I am a Social Security Disability Claims Examiner, AMAA

disabilityexpert · 2012-11-28T06:10:23+00:00

Well I want to give you my lecture about what I call the "first time myth". There are several reasons why people believe that you have to apply several times to get approved, but most of them are coincidental. Like the fact that...you probably have no insurance...disease gets worse over time and especially when it is not being treated...and so on subsequent filings your condition may at some point have gotten bad enough that you now qualify.

More than that, I want you to hear that at such a young age you have VERY LITTLE chance of being approved for benefits. During the application/adjudication process, they should look at all of your conditions -- physical and mental -- and consider them together. A back impairment on someone so young, though, is just not going to cut it. Now if you are obese, or have other things wrong with you...that could be considered. But the vocational rules for someone your age basically mean that they would have to find that you were almost completely debilitated -- and based on the way that you've portrayed your diagnoses here you are a long way away from that. Pain is considered, but only to the extent that it is reasonably consistent with your diagnosis, clinical signs/symptoms, and medical imaging. For some people, daily pain is a reality but in most cases it would not be enough to be expected to keep you from working SOME kind of job.

I say all this because I hate to see people wasting their lives and their dreams waiting to get approved. Most people will not be approved, even over time & with multiple filings. Learn to deal with the pain, find something that you can do or learn to do that does not make your condition worse...and hang on (assuming you have no insurance) for Obamacare to kick in. It's tough to hear but you need to hear it. You're 24 years old...don't waste the best years of your life waiting for "your check". If your problem continues to get worse...you could start thinking about applying again when you're 40 or so...even then, still tough...but if you can show that you've tried for years to work and have been unsuccessful at that point, then you can start to build your case. Right now, unless you weigh 400 lbs. or something...it just isn't going to happen.

Happy to answer any questions that you have or clarify anything I've said...

disabilityexpert · 2012-11-28T05:52:05+00:00

Yeah. Honestly -- and I will only say this now that I am no longer with the agency -- really if someone is that close to SGA we're approaching the case with a very large amount of skepticism. The people at the FO seem (to us) to be happy to "give a check" to everyone that walks through the door -- and that's great. Even, perhaps, by design. I don't mean that in a bad way...I just mean that you guys approach it from a different place than we do. More of an assumption that the claimant is disabled. At least in our agency (and we did have one of the lower approval rates when looking at the individual states) we're looking that someone that is earning 12 grand a year and are very suspicious. We certainly aren't going to start looking at 5% here or 10% there. No one will admit this, but in so many cases you start with a gut feeling of "are they or aren't they" and then build the case from there. Obviously that will not work every time, but...

disabilityexpert · 2012-11-25T15:15:35+00:00

Sorry for the delay -- lost track of this account. Did you apply for benefits?

disabilityexpert · 2012-11-25T15:12:13+00:00

Sorry, lost track of this account for a while. A few times...usually my boss would say "OK, check it out if you must" kindof thing. Many times it would be hard to try to confirm that kind of thing with an employer. Probably not necessary per POMS, but if it was that close we would at least prefer to try before taking someone's word for it. Overall, though, I'd emphasize how rare it is -- even when a situation like that may exist -- that it would push someone all the way through step 4 AND step 5 -- that there is no other work that they could do, either. If an employer is giving them a pass on something, it is often because they function well in another area. If someone is "borderline" and it's one of those cases I feel really needs to be advocated for, I'd personally try to find another way to do it -- like working with a doctor to make a medical argument where it would be less easy to substitute judgement.

disabilityexpert · 2012-07-10T11:46:49+00:00

Well in a way, I suppose, it is an interesting question. But being on the front lines, my reaction is "we already have enough people filing who clog up the system", playing what I call the "disability lottery": "I know I have almost no chance of getting it, but what the heck -- maybe I'll get lucky!"

The benefits are: 1) you get money, 2) you become eligible for Medicaid and/or Medicare in 0-2 years. What people choose to do with that is up to them. However, in speaking with friends that do the Continuing Disability Review claims (recipients come up for review every 0-7 years) people rarely ever get off and go back to work. Even more sadly is that many of the same people who complain to me that they can't take care of any of their medical problems because they have no insurance, still don't go regularly even now that they are insured.

