Sample doctor's letter supporting disability application

October 16, 1997

RE:

To Whom It May Concern:

This letter is in support of the application for disability insurance benefits and/or Supplementary Security Income by the above referenced patient/person who has a disabling impairment of visual function -- Essential Blepharospasm (with or without associated myofacial dystonial Meige syndrome).

Essential blepharospasm is a neurological condition characterized by abnormal, involuntary, prolonged closure of the eyelids and/or impaired eyelid opening in the absence of spasm. This disabling condition may be present when the patient is seated and at rest (for example, when driving a motor vehicle, engaging in social activities such as conversation across a desk or table, watching television or reading.) The condition also may be present when the patient is walking.

Thus, at times, to avoid a collision or fall, the patient may be forced to attempt to hold his/her eyelids open with one hand while driving with the other, or to stop the vehicle completely, or to stop walking until the spasm is relieved.

The symptom can be associated with other abnormal movements of the mouth, neck and muscles involved in speech, in which case the patient can have occupationally and socially unacceptable movements of the face, mouth, head and neck. These motions are regarded as disabling and occupationally unacceptable because they so distract other persons that the afflicted person might not be able to engage in a normal occupational relationship, such as sales or teaching.

The Blepharospasm patient might also have severe spasmodic dysphonia in which voice quality suffers from extreme breathiness or a constricted, choking impairment. This, too constitutes a severe occupational impairment.

Essential blepharospasm, with or without related myofacial or other focal dystonias (such as spasmodic torticollis), is usually idiopathic, although it can be secondary to other neurological syndromes such as stroke, neuro-degenerative diseases, or drug toxicities. Very few patients have familial involvement.

With regard to categories of impairment under the listing of impairments -- Appendix 1, Subpart P of Social Security's Regulation 4 -- the main disabling features of essential blepharospasm are cited under Sections 2.02 and 2.03. When the patient's eyes are essentially closed, he/she might have no vision or visual acuity in the better eye after best correction of 20/200 or less.

With regard to Section 2.03, the patient may have loss of contraction of the peripheral visual fields in the better eye such as to have a visual field that neither extends 10 degrees from the point of fixation nor subtends an angle greater than 20 degrees, thus producing a visual efficiency of less than 20 degrees. Although these losses are intermittent and episodic, they nevertheless prevent the patient from functioning continuously in order to drive, walk or read.

I believe this patient, like some other Essential blepharospasm patients, could meet the standard of impairment under Sections 2. 02 and 2. 03 because this person is at that level of impairment at least _ percent of the time. The condition is not reversible by medical means and is expected to persist for the rest of his or her life.

Furthermore, the patient's essential blepharospasm and associated dystonia, vocal problems and spasmodic torticollis (if present) might also qualify under Section 11.17 as a "degenerative disease not listed elsewhere" as causing disorganization of motor function.

Please review the enclosed consultation report that indicates the prior pharmacotherapies as well as any surgical treatment this patient has had. Unfortunately, in general, there has not been a significant and sufficient benefit from the various treatments to enable all patients to continue in productive work. Severe loss of efficiency, mobility and ability to maintain normal social interactions is not unusual. Further medical improvement is not expected at this time. Because of these problems in work function, the disorder with which this person is afflicted could very likely demonstrate that he/she is totally and permanently disabled, as I understand the relevant Social Security standards.

Please let me know if additional information is required.

Sincerely yours,

Jonathan D. Wirtschafter, M.D., F.A.C.S.
Professor, Frank E. Burch Chair of Ophthalmology
Director, Neuro-Ophthalmology, Orbital and
Oculoplastic Surgery Services