Dear Dr. Jones:
As we have discussed, I have made the difficult decision to apply for Social Security disability because of the on-going circulation problems in my legs. As you may know, Social Security will deem me disabled if I meet a “listing,” – in this case Listing 4.11 Chronic venous insufficiency, which is shown below:
4.11 Chronic venous insufficiency of a lower extremity with incompetency or obstruction of the deep venous system and one of the following:
A. Extensive brawny edema (see 4.00G3) involving at least two-thirds of the leg between the ankle and knee or the distal one-third of the lower extremity between the ankle and hip.
B. Superficial varicosities, stasis dermatitis, and either recurrent ulceration or persistent ulceration that has not healed following at least 3 months of prescribed treatment.
The entire Cardiovascular System listing may be found at https://www.ssa.gov/disability/professionals/bluebook/4.00-Cardiovascular-Adult.htm.
If you agree that I meet this listing it would be extremely helpful if you could write a letter to Social Security about my condition. I would ask that you include:
□ dates of treatment
□ types of treatment attempted
□ types of medications used
□ explanation of treatments attempted
□ conclusion that my condition meets what is described at 4.11 as of _______________ (the onset date I am claiming).
As I have stated, I will consider any type of treatment that may help restore my function so I can return to work. At this point in time, however, I feel that I have no choice but to file for disability and anything you can do to help me in this pursuit would be greatly appreciated.
Very truly yours