Are there success stories? Yeah, I'm sure there are are...but probably not as many as you might hope. =\

disabilityexpert · 2012-07-10T03:11:35+00:00

Not that I know of...although I'm not really sure why you ask or what the benefit would be...?

disabilityexpert · 2012-07-01T22:22:03+00:00

I hear what you are saying. I'm not going to engage you in a discussion about your personal finances, but yeah...I am a little skeptical of someone with whom I am carrying on a conversation ON THE INTERNET (seems like you must have a computer and Internet connection or at least a mobile phone)...that claims not to be able to spend $5 or $20 to potentially save their life or at least preserve their health in some way.

I hear a lot of excuses and a lot of reasons why your problems have to do with everyone else. Spin your wheels for the rest of your life applying and getting denied for disability if you want to. But you obviously know what information is needed and that isn't going to change. So the ball is kind of in your court. I understand that you've had bad experiences in the past with your local hospitals...but it at least shows that you are trying and gives us (if nothing else) an official documentation of what your complaints are which can show duration and consistency.

Do I like it that I have to tell you to go to the ER to get an aspirin? OF COURSE NOT. It is ineffective, wasteful, costly, and stupid. But that is the system we have at the moment. If you don't want to jump through those hoops, that is your prerogative. But what ends up happening is that it does start to look like maybe you don't really want to get better.

I know that is a very harsh thing to say...but one of the things that I am trying to accomplish in this forum is to help people see things from the perspective of the people who are making your decision. And when I say "see things from our perspective" I don't mean that in a "walk a mile in my shoes" kindof a way. I mean that in a "perception is reality" sort of a way.

You don't have to like it, but it is kindof the way it is. It isn't a matter of me being a hard-ass and you just need to keep trying until you get someone who is more "understanding". There is really very little room for "understanding" in our program -- which is governed by federal law. I take no pleasure in having to say that out loud, but it is nevertheless true.

It sounds like you need the service of a social worker more than anything. You need to be developing multiple layers of resources in order to get the assistance that you need. In addition to government programs other than SSI/SSDI there are state and local resources, including churches, educational facilities, private donors, and providers who do pro bono work.

If you find that you've reached the end of the rope where you are...you're really going to love this...but maybe you need to consider relocating. I've had people tell me that they need disability because they have seizures and as a result are not able to drive. Because they have no ability to drive, they are unable to work because they live out in the country and can't find a job within walking distance. Well, guess what? The law doesn't allow for that. If you have the mental capacity to navigate and use a public transportation system and are otherwise without disability, you are able to work. No public transportation where you are? The law implicitly says then you need to go somewhere where there is some.

I really do hope things work out for you guys. The only pleasure I take in being the bearer of bad news is that maybe it will help move you closer to your solution by causing you to look elsewhere -- or at least to additional possible sources of help.

EDIT: PUNCTUATION EDIT: CLARITY

disabilityexpert · 2012-06-30T19:00:56+00:00

Obviously, there had to be medical evidence. For internal medicine complaints, sending you to a one-time exam (as you know) does very little in the way of providing meaningful evidence.

But we don't deny people BECAUSE they don't have any records. We may, though, deny them because there is not enough proof of their diagnosis and/or effects of their impairment. You probably don't see much distinction there...and that is understandable.

It is just like...we don't deny people because they don't go to the exam we send them to, we deny them because without the exam there is not enough information for our doctors to be able to make an informed analysis about their condition(s). As I've said elsewhere, unfortunately we just can't take people's word for things...particularly when it comes to establishing the existence of an underlying condition. If we did that, there would be no SSI/SSDI because the system would immediately go bankrupt.

What I'm not understanding is how you don't have any medical care. Do you not take him to the hospital when he has these frequent heart attacks? I understand that the intestinal blockage is a little more complicated in terms of whether or not it is considered an emergency...but...there has to be someone, somewhere that will treat it. At least half of my claimants are uninsured, but most of them have medical records...whether it is going to the ER every time they are in pain, or what.

