Follow-up question , Mean PAP of 40

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Follow-up question , Mean PAP of 40

Question from Phran:

Thanks for the information about quarters.

I was also told by Access that if I had a mean pressure of 40, I would qualify for social security disability. My first right heart catheterization pressure was calculated incorrectly but my last 2 mean pressures are all above 40. Do you know if this is true? My pressures when diagnosed in February of 2004 were 83/36 but the report shows that the mean pressure was 34. I know this is wrong because the formula used is twice the diastolic pressure plus the systolic number divided by 3 and that would be around 52. I have since moved to another state and changed doctors and wonder if it would be beneficial for my current doctor to write a letter stating that the pressure was calculated incorrectly.

Also, Access just wants to request my medical information from January 2006 to the present but I think they should request it from the date I started showing symptoms in October of 2003 since it sounds like they will be deciding my disability from before March 31, 2005? Another question I have is that my former doctor ordered periodic echos to see how my pressures were doing. It showed that they were decreasing but when I moved in June of 2006 it showed that my pressures never got any better. I mentioned this to social security when I first filed but do I need to reiterate this in my appeal?

Thanks again

Response from Alan:

Hi again Phran,

First, a disclaimer: Making the medical decision wasn't part of my professional role. So as I wrote in my brief bio, I'm not an expert in the medical decision-making area. My only head-on experience came as my wife's case was worked.

That said, Mean Pulmonary Arterial Pressure of 40 or above is only one part of the requirement as currently written. The other is demonstration of right heart failure. Social Security's listing of impairments refers to that as "cor pulmonale" although that phrase is archaic and seldom used in medical records anymore. But the way it is written, you must have both MPAH of 40 or more, AND evidence of right heart failure. Further, medical evidence must show you had both prior to March 31, 2005, the date you last met the work credit requirements.

Current medical evidence such as the post-2005 records Access is requesting can be relevant. However their only use would be to show that your disability continues after a pre-March 31, 2005 starting date.

I think it would be important for you and/or Access to obtain a copy of your medical folder to see what's in it before deciding what else needs to be obtained. (See my article: "What's in YOUR Folder?" on the PHCentral site for more info on that. )

And I think you're absolutely right to seek clarification of that first MPAP mistake. I think it would be very important to have your current physician comment on the inaccuracy of the MPAP computation, especially if it is the only measurement via right heart cath prior to March '05. If there was evidence of RHF (edema in your ankles, maybe?) that would be important to stress as well.

The other thing to consider is that your claim can still be awarded without exactly meeting the listing. SSA will look at your overall limitations (again, prior to March 2005) to see if you had the residual capacity to earn a substantial wage. Access should be able to discuss that process with you in great detail.

Part of the work during your appeal will be to educate your adjudicator (the person who will decide your case) about the current diagnostic language of pulmonary hypertension, and to relate it to the outdated language in SSA? listing of impairments. The other will be to demonstrate that you met the requirements before March 31, 2005.

Hope this helps, and again, best of luck on your appeal.


May 13, 2008


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