Important information about applying for disability benefits.
Little attention has been given to the impact Long COVID has on the healthcare system, economy, workforce and community. This article provides information about the process of applying for disability and the documentation needed for social security disability and long-term disability.
Updated February 14, 202
Does COVID-19 continue to be an issue?
Many are of the opinion that the pandemic is over, but it is more accurate to say that we have learned how to deal with COVID-19 infections. People have returned to their normal routines, and western science has learned how to deal with the acute life-threatening components of the virus, but we cannot disregard this virus as a threat to our health. A significant number of people exposed to the spike protein in both the virus and the vaccine have long term health issues referred to Post COVID Condition (PCC), or “Long COVID”. According to the Journal of the American Medicine Association (JAMA), Long COVID affects at least 12% of those that contract COVID-19. Other researchers, including the CDC, estimate that 30-50% of people infected with COVID-19 may develop Long COVID, regardless of the severity of the infection.
In 2024 marks 4-years since the “official” start of the COVID-19 pandemic. COVID-19 continues to mutate and spread, causing disability and death from primary and secondary health issues the acute viral infection causes.
Newer variants are lighter and smaller, meaning they stay suspended in the air and travel farther, making them more contagious. They are considered less fatal in the acute phase, but in the weeks, months and years after the exposure, the spike proteins are disrupting the immune system in a way that can lead to the gradual development of post COVID health complications including autoimmune issues and organ damage/failure. Long COVID will be a community health risk for many years.
Barriers to diagnosis and treatment
Some post-COVID conditions cannot be detected with the current diagnostic tools. Clinical evaluations and results of routine blood tests, diagnostic imaging, and electrocardiograms may be normal. Many of the symptoms are similar to those reported by people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other poorly understood chronic illnesses that may occur after other viral infections such as Epstein Barr Virus (EBV or mononuecleosis) and Lyme Disease. People with these unexplained symptoms may be misunderstood by healthcare providers, which may result in delayed diagnosis and treatment.
Most social security applications are denied due to lack
of:
Lack of documented evidence of disability
Lack of awareness of Long COVID by providers and patients
Lack of diagnostic testing to confirm Long COVID
Conflicting reports about safety and risks associated with the long-term outcomes of the infection and vaccine.
Qualifying for Social Security Disability
According to JAMA, at least 12% of people have been disabled by the COVID-19 spike protein, regardless of the severity of infection or how they were exposed (virus or vaccine). That number equated to 10.8 million people in the US as of August 1, 2022 based on the 90 million cases of COVID infections on that date. Other researchers estimate the frequency of Long COVID is closer to 30-50%.
Symptomology that lasts or increases at the 6-month mark indicates some level of disability, the benchmark for social security disability (SSD) eligibility. 4 or 5 months of persistent or worsening post COVID sequelae indicates that it is time to consider what is needed to transition to SSD benefits.
The U.S. Department of Health and Human Services and the Department of Justice jointly published a guidance document on “long COVID” as a disability under the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, and Section 1557 of the Affordable Care Act. The guidance, released as we commemorate the 31st anniversary of the ADA, provides additional clarity on how these disability nondiscrimination laws apply to people who may be newly covered under these laws because of the impact of the COVID-19 infection on their bodies and their lives. The document discusses when long COVID may be considered a disability under the ADA, Section 504, and Section 1557, and shares examples along with related resources that may be helpful. Follow this link to review the US Guidance on “Long COVID” as a Disability Under the ADA, Section 504, and Section 1557.
Key medical documentation:
Confirmation of COVID-19 infection by positive test or documented new onset health issues that started after being infected or vaccinated
Inflammatory markers and/or COVID-19 antibodies detected in blood work
Diagnostic testing that indicates organ dysfunction (bloodwork, CT, MRI, Ultrasound, etc)
Full neuropsychological evaluation to assess cognitive impairment
Functional capacity exam to assess physical impairment
Steps 4 & 5 are especially helpful in providing that documentation if you are denied on the first SSD application. This approach should work even if you do not have a specific diagnosis of Long COVID by identifying your specific limitations.
Advocacy
The process of applying for disability benefits of any type is complicated.
ProMedView Clinical Consultants can guide you through the process of obtaining sufficient documentation for your SSD application.
You may also need to consider engaging a disability lawyer to help you with your filing. An online search for the costs associated with retaining a lawyer to file a social security application indicates that there are caps and limits on the amounts that can be charged for services, and the way those fees can be collected. Attorneys do not require a retainer (down payment) because they are paid out of your past-due benefits when your benefits start (back pay), and they do not get paid unless you receive back pay benefits.
Keep moving forward…
The future may look different than it did before the pandemic, but we are resilient, and we can choose not to be defined by Long COVID because we are capable of adapting to new challenges. It’s important to keep in mind that over the next few years, you may recover to the point of being able to return to work.
Testing may identify a treatable condition, inflammation may resolve, etc.
You may find a new career that allows you to work within your limitations.
You can stop or modify SSD benefits at any time when you and your body are ready.
With lifestyle changes and time to recover, many of us have the ability to get stronger and back on our feet.
