Social Security Disability: Mastering the Red Tape When You have Invisible Illness

Scales of Justice

SSDI and Their Expert Witness

Make sure you doctor is documenting what you say in your medical record. Don't assume anything.

What the SSA wants to see is how illness affects your ability to function and with objective measurable criteria.

• What is your cognitive-neuro score? This is a grueling all day tests that measures your cognitive deficit and is administered by a credentialed forensic specialist psychologist.
• How does altered sleep interfere with your ability to copy with everyday things?
• How long does it take you to prepare for work?
• What is your life like at work?
• Is your work willing to make accommodations?
• Have you had to make adjustments to your work schedule in order to cope with the pain and fatigue?
• What is your work record like, are you unable to make it many days, and if so, why?

Excerpt from Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain. Read more here.

The ALJ may request expert testimony from medical and vocational experts. These “experts” may or may not have firsthand knowledge of [FM, CFID, myofascial pain, systemic Lupus, RSD/CRPS, Lyme’s disease, GWS, or other invisible illness.]  In my experience, finding a doctor who is aware of these conditions was difficult, so you can well imagine the knowledge base of the ALJ’s “expert witness.” The laws protect the claimant to some extent in that the ALJ must give more weight to the opinion of the claimant’s treating doctor than to the opinion resulting from a one-time medical exam requested by SSA or their team. However, the judge’s expert witnesses have more impact on the ALJ’s decision when the claimant’s physician has not adequately addressed and documented key issues in the claimant’s medical record. This is why it is so important to make sure your medical records reflect the continuing disabling effect of chronic pain.

WINNING A SSDI APPEAL

Getting Turned Down—What Next? Book excerpt  from “Approaching the System Systematically”

Your denial letter will most likely suggest you do some specific type of simple, sedentary work. The SSA gets their suggestions from the Dictionary of Occupational Titles and their suggestion may have little or no relevance to your claim. If you disagree with the decision, you can request a review, called an “appeal.” There are certain guidelines for filing the appeal, so be sure to verify information with the Social Security Administration.

Here  is a link you might find helpful. http://www.ssa.gov/pubs/EN-05-10041.pdf

IF YOU ARE IN APPEAL, you need a good attorney. I hear over and over again from people who lose at this stage, they are not happy with their legal representation. Your attorney needs to understand what your illness is, the repercussions, other issues, and how they all come together to affect your ability to function. Educate them.

How do you make it through a day? How many hours to you have to care for the unpredictability of it all. Day by day, moment by moment we are held hostage by our symptoms.

Explain this in a daily diary; buy a calendar at the $1 store and document symptoms, treatments, medications, and whether or not they work. Photo it and get it into your medical record and give a copy to your attorney. Let them see, make them see, what it is to walk a day in your shoes.

Even though you may have a SSA qualified illness, your application for SSDI benefits can turned down. They based their decision not on your diagnosis but on your ability to function, or more sadly, the lack of documentation.

If you have brainfog, get that neurocognitive exam.

My doctors saw me holding on to work by my fingernails. I did not go down easily. I cut my hours, changed gears, until I had to face the grim reality. The majority of us have stumbled down this road, quite literally. The SSA does take stock in what your personal doctors have to say. Make sure they say it.

If you lose at this level, don't give up! Remember, get your documentation in order, and consider hiring another attorney if yours is unfamiliar with our illnesses. Most work on commission and their fee is capped.

There is an entire section in the book devoted to SSA filing, documentation, what to expect, etc. The book has many documentation tools throughout to help you explain your condition and needs, painting a picture for your physician to help in his assessment. Using the forms will also get the information in your medical record. Make sure you physician puts the help sheets in your record where it belongs. It will help him/her save time and validate to the powers that be, why the treatments and medications are given, etc., and explain what it is like to be in your body.

When defeat comes, accept it as a signal that your plans are not sound, rebuild those plans, 

and set sail once more toward your coveted goal."

--Napoleon Hill

 Final Tips:

• Always be truthful
• Document everything, even your conversations with SSA (you won't remember, but they will)
• Explain what it is like on your worst day (I recommend having someone help you fill out the paper work during these periods, as most likely you will not be able to. It is human to dismiss how bad things are on a bad day when you are having a good one. This is what your life is like, explain it in no uncertain terms, it is difficult for those who do not experience our pain and fatigue to know what it is like).

Other links you might find helpful:

From my website - When pain and disability is life limiting. The Seven Rules, here.

https://thesethree.com/Pain___Disability.html#.UhDfDJKOAtg

Social Security Application

http://www.socialsecurity.gov/applyfordisability/

SSA Listing of Impairments (Blue Book)

http://www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm

SSA Listing of Impairments Part A

http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

SSA Listing of Impairments Part B (Childhood)

http://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm

Fibromyalgia Residual Function Questionnaire

http://www.docstoc.com/docs/16448838/Fibromyalgia-Residual-Functional-Capacity-Questionnaire-_without

You can find the book at all major retailers. There is a synopsis on the book and links for purchase.  though it was written with specific patients in mind, 80% of the material can apply to anyone living with invisible illness.  In healing and hope, Celeste

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Social Security Disability - Mastering the Red Tape

SSDI and Their Expert Witness

Make sure you doctor is documenting what you say in your medical record. My neuro of 25 years, put only, no changes. I developed a form, filled it out, reviewed it with him. He said, yes I know all this, but it is not new. I asked him if he would sign it and put it in my medical record. He did! Don't assume anything.

What the SSA wants to see is how illness affects your ability to function and with objective measurable criteria.

