and/or discharge

The SSA defines the minimum evidence required for approving an application for disability with an ESS diagnosis as:

  • A clinical history and examination notes that document and describe the features of your condition, including physical features and symptoms you experience
  • Pathology reports that show the presence of stroma cells in your endometrial tissues, with a biopsy being the standard method of retreating and examining cells
  • Imaging test results and/or notes following surgery that document the spread of your cancer

Applying for Benefits

To ensure your application is processed as quickly as possible, collect your medical records in advance and submit them at the same time you turn in your application. You can apply online via the SSA’s website, or at your local SSA office, through an in person interview.

If you apply in person, call ahead to schedule an appointment or you will be turned away, with an appointment date that you should return. There can be a wait for an available appointment date, and online application is often the fastest method for initiating a claim.

Most disability applicants must wait at least four months for a decision on their application. You should hear something within just a few weeks, especially if you ensure your medical records are thorough.

Compassionate Allowances - Erdheim Chester Disease

As a rare and progressive, often terminal illness, Erdheim Chester Disease (ECD) automatically qualifies for Social Security Disability (SSD) benefits, though you must still go through the application and review processes, and thoroughly document your condition, in order to get benefits.

Disability Programs

The Social Security Administration (SSA) has two disability programs for which you may qualify with ECD:

  • Social Security Disability Insurance (SSDI), which has work history and work credit requirements.
  • Supplemental Security Income (SSI), which sets strict limitations on income and other financial resources.

In addition to the basic technical eligibility for each program, you must also prove medical disability. With ECD, substantiating your disability is fairly straightforward.

The Compassionate Allowance Program

This program, which is also known simply as CAL, ensures applications filed for specific medical conditions are reviewed more quickly, in order to get benefits to those who need them most. ECD is a CAL condition, which means you will only have to wait a matter of weeks to receive a decision on your application.

While CAL designation ensures a quicker decision and an “automatic” approval for disability benefits, you must still document your illness through substantial medical records in order to be approved.

Evidence Required for Proving Disability

The SSA reviews your medical records to confirm two key pieces of information:

  • A definitive diagnosis
  • A severity level that results in disability

To confirm the definitive diagnosis of ECD, the SSA needs to see any or all of the following diagnostic test results:

  • Imaging scans, including MRIs, CTs, X-rays, and bone scans documenting the presence of masses and lesions
  • Biopsies of tissues from the affected areas of your body
  • Breathing tests, renal function tests, and other exams that document compromised organ function due to masses and lesions

To document the severity level of your ECG, the SSA will also need to see in your medical records that you suffer from signs and symptoms consistent with disability and with the specific areas of the body affected by your condition. These may include any or all of the following physical findings:

  • Bone pain, particularly in the legs and arms
  • Muscle and joint aches and pains
  • Weight loss
  • Fatigue and weakness
  • Compromised organ function, which may include kidney issues, breathing difficulty, trouble speaking, vision loss, and heart problems
  • Decreased immunity and more frequent infections

The minimum evidence required by the SSA includes:

  • A thorough clinical history describing the features and prognosis of your ECG.
  • Physical examination notes that also document the features of your condition and the symptoms from which you suffer.
  • Biopsies of tissues from the organs affected by your ECG.
  • Results from organ function tests

Applying for Benefits

You can apply in person at your local SSA office, but you will need to schedule an appointment and then wait for that appointment date to arrive. Applying online with the SSA’s website is faster and allows you to begin your application at any time.

While denial of benefits is rare with a CAL designated condition, they do occur. When this happens, it is usually due to a lack of appropriate medical evidence. Lacking documentation can also lead to delays in approval, while the SSA seeks out and reviews your medical records. To shorten your wait for disability benefits and ensure approval, submit as many of your medical records as possible along with or just after sending in your SSD application.

Compassionate Allowances - Dravet Syndrome

Dravet Syndrome is a rare and severe form of genetic epileptic encephalopathy that begins to present with symptoms before the age of one. Children with this condition experience progressively worsening and multiple types of seizures and generally have underdeveloped motor skills and language abilities. They also commonly experience behavioral problems and have difficulty relating to others, in a manner quite similar to autistic children.

As a rare and severe genetic disorder that progressively worsens with time, Dravet Syndrome is a part of the Social Security Administration’s (SSA’s) Compassionate Allowances (CAL) program, which means disability applications filed for the condition are reviewed more quickly and are rarely denied.

CAL Designation and Medical Documentation

Although Dravet Syndrome is a CAL designated condition, you must still fill out an application for Social Security Disability (SSD) benefits and must also thoroughly document, through appropriate medical records, the diagnosis, treatment, and effects of the condition on your child’s everyday life and abilities.

The SSA requires specific medical evidence is present in your child’s records, including:

  • Genetic testing results that show the presence of mutations in the SCNIA gene
  • Lab test results ruling out other causes for the gene mutation and for the seizures
  • EEG results showing abnormalities in brain function
  • Notes of findings from physical examinations, documenting the physical signs of the condition and of seizures, including: tremors, abnormal eye movements, uncontrolled muscle movements, lack of muscle control in the face, mouth, or voluntary muscles responsible for respiration
  • IQ test results or other documentation of intellectual deficits
  • Treatment protocols, including medications and their effects
  • Records of supportive care requirements
  • Hospitalization and emergency intervention documentation
  • Doctor’s notes reporting the physical and cognitive features of the disorder
  • Imaging test results showing any changes in the brain, including PET, MRI, and/or CT scans

Meeting or Matching a listing in the SSA’s Blue Book

Though Dravet Syndrome “automatically” meets the SSA’s medical eligibility rules for SSD benefits, the severity level of the condition must still be proven through thorough medical evidence and other details in your application. To evaluate the severity level of the condition, the SSA uses the following listings in the Blue Book:

Applying for Benefits

Whether applying for benefits on behalf of a minor child with Dravet Syndrome or for an adult with the disorder, you will need to complete the full application process.

For children, an in-person interview at the local SSA office is required. For adults however, you can complete the application online or at the local office. However, you must still ensure that you submit thorough medical records supporting the claim.

If applying in person, be sure to schedule the appointment in advance and to collect as much documentation as possible prior to the appointment.

The initial review of an application usually takes at least four months, but as Dravet Syndrome is a CAL condition, you should anticipate having a decision from the SSA within just a few weeks.

While it is unlikely that the claim would be denied for medical reasons, it is possible. If you receive a denial, you can appeal the decision and having the help of a Social Security advocate or attorney can aid in your efforts.