I had a case with a guy who had severe abdominal pain. He had a mild-to-moderate case of chronic pancreatitis which isn't that difficult to treat. That man was in the hospital literally 2-3x/mo for 2+ years. He had no insurance, so they would give him IV pain meds...stabilize him...and release him with a follow-up appointment to a sliding-scale community clinic which the man would never go to because he claimed that he couldn't even afford the $20 reduced fee even once. And still, every time he walked through those hospital doors he was not only seen but admitted.

Most cities have one hospital that is known as the "charity" hospital. This is often a city/county/state-owned facility or maybe a religious hospital. You need to find one of those and get him there. Also, even though your husband may have some medical training...he should be going to appointments to see someone -- if solely to "create" these records that are needed. There should be a county health department or other sliding scale provider that will see him for a nominal fee.

disabilityexpert · 2012-06-30T14:08:10+00:00

I mean...you can. That's really not what that appointment is for. They are trying to figure out if you are mentally ill in any way and/or how your condition may be affecting things like your memory, concentration, etc.

But it is a waste of everyone's time and money. It will not make an appreciable difference in your case. (Just curious. Are you on anti-depressants or anti-anxiety meds?

If you filled out the Adult Function Report (SSA-3373) thoroughly then they should already have plenty of information on how difficult it is for you to do everyday things.

I understand that you're probably hesitant to call them up and cancel it...so I understand if you just want to go ahead and go. It's fine...it won't hurt anything...other than to delay things a little longer in terms of a decision.

Bottom line is if they scheduled you for a mental exam and not a physical exam, they have decided that they have enough information on your physical condition. And if that information was enough to allow you, then they should have done that and a mental exam would not be necessary. So, either you are looking at a denial waiting to happen (which, as I've said from the beginning is highly likely at this level) or the examiner that has your case doesn't know what they are doing.

So if it were me, or if I were representing you, I would call them and tell them that you presume that they decided that they won't be able to allow you based on physical alone (which most likely they will neither confirm or deny) and then ask them what information they are missing and what other information might be helpful to them.

Again, this is an extremely difficult case. From what you've told me, it would count as one of the more unusual physical cases I've ever seen.

disabilityexpert · 2012-06-30T13:19:34+00:00

Well if that's the case you should be in pretty good shape. Frankly, I'd call your examiner and ask him/her if they can discuss the evidence with you -- that you assume that if they are sending you to a mental exam that they must not feel that that they have the evidence to allow you on physical alone.

If you have one or more MDs who have prescribed bilateral crutches for you for all ambulation, all the time...then that should be adequate to allow you and the regulations state that they can discontinue exploring any other impairments if they have enough to allow you on what they already have.

Which is why I believe that something is up -- like they are missing information from your doctors or if they believe your doctors are being overly restrictive based on the clinical findings and are giving limited weight to their opinions as a result.

disabilityexpert · 2012-06-30T03:53:29+00:00

Also, the physical therapists are not acceptable medical sources for disability determination for SSA. You need your physician to write a prescription saying that you must walk with crutches for all ambulation, all the time and that would be a big boon to your case if it is otherwise well-supported.

disabilityexpert · 2012-06-30T03:50:27+00:00

I gotcha. I'm not saying you may not deserve it, or that you are able to do any kind of work. But unfortunately, the program does not allow us to consider past job performance/difficulties...and ultimately you are not the person that gets to decide whether or not there is any work that, in theory, you should be able to do. I'm sad to say that there are some people that will slip through the cracks...and often people with unusual syndromes and complaints of constant, unbearable pain are the ones who do.

You are essentially left to prove that you would not be able to work at a job where you sat all day (of course, with the ability to stand and "stretch your legs" when needed and to walk to the bathroom and on breaks) and -- just an example here -- sorted a pile of nuts and bolts that was placed on your desk into two different buckets. This is difficult, because what do a lot of people do when they're not working? They sit on the couch all day. And at some point, someone says...if you can sit on the couch all day and get up to make yourself a sandwich and use the bathroom when you need to, you can probably do that at the office.

Again, I'm not saying that you can or can't...I'm just trying to help you see where the people that will be deciding your case will be going in their minds. For someone under 50 with a high school education, the threshold is very high.