-What is your cognitive-neuro score? This is a grueling all day tests that measures
your cognitive deficit and is administered by a credentialed forensic specialist
psychologist.
-How does altered sleep interfere with your ability to copy with everyday things?
-How long does it take you to prepare for work?
-What is your life like at work?
-Is your work willing to make accommodations?
-Have you had to make adjustments to your work schedule in order to cope with the
pain and fatigue?
-What is your work record like, are you unable to make it many days, and if so, why?

The Social Security Administration's (SSA) own doctors said I should not do anything that requires repetitive long term motion of my upper extremities and hands, and that I should not stand or sit for prolonged periods. This was THEIR doctor. Yet in my denial letter they suggested I get a job as a "doll maker." Obviously the system is overloaded. Don't stop, file an appeal.

(Excerpt, please see copyright guideline)

The ALJ may request expert testimony from medical and vocational experts. These “experts” may or may not have firsthand knowledge of FM, CFID, or CMP. In my experience, finding a doctor who is aware of these conditions was difficult, so you can well imagine the knowledge base of the ALJ’s “expert witness.” The laws protect the claimant to some extent in that the ALJ must give more weight to the opinion of the claimant’s treating doctor than to the opinion resulting from a one-time medical exam requested by SSA or their team. However, the judge’s expert witnesses have more impact on the ALJ’s decision when the claimant’s physician has not adequately addressed and documented key issues in the claimant’s medical record. This is why it is so important to make sure your medical records reflect the continuing disabling effect of chronic pain.

WINNING A SSDI APPEAL

Getting Turned Down—What Next? excerpt from “Approaching the System Systematically” (copyright rules apply – See copyright in the discussion topics)

Your denial letter will most likely suggest you do some specific type of simple, sedentary work. The SSA gets their suggestions from the Dictionary of Occupational Titles and their suggestion may have little or no relevance to your claim. In my case, their own doctor told them I shouldn’t do any type of work that required repetitive hand motion. When they then suggested I get a part-time job as a doll-maker, I was quite sure they hadn’t really looked at my case with genuine concern(By the way, I use a voice-activated program to prepare most of my writing, which takes a great deal of time, compared to direct transcription. It’s not conducive to steady employment, but the finished product, regardless of the overwhelming amount of time it takes to prepare, is rewarding in other ways.)

If you disagree with the decision, you can request a review, called an “appeal.” There are certain guidelines for filing the appeal, so be sure to verify information with the Social Security Administration.
-End excerpts

IF YOU ARE IN APPEAL, you need a good attorney. I hear over and over again from people who lose at this stage, they are not happy with their legal representation. Your attorney needs to understand what FM, CFID, CMP or other issues are and how they affect your ability to function. Educate them.

How do you make it through a day with FM, CFID or CMP? How many hours to you have to care for the unpredictability of it all. Day by day, moment by moment we are held hostage by our symptoms.

Explain this in a daily diary, buy a calendar at the $1 store and document symptoms, treatments, medications, and whether or not they work. Photo it and get it into your medical record and give a copy to your atty too. Let them see, make them see, what it is to walk a day in your shoes.

A close family member has MS. Even though she had a SSA qualified illness, her application for SSDI benefits were turned down. They based their decision not on her diagnosis but on her ability to function, or more sadly, the lack of documentation.

If you have brainfog, get that neurocognitive exam.

My doctors, FP and neurologist, had witnessed my steady decline and their opinion does count. They saw me holding on to work by my fingernails. I did not go down easily. I cut my hours, changed gears, until I had to face the grim reality. SSA sure isn't RN pay, but it gets us by. The sad thing is because I had cut my hours back the last 3 years of the 5 year look back, my SSDI is not as much as it would have been otherwise. And, because I didn't have any extra money, I let my long term disability insurance lapse. But, hey, can't cry over spilt mild, we don't get do overs. The majority of us have stumbled down this road, quite literally. The SSA does take stock in what your personal doctors have to say. Make sure they say it.

If you lose at this level, don't give up! They would like nothing better than to break your will. Remember, get your documentation in order, and consider hiring another attorney if yours is unfamiliar with our illnesses. Most work on commission and their fee is topped by the USA, finally something in our favor.

"When defeat comes, accept it as a signal that your plans are not sound, rebuild those plans, and set sail once more toward your coveted goal."
--Napoleon Hill

Social Security Application

http://www.socialsecurity.gov/applyfordisability/

Fibromyalgia Residual Function Questionnaire

http://www.docstoc.com/docs/16448838/Fibromyalgia-Residual-Functional-Capacity-Questionnaire-_without

Good article on SSA disability process.
http://home-improvement-power.com/security/fibromyalgia-and-social-security-disability-benefit-payments

Lamb hugs to all on their journey; it is a winding road, hold on tight for a rough ride. At a time when I suggest focusing away from pain, you will be focusing on pain, it is the nature of this beast, and necessary for you to win either on initial application or appeal.

There is an entire section in the book devoted to SSA filing, documentation, what to expect, etc. The book has many documentation tools throughout to help you explain your condition and needs, painting a picture for your physician to help in his assessment. Using the forms will also get the information in your medical record. Make sure you physician puts the help sheets in your record where it belongs. It will help him/her save time and validate to the powers that be, why the treatments and medications are given, etc., and explain what it is like to be in your body.

Tips:-Always be truthful
-Document everything, even your conversations with SSA (you won't remember, but
they will)
-Explain what it is like on your worst day (I recommend having someone help you fill
out the paper work during these periods, as most likely you will not be able to. It
is human to dismiss how bad things are on a bad day when you are having a good one.
This is what your life is like, explain it in no uncertain terms, it is difficult
for those who do not experience our pain and fatigue to know what it is like).