- Based on current Social Security Administration guidance, rapid at-home testing for COVID-19 may not be sufficient to identify medically identifiable injuries.
- Some people report being turned away from health clinics that study and treat long-term COVID because there is no official medical record of the diagnosis.
- If you test positive for COVID-19, contact a healthcare provider and seek treatment.
As the number of COVID-19 cases in the U.S. continues to rise, COVID long-distance transporters and other disability advocates are advising people to get on-site PCR testing if they test positive for a rapid home test. It may be important to keep a record of your diagnosis if you need to apply for disability benefits.
If someone tests positive for a rapid test at home, the Centers for Disease Control and Prevention (CDC) advises them to contact a healthcare provider for test results and symptoms. Testing at home or documenting with a healthcare provider whether symptoms are sufficient to receive Social Security disability benefits or long-term COVID treatment is no easy task. But in the past, that wasn’t always enough.
In mid-March 2020, New York City freelance writer Suzanne Zuppello woke up with a fever and body aches. After lighting the candle, she found that she, too, had lost her sense of smell. Zuppello made a telehealth appointment with her primary care physician, who diagnosed her with a suspected case of COVID-19. At the time, rapid tests were not widely available.
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Three and a half weeks later, Zuppello was finally able to get tested for COVID-19, when she tested negative. When Zuppello contacted Mount Sinai’s Post-COVID Care Center, she was not eligible for treatment at the clinic. Zuppello said she was told she needed to test positive for COVID-19 and that presumptive COVID-19 cases diagnosed by doctors were not enough.
“I did feel very frustrated and very doubtful of myself, even if what happened to me was real or legal,” Zuppello said. “I think a correct diagnosis does legitimize what a lot of people feel and helps them.”
How to qualify for long-term COVID disability benefits
On April 16, 2021, the Social Security Administration (SSA) issued policy guidance for long-term COVID patients. The first step people must take to qualify for benefits is to determine the medically identifiable damage from COVID-19.
What is a medically identifiable injury?
To qualify for Social Security disability benefits, you must demonstrate that you have a physical or psychiatrically identifiable disability that prevents you from working. The SSA defines it as “injury resulting from an anatomical, physiological or psychological abnormality that can be demonstrated by medically acceptable clinical and laboratory diagnostic techniques.”
For those with or with COVID-19, there are three options:
- Reports of a positive COVID-19 virus test
- Diagnostic tests consistent with COVID-19 (such as chest X-rays with lung abnormalities, etc.)
- A COVID-19 diagnosis with signs consistent with COVID-19 (such as fever or cough)
“Medically identifiable harm can be identified for all,” Stacy Cloyd, director of policy and administrative advocacy at the National Organization of Social Security Claimants’ Representative, told VigorTip. “So this suggests that PCR testing is not the only way to establish a medically identifiable injury.”
A rapid antigen test at home will not by itself identify a medically identifiable injury. Whether the self-administered test qualifies as “objective medical evidence” is questionable because it is not assessed in a laboratory.
People who have been chronically infected with COVID-19 may have very different experiences when applying for disability benefits because the virus affects people’s bodies in different ways.
“One of the challenges in making disability claims based on COVID-19 is that COVID-19 manifests in many different ways and affects people very differently,” Cloyd said.
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To qualify for Social Security disability benefits, people must also demonstrate that their condition has a significant impact on their ability to live and work for at least twelve months. For example, if someone develops kidney failure and needs a transplant, it may be easier to show that the problem affects someone for a longer period of time.
While brain fog can greatly affect a person’s quality of life, it’s hard to prove that it affects a person for at least a year and prevents them from working.
what does this mean to you
People with few symptoms during COVID-19 can still experience an impact on their quality of life due to prolonged use of COVID-19. You can learn more about applying for disability benefits here.
Working with a lawyer may help
Even for those who meet the criteria for disability benefits (long-term COVID or other health conditions), the process of applying for and receiving these benefits can be complex.
Cloyd advises people looking to apply for disability benefits to work with a lawyer who can help them navigate the process. Most attorneys only charge fees if the disability claim is successful.
“Having someone who understands the process and has dealt with disability claims is very useful in terms of filling out paperwork, submitting evidence and knowing what to expect,” Cloyd said.
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If people’s claims are denied by the SSA, whether they cooperate with an attorney or not, Cloyd recommends that they prepare for a potential appeal by reading and understanding why their original claim was denied.
“I also encourage people to read the notices they receive carefully so they know how the case is going and any upcoming deadlines they have,” Cloyd said.
This problem is not new
COVID-19 is a mass disabling event, but the issue of Social Security disability benefits and the lack of support from the health care system and its communities is nothing new for people with chronic illnesses and disabilities.
Kathy Flaherty, executive director of the Connecticut Legal Rights Project, told VigorTip: “The problems that people who are new to the system are discovering are actually problems that people with disabilities have discovered a long time ago.”
It is not uncommon for Social Security disability benefits to be denied. For example, in 2019, less than 30% of applicants received disability benefits. Flaherty said it’s not uncommon for people to be unaware of these issues until they need a benefit plan, whether it’s due to disability, poverty, or both.
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People with conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) (long-term compared to COVID) also face rejection. Symptoms associated with these conditions, such as extreme exhaustion and poor stamina, are difficult to capture objectively in the data. Policy guidance on applying for Social Security benefits for ME/CFS patients was only issued in 2014.
Flaherty himself contracted COVID-19 in March 2020 and was unable to get tested. She finds solace in disability advocates like Imani Barbarin on Twitter, who welcome new disabilities, explain the barriers they face, and stress the importance of rest.
“It helped me because I knew I was going to force myself to go back to work right away,” Flaherty said.
Barriers to Healthcare and Access
Some people with long-term Covid-19 infections have difficulty accessing care without PCR testing, even if their symptoms are medically documented.
In July 2020, Connecticut Governor Ned Lamont issued an executive order on workers’ compensation for COVID-19 patients, requiring “pass a positive laboratory diagnostic test within three weeks of the date of injury Confirmed infection or within 3 weeks.”
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“The governor issued an executive order that if you get sick at some point in the pandemic, you’re presumed to be sick, but you need a PCR test,” Flaherty said. “I can’t buy one. ”
Brittany, who lives near Boston and works in higher education, tested negative for COVID-19 in March 2020 after seeing a doctor. Because her symptoms were consistent with COVID-19, the doctor wrote a note to her employer saying “regardless of the test results, this is a presumptive case.” For various reasons, Brittany chose not to apply for disability benefits .
While Brittany is now working remotely, she is expected to be back in the office around January 14. Her employer wants her back in the office because she doesn’t meet their diagnostic criteria to keep her working remotely.
“They’re now advising us to wear masks at all times, and I’ve been wearing a surgical mask because I have breathing problems,” Brittany said. “An N95 [mask] Made me feel like I was suffocating, so I was very, very concerned that I would be vulnerable by going in. ”
Brittany is also trying to get treatment for persistent COVID-19 symptoms. When she first coughed up blood, she contacted her GP for help.
“She looked at my chart, looked at the test results, and said, ‘Okay, you tested negative for COVID, so I think it was allergies,’ so I switched GPs,” Brittany said. “The next one laughed off a lot of what I told her.”
*Brittany’s last name has been omitted to respect their privacy.
The information in this article is current as of the date listed, which means that you may have updated information as you read this article. For the latest updates on COVID-19, visit our Coronavirus news page.