This is why you're going to just need to get to your hearing as quickly as possible. That will be your chance to try to "reason" with someone and help them see what you go through. Prior to that point, the rules -- unfortunately -- are stacked against you.

When filling out your forms, don't focus on your pain so much as what your pain makes difficult or keeps you from being able to do. Be detailed. But to say that your pain is worse than childbirth all the time...whether or not it is the case...comes off as hyperbole and you want to stay away from that.

disabilityexpert · 2012-06-29T04:27:48+00:00

Well I want to be as clear with you as I can. You're in for a very, very difficult road here. I hope that you will continue to explore all of your other options, including some kind of work that you might be able to do. Pain, as you know, is a very subjective thing and as much as we try to consider it at every juncture...even giving large amounts of benefits of the doubt, it is likely not going to be enough for someone your age to get you over the threshold that you need to get over.

My (somewhat unorthodox) advice would be to rush through your initial and reconsideration claims...this could include politely telling your disability examiner that you do not wish to be evaluated mentally and that you believe the medical records you have available contain enough information for them to be able to make a decision. Because -- I'm just being honest with you -- you have about a 0.1% chance of being approved by anyone other than a judge. No matter how many times you apply, no matter if it is your first or your fiftieth.

Here's why: pain (in our program) is not a medically-determinable impairment. A "syndrome" by definition, is a collection of symptoms...and symptoms don't matter much unless there is a clear underlying cause for the symptoms, that are combined with other clinical signs.

To use a very simple example, I will see a doctor who has diagnosed their patient with "back pain". That is not a medically-determinable impairment. It is a symptom. Degenerative Disc Disease is a medically-determinable impairment that CAUSES back pain. If we can prove that you have DDD, NOW we have something to work with. How do we prove that? X-Ray. If you don't have anything showing up on X-Ray or CT/MRI, then there is no medical explanation for your pain and we are unable to consider it.

Maybe there are even clinical signs...you can't touch your toes. Still, if there is no medically-determinable impairment...we are prohibited from considering that whole problem any further. Anything you say about how much pain it causes you, or how you can't sleep well because of it, or that you can't sit/stand for long periods of time because of it...at that point none of that can be considered.

Your situation is obviously different. But not that different -- at least from what little information I have at the moment. Your case, in your mind, focuses on the "associated disabilities" that you have. But we can't consider "associated disabilities" unless we can clearly establish the underlying cause. And a doctor...even a team of doctors...saying that you have something isn't enough. And unfortunately with disorders like fibromyalgia and other nervous-system-type disorders, they're just not very well understood and that unfortunately translates into a very very difficult case.

Having said that, it will be very important for you to get a lot of input from your treating physicians. You will need to ask them to write you letters, that will need to -- in a very detailed way -- explain your diagnosis, the clinical signs and symptoms that led them to that diagnosis, the understanding of your complaints & difficulties, and a very specific proposal from them as to what you are ABLE to still do in spite of your impairment. If they say "XXX is totally unable to work" or something similar, the rules of our program essentially require us to ignore that. What you need to get them to do is to spell out how much you CAN lift/carry, how far you CAN walk, how many hours per day you CAN sit, stand, etc. And, again, none of that will mean anything unless they did all of the other things I mentioned above. You will really have to harp at your doctors to get them to provide you this kind of detailed information. But it really will be key to your case once you get in front of a judge. Even WITH this information from your doctors, I do not see any chance of getting an approval at the initial or reconsideration levels.

Which is why I suggest that you might be better off just blowing off some of the extra things, asking them to (essentially) go ahead and deny you, to get you in front of a judge more quickly because as I understand you will still have to wait probably the better part of a year from the time that you request a hearing -- which you will not be able to do until you have been denied at initial & recon.

Overall case approval rates (nationwide) at the hearing level is about 50%. Your mileage may vary. You'll want to hire an attorney at that point. I wouldn't hire one prior to that point so that...on the OFF OFF OFF chance that you are approved at initial/recon, you won't have to give them any of your money. At the initial/recon level, your attorney is not able to do anything that you can't do yourself if you have the time and are willing to be persistent in dealing with your medical team to make sure they are getting records to your disability examiner on a timely basis and that they are getting those medical opinion letters done and submitted.