It’s better for you if you are living as close to a normal life as possible including family, home, work, and social activities.
Do your best to stay focused on recovery and management of Long COVID and try to avoid the “disabled” or “sick” mindset.
Social Security Administration Key Information
Supplemental Security Income program for the aged, blind, and disabled.
Service: Disability Benefits
Website: Social Security Administration (SSA)
Contact: Contact the Social Security Administration
Local Offices: Find a Social Security Office Near You
Main Address: 6401 Security Blvd. Baltimore, MD 21235
Toll Free: 1-800-772-1213
TTY: 1-800-325-0778
Forms: Social Security Administration Forms
Social Security Disability Guidance
Guidance on “Long COVID” as a Disability Under the ADA, Section | HHS.gov
Just having a diagnosis of a serious condition is not enough to demonstrate disability. There are many conditions which are sometimes disabling, and other times not. Good examples are lupus and multiple sclerosis. These conditions can cause symptoms which render someone unable to perform the material and substantial duties of an occupation with reasonable continuity.
For a medical condition to be considered disabling, it must result in symptoms which cause “restrictions” and “limitations.” Restrictions are things a person cannot do without harm or exacerbation of symptoms. Limitations are things a person is physically or mentally unable to do. For example, an individual with a serious cardiac condition might be physically able to perform a high stress job but doing so might greatly increase the likelihood of a heart attack or stroke. The cardiac condition is not a limitation, as they are physically able to perform the job, but they should not do so due to the risk of a heart attack. They are restricted from performing the occupation. This is known as a “risk of relapse.”
Consider people with lupus or multiple sclerosis. They are likely to be immunosuppressed, have a higher likelihood of becoming infected, and have a higher risk of serious side effects or even death if they become infected. If someone with lupus or multiple sclerosis also has a job which cannot be done from home, for example, an Emergency Room Physician, we would take the position that such a person is entitled to disability benefits.
In light of the rise of long COVID as a persistent and significant health issue, the Office for Civil Rights of the Department of Health and Human Services and the Civil Rights Division of the Department of Justice have joined together to provide guidance.
The civil rights protections and responsibilities of these federal laws cannot be waived and apply even during emergencies.
1. What is long COVID and what are its symptoms?
According to the Centers for Disease Control and Prevention (CDC), people with long COVID have a range of new or ongoing symptoms that can last weeks or months after they are infected with the virus that causes COVID-19 and that can worsen with physical or mental activity.
Examples of common symptoms of long COVID include:
Tiredness or fatigue
Difficulty thinking or concentrating (sometimes called “brain fog”)
Shortness of breath or difficulty breathing
Headache
Dizziness on standing
Fast-beating or pounding heart (known as heart palpitations)
Chest pain
Cough
Joint or muscle pain
Depression or anxiety
Fever
Loss of taste or smell
This is a partial list. Some people also experience damage to multiple organs including the heart, lungs, kidneys, skin, and brain.
2. Can long COVID be a disability under the ADA, Section 504, and Section 1557?
Yes, long COVID can be a disability under the ADA, Section 504, and Section 1557 if it substantially limits one or more major life activities. These laws and their related rules define a person with a disability as an individual with a physical or mental impairment that substantially limits one or more of the major life activities of such individual (“actual disability”); a person with a record of such an impairment (“record of”); or a person who is regarded as having such an impairment (“regarded as”). A person with long COVID has a disability if the person’s condition or any of its symptoms is a “physical or mental” impairment that “substantially limits” one or more major life activities.
This guidance addresses the “actual disability” part of the disability definition. The definition also covers individuals with a “record of” a substantially limiting impairment or those “regarded as” having a physical impairment (whether substantially limiting or not). This document does not address the “record of” or “regarded as” parts of the disability definition, which may also be relevant to claims regarding long COVID.
2a. Long COVID is a physical or mental impairment
A physical impairment includes any physiological disorder or condition affecting one or more body systems, including, among others, the neurological, respiratory, cardiovascular, and circulatory systems. A mental impairment includes any mental or psychological disorder, such as an emotional or mental illness.11
Long COVID is a physiological condition affecting one or more body systems. For example, some people with long COVID experience:
Lung damage
Heart damage, including inflammation of the heart muscle
Kidney damage
Neurological damage
Damage to the circulatory system resulting in poor blood flow
Lingering emotional illness and other mental health conditions
Accordingly, long COVID is a physical or mental impairment under the ADA, Section 504, and Section 1557.12
2b. Long COVID can substantially limit one or more major life activities
“Major life activities” include a wide range of activities, such as caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, sitting, reaching, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, writing, communicating, interacting with others, and working. The term also includes the operation of a major bodily function, such as the functions of the immune system, cardiovascular system, neurological system, circulatory system, or the operation of an organ.
The term “substantially limits” is construed broadly under these laws and should not demand extensive analysis. The impairment does not need to prevent or significantly restrict an individual from performing a major life activity, and the limitations do not need to be severe, permanent, or long-term. Whether an individual with long COVID is substantially limited in a major bodily function or other major life activity is determined without the benefit of any medication, treatment, or other measures used by the individual to lessen or compensate for symptoms. Even if the impairment comes and goes, it is considered a disability if it would substantially limit a major life activity when the impairment is active.