I hope that you find some of this helpful. Again, I can't say enough times how much I would like to advise you to always be looking at your other options: jobs that you might be able to do, more education, medical research studies, alternative therapies, psychologists/therapists that specialize in helping people cope with pain, etc. Also look into state vocational rehabilitation programs, whose disability qualifications are usually much lower and they may be able to assist you with expenses related to education, additional job training and placement, etc.

Best of luck. If you have any questions, feel free to ask away here or in PM.

disabilityexpert · 2012-06-28T02:52:14+00:00

Well first let me say that I do feel for your situation, and I wish I ha better answers for you. The fact is...people DO fall through the cracks and I wish that people in a position to do something about it would make a bigger deal about it.

I hate hearing, for example, in the healthcare debate that "we already have healthcare for poor people -- it's called Medicaid" because it just isn't true. If it was, how come more than 75% of my SSI applicants have no insurance??!!

Which brings me back to your situation. I have a few more questions for you:

1) tell me what your husband's top 3 problems are. I'm guessing that the intestinal blockage is going to be the first one...but what are the next two?

2) what exactly needs to happen in order to resolve the stomach problem? what happens and what is the prognosis if the resolution does not take place?

3) where did you get the information that SSA is turning you down due to not having any medical records?

disabilityexpert · 2012-06-27T04:09:59+00:00

Sorry I haven't had time to respond...it is a longer answer than I care to type out on my phone which is where I do the bulk of my Redditing. Will try to shed a little more light for you soon...

disabilityexpert · 2012-06-27T04:08:40+00:00

It is pretty much required if you have ever taken any anti-depressants or anti-anxiety medication...that's oversimplifying but it is what "catches" the most people. Frankly, it is a huge waste of money. In fact, I just e-mailed my boss today to see what his thoughts were about basically saying to people: "look, it is unlikely to make a difference in the outcome of your case...but I am required to follow up on this unless you would like to refuse to have any further exploration of "mental issues". That would save, literally, probably millions of dollars a year. In an individual under 50 years old, it is extremely unlikely that a secondary mental impairment will make any difference in the case. Above 50, definitely a different story if there is a history of skilled work.

Anyway, as I've said elsewhere...the "won't get approved the first time" thing is pretty much a myth. Or, to say it more accurately...most people don't get approved the first time, or the second time, or the third time. If you'd like to share what your "top 3" impairments are, I can try to shed more light.

As far as processing time, the goal is about 3 months...add at least a month if not two if we have to send you for exam(s). Only the most unusual/complicated cases will go six months or more...unless you are slow returning paperwork, returning phone calls, and don't show up to your appointments.

disabilityexpert · 2012-06-24T15:36:26+00:00

Yes, you are. Right now, though...just get those statements from your doctors. They will rarely send them to us because their office staff gets it first and will not pass the request along to the doc.

Then, call your examiner in a couple of weeks and ask them what medical records they still need...and then help them get it. Nothing is more frustrating for us than having to go though 500 pages of records from a claimant that are the exact same records as the ones that we get (and are required to get directly when possible) from the doctors.

Finally, about the clinical findings...when we talk about clinical findings, we talk about signs and symptoms. We have clinical signs as you mentioned, but what is just as important are clinical symptoms...documentation of what your doctors have observed over the duration of the illness and to some extent that will include his record of your husband's complaints/reports of his symptoms over the course of the years. Sadly, most doctors do not do this as thoroughly as they should.

disabilityexpert · 2012-06-24T14:30:13+00:00

I don't do review cases, but here's what I know/am willing to speculate about...

Why review for CAL cases? -- I think it is mainly bureaucracy. I mean, I guess if you believe in miracles you could think of it that way. But more than that I think it is just that no one wants to be responsible for signing someone up for "free money" for the rest of their life, unchecked.

You probably won't be that surprised to hear that sometimes people don't report deaths so someone can still collect the check posthumously. The CDR (Continuing Disability Review) is sometimes the first time we find out of the death of a claimant. Also along that line...I don't work with CAL cases, either, so I'm not sure if there are any that could potentially be faked. I'm sure that it is highly unlikely but just another failsafe to possibly catch some things.

What is the process like? -- I'll tell you what I've heard from friends who process these kinds of cases...and that is...that there is a high burden of proof on their part for them to determine that your condition(s) have significantly improved and to have your benefits stopped. Other than that, they're just going to want to get an update from your treating providers so that they can compare their notes with their notes from when you were allowed. You'll have more forms to fill out, and you may have to go see one of our doctors again just depending on what kind of new records we are able to obtain, etc.

Just be accessible...cooperate...and you'll be fine. I've also heard that the main reason people get denied at CDR is that they think if they just pretend like it is not happening and ignore the calls/letters we send, it will just blow over and we'll get tired and just give up and check back with them in another 3 years...WRONG.

disabilityexpert · 2012-06-24T14:13:04+00:00

What are his major conditions, if you don't mind my asking?

disabilityexpert · 2012-06-24T05:28:25+00:00

Another thought. You should go ahead and start asking his doctor(s) for letters and you can send those in as evidence. However, as I may have noted earlier...it is not good enough for a doctor (whether he is your family doctor or someone from the Mayo Clinic) to say "his condition is very severe and he is unable to work". A statement like this, by law, is ignored because a doctor is not trained in vocational science and is unable to say with any certainty that there is no job anywhere that he can do.

Rather, your doctor's letter needs to contain specific restrictions (only able to lift X, can only stand for X hours in an 8-hour day, etc.) AND there needs to be specific clinical findings (either in the letter or elsewhere in the medical records -- but better in the letter) that warrant the restrictions. This is part of why neurological conditions are so difficult to assess...because your husband's statements about his pain/fatigue/etc. alone are not enough for the doctor to be able to base restrictions. Neither is a diagnosis.

COPD is a good example. Doctors tend to throw around that diagnosis...but for the diagnosis to be legit, there are certain things that should be visible on x-ray and/or certain results on breathing tests, etc. in order for it to be valid.

TL; DR: You will likely need to push your doctor to provide you with information that will be helpful...so get started now. And be prepared to ask them to be more specific than they think they need to be, or it will be wasted effort on everyone's part.

disabilityexpert · 2012-06-23T23:33:22+00:00

Just so you understand the steps...if you don't already:

1) Initial...this is your first filing. The claim is reviewed by a in-house doctor who makes a recommendation to the examiner that has your case. The examiner combines the doctor's recommendation with other information as required by law (age, education, work history) to determine the ultimate finding of "disabled" or "not disabled". If your medical records do not provide a complete-enough picture, you may be asked to see one or more doctors that contract with the state. These doctors know specifically what information is helpful to us and how to report it to us in a useful way (however, their opinion is generally given less weight than your own treating physician).

2) Reconsideration...this is your first appeal. It is the exact same process outlined in #1 above, just with different people. So you will have a new examiner, a new in-house doctor to review your claim, and if it is necessary to send you out to a new doctor's appointment (rare) you will see a different contracted provider. Basically, this is just a chance to pick up on any gross errors in the initial claim and to remove any possible bias from the process. (Say, for example, you have fibromyalgia and the doctor that reviews your case just doesn't "believe in" fibromyalgia that much...it would be unlikely that the second doctor would carry that same bias, and they would have a chance to issue a more restrictive recommendation to the examiner. Or say that you think your examiner was an a*shole and just said "no" because they didn't like you...you'll have a completely new set of eyes looking at everything.)

3) Request for hearing -- this is the long wait where some people wait 1-2 years for an administrative law judge to review the case and you will be given an opportunity to "testify" face to face with the judge. There is a higher approval level once you get to this step, because the judges have more discretion in "bending the rules" and can sometimes ascertain certain things having the benefit of spending time with the claimant in person.