Long COVID can substantially limit a major life activity. The situations in which an individual with long COVID might be substantially limited in a major life activity are diverse. Among possible examples, some include:
A person with long COVID who has lung damage that causes shortness of breath, fatigue, and related effects is substantially limited in respiratory function, among other major life activities.
A person with long COVID who has symptoms of intestinal pain, vomiting, and nausea that have lingered for months is substantially limited in gastrointestinal function, among other major life activities.
A person with long COVID who experiences memory lapses and “brain fog” is substantially limited in brain function, concentrating, and/or thinking.
3. Is long COVID always a disability?
No. An individualized assessment is necessary to determine whether a person’s long COVID condition or any of its symptoms substantially limits a major life activity. The CDC and health experts are working to better understand long COVID.
4. What rights do people whose long COVID qualifies as a disability have under the ADA, Section 504, and Section 1557?
People whose long COVID qualifies as a disability are entitled to the same protections from discrimination as any other person with a disability under the ADA, Section 504, and Section 1557. Put simply, they are entitled to full and equal opportunities to participate in and enjoy all aspects of civic and commercial life.
For example, this may mean that businesses or state or local governments will sometimes need to make changes to the way that they operate to accommodate a person’s long COVID-related limitations. For people whose long COVID qualifies as a disability, these changes, or “reasonable modifications,” may include:
Providing additional time on a test for a student who has difficulty concentrating
Modifying procedures so a customer who finds it too tiring to stand in line can announce their presence and sit down without losing their place in line
Providing refueling assistance at a gas station for a customer whose joint or muscle pain prevents them from pumping their own gas
Modifying a policy to allow a person who experience dizziness when standing to be accompanied by their service animal that is trained to stabilize them
5. What federal resources are there for people with symptoms of long COVID?
The Office for Civil Rights of the Department of Health and Human Services (HHS) has the following page on civil rights and COVID-19: https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/index.html.
If you believe that an entity covered by HHS civil rights laws has violated your rights protected under these authorities, you may file a complaint at https://www.hhs.gov/ocr/complaints/index.html.
The Civil Rights Division of the Department of Justice has the following page on its ADA.gov website that discusses topics related to COVID-19 and the ADA: https://www.ada.gov/emerg_prep.html.
If you believe that you or another person has been discriminated against by an entity covered by the ADA, you may file a complaint with the Disability Rights Section (DRS) in the Department of Justice. Information about how to file a complaint is available at https://www.ada.gov/fact_on_complaint.htm.
CDC’s website has the following page on post-COVID conditions, which discusses long COVID: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html.
The Administration for Community Living’s document, “How ACL’s Disability and Aging Networks Can Help People with Long COVID,” provides information on resources and programs to assist people with long COVID. This document is available at https://acl.gov/sites/default/files/COVID19/ACL_LongCOVID.pdf - PDF .
While employment is outside of the scope of this guidance document, individuals who wish to learn more about COVID-19 and employment can visit the following Equal Employment Opportunity Commission page, which provides COVID-19 information and resources: www.eeoc.gov/coronavirus.
The EEOC’s main COVID-19 publication, What You Should Know about COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws, is available at: https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws.
For information about filing an employment discrimination charge, see https://www.eeoc.gov/filing-charge-discrimination.
Things you can do to help yourself
Minimizing physical & psychological stressors is essential in recovery from Long COVID.
Nutrition: Try to eat protein and fresh vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.
Don’t skip meals. Your body needs protein , vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.
Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time. Remember that caffeine and alcohol have dehydrating effects.Sleep hygiene: Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.
Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring sleep apnea. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that pushes air into your lungs when it senses an apneic episode (periods of not breathing).Stress management: Stress affects every component of your life.
The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
Exercise within tolerance: Pace yourself and do not push your body to extremes in any way.
For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress. This can be hard to gauge, because when you feel good you naturally do more, but if you do too much you may experience symptom flare ups 1-3 days later as the post exertion inflammation builds. Some people describe this as post exertional malaise, others experience severe recovery set backs.
Breathwork: You can literally stop the fight or flight reaction by taking slow deep breaths.
Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.
Long COVID Solutions
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Individual coaching
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Keep moving, keep breathing.
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Resources from covidCAREgroup
Recovery Tools — covidCAREgroup
Education Blog Table of Contents — covidCAREgroup
Long COVID Recovery Information and Resources — covidCAREgroup
Long COVID FAQ — covidCAREgroup
COVID-19 Long Haulers Support Group (Facebook)
Highlights from covidCAREgroup
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Article resources
Social Security Administration | USAGov
Guidance on “Long COVID” as a Disability Under the ADA, Section | HHS.gov
Long-term Symptoms After SARS-CoV-2 Infection in Children and Adolescents
Sequelae in Adults at 6 Months After COVID-19 Infection
Original publication date: January 18, 2023