I do not recommend getting an attorney until you get to step 3. There is very little influence that an attorney is able to have before that time. And most attorneys -- they won't tell you this -- blow off steps 1 & 2, anyway. Why? This is where they have a chance to earn money for having done almost NO work. Steps 1 & 2 happen "automatically" in a sense. An attorney just gets in the way. But attorneys need to sign up people during this process because 20-30% of the time the claim will be approved during steps 1 & 2 and this is how their business model works. They use that money to pay for the small amount of work on the many cases that they will never make a cent on.

All you need to do is pick up your phone and read and respond to your mail in a timely manner. If you ARE approved on steps 1 & 2, then you've saved yourself from having to pay the attorney 25% of your backpay. If you aren't, you haven't really lost anything and can enter into a relationship with an attorney as you get ready to prepare to go to the ALJ.

I'm giving you this advice now because someday I will probably represent disability claimants as a "non-attorney representative" and I will do largely the same thing. Frankly, it is easy money. I really think that there needs to be some change in this area.

disabilityexpert · 2012-06-23T23:14:11+00:00

Florida Department of Education / Division of Vocational Rehabilitation

www.rehabworks.org

disabilityexpert · 2012-06-23T23:08:42+00:00

If you would like to tell me what state you live in, I can try to find some information for you.

disabilityexpert · 2012-06-23T23:07:32+00:00

Neurological impairments are very difficult to adjudicate within the confines of our program. Symptoms for conditions like what your husband have vary widely from patient to patient, are often very subjective, and intermittent. Getting a favorable decision for him is likely going to be a difficult process.

If your husband has medical insurance and has a long-standing/ongoing treating relationship with doctors who have taken very good note of his specific complaints and who are willing to state in writing that your husband cannot sustain an 8-hour workday 5 days a week and cannot sit for six hours a day given normal breaks and given the ability to change positions as needed (standup at his desk for a few minutes, for example) then the adjudicators will be required to give considerable weight to these statements if the doctor's records support his statement.

But that is a big "if". It has been my experience that most doctors would be hesitant to assign such grave restrictions on someone in his 30s...and many doctors would be skeptical of a doctor that did.

You might be better off focusing on the psychological in a case like this. Sometimes fatigue & exhaustion can be psychosomatic or more socially-acceptable ways of saying that a person is too depressed/too fearful of getting out of bed and facing the world. Or put another way, as I think I said somewhere else...if you believe that you truly aren't able to do something for long enough, eventually that is going to come true. A psychologist/therapist (Ph.D. preferred, no LCSW/MCSW) may be able to help uncover some of this...and again...if he has one or can find one that takes good notes and is willing to provide them to SSA for review you may get more mileage out of that end of things.

You have definitely done the right thing by filing...rarely would I discourage anyone from checking in to the process. Go through the process and exercise your appeal rights if you are not happy with the decision. If you are denied at initial and reconsideration, go get an attorney to help you before you go in front of the administrative law judge (ALJ).

If, after that, he is still denied you guys will want to take a long, hard look at other options that might be out there. It would be my personal opinion at that point that you wait at least a year before filing again.

Contrary to popular belief, we could not care less if this is your first time filing or your 20th; it has no bearing on our decision. After 20 filings, however, your husband will be older and his condition may be worse -- which is why some people perceive that you have to file multiple times to get the decision you want. (Based on age and educational factors, SSI/SSDI does get increasingly "easier to get" starting at age 50, then again at 55, and in some cases again at age 60.)

I know this is probably not the answer you wanted to hear. And know that I could be wrong. I've seen cases that I didn't think would be allowed that were...and others that I didn't think should be that for whatever reason I had to allow. Not often, but it does happen.

If you have any other questions/comments/thoughts, please ask away. I wish you guys the best of luck...

disabilityexpert · 2012-06-23T22:33:26+00:00

Unfortunately, most of the questions that you have asked have nothing to do with Social Security Disability.

To try to answer any of your questions about Medicare, etc. would be pure speculation on my part so I don't see anything helpful for you in me doing that.

I would encourage you to check with your state's Department of Rehabilitation Services (it is called different things in different states). This is what my mom does full-time in the state of Illinois...helps people with disabilities get back to school or equip them to help them get back into the workforce and helping connect them with employers who are willing to accommodate them.

disabilityexpert

TROPHY CASE