What do YOU think? | Arthritis Information

SS does not think I need to see one of THEIR doctors.

Could be a good sign. However, it can also just mean that you have thorough, current medical records that are likely sufficient to make a determination once one of the "their" doctors has seen you.

I'm not trying to discourage you. I think you should be encouraged. I just want you to know that it can mean more than one thing.

I hate admitting this on this board, but long long ago in a galaxy far far away, I was a social security disability examiner.

There, I admitted it.

Now listen, I forgot more than I ever knew within a year of leaving the job, and it has been decades. And I'm sure processes and requirements have changed a lot over the years. So please, don't anyone ever take anything I say about disability as insider information. Those of you who have been through the application process are far, far more knowledgeable at this point than I could hope to be.

I think it's still true, though, that it's enormously hard to get disability the first go-through, but it's not impossible.

The rules are very strict and specific, and it can be hard to demonstrate them to the required letter even if you meet that "intent" of the rules. That's partly why they have the reconsideration processes.

There really is a desire to have a net to catch the "really" disabled in the eyes of the law (I hate all the words I'm putting in quotes) who might fall through the specific letter of the law, which is necessary because you can just imagine how many folks think they are disabled but don't come close to meeting levels of disability that society can afford to support.

A key issue with disability is that many people feel that because they are unable to do their old job now, they are disabled. In the eyes of the law, if we are able to do other kinds of work that are generally available in the economy, we are not legally disabled (unfortunately it doesn't matter if your town isn't loaded down with job opportunities of the sort you could "reasonably" be expected to do given the functionality we still have.)

And pain-based disability is a really tough one, as you can imagine. It helps an awful lot if it's medically demonstrated that you have severe reductions in range of motion, grip, etc. However, all disability isn't based solely on lab findings, and as I said I sure don't know the requirements they have these days, so don't despair if you feel like your labs or measures don't fully reflect what you unable to do now.

It's very common to have to go through the reconsideration processes, and sometimes you need to go before the "judge" with an attorney in order to get the disability that you "deserve" (I put that in quotes not as sarcasm but because it's such a squishy word). The processes are long, as case loads are enormous and processes are backed up through the system, as is true everywhere in government. It must be utterly maddening to go through this as an applicant.

I want to give you a bouquet of "no-sweat" encouragement, but it's just a tough process. The waiting must be rotten. I feel for you, and all of you who are waiting through this process. And still, if I had to tell you to feel encouraged or discouraged, I would say you should be encouraged.

Roxy,

Could be a good sign. However, it can also just mean that you have thorough, current medical records that are likely sufficient to make a determination once one of the "their" doctors has seen you.

[/QUOTE]

RK - I am finding myself more and more discourage but this quote from you sounds like you think I will still be seeing one of their doctors.  The determination worker said I did not need to see one of their doctors !!!  That is what encouraged me.  What discouraged me most was he asked about my education.  I have a Master's degree.  I am afraid they will decline me because of that.  We sure need the money and I sure can't work

I'm sorry I misunderstood what you said about seeing their docs. And maybe I made you more worried and confused. I should have stayed out of this.

But since I got into it, I'll have to say I agree even more with the others who think this is good news.

I think you're going to get it Roxy, but I so want to protect you from disappointment. With what I know about you, I'd be so surprised if they already have enough info to deny your claim outright. But it's certainly possible. It's a complex process. But the truth is I'm feeling more like the other people who posted a thumbs up for you on this thread.

Before you go whooping and hollering, you need to know that things can change during the decision process. Both the disability examiner and at least one case-review doctor on staff will look at all the evidence in the file, and there will be some back and forth between them about it, and that can lead to needing to go see their doc before it's all  over with because sometimes the case-review doc wants more data than the disability examiner though was required.

Education and work history do matter too, if you don't meet the straight medical requirements outright. If you had an eight grade education, they wouldn't be telling you could go from, say, ditch digging to rocket scientist just because it was desk work instead of field work. 

I approved many, many people for disability who had advanced degrees and professional/sedentary work backgrounds. 

When I say "I approved" it sounds like I used professional discretion to make a decision. Sorry that's misleading. There's no professional discretion involved in the decision unless you get to the point of going before the "judge" after denials in the application and reconsideration processes. Everything is based on huge binders full of rules, codes, requirements, as you can imagine with government work. You either are or aren't within the required ranges of those rules and regs for your condition.

It broke my heart when I had to deny a claim that I really felt "should" be approved but didn't meet the rules exactly. I always hoped they'd win on appeal, and I'm sure many of the did.  

There is some medical opinion involved, of course, but still it's mostly a matter of standard medical evidence and validated medical opinion. 

Fingers crossed here, hoping for good news fast. And I'm hoping I haven't made it more discouraging or confusing for you than it already was.

RK,  You are such a sweetheart.  I was just in the mood to celebrate

So do they look at how many meds you are on?  Because I am on a ton of meds. could that help me?  I told the guy yesterday I would love to work and once I was on disability I would give it up if I got better.  I hope that won't hurt me but it is the truth.  I would way rather work. 

One thing is he said he made my case a priority as CA had me waiting way too long.  Thank you so much for trying to help RK.  Everything you said was helpful.  And everyone else............ I need some hope

Please, please read her postings, suggestions and email her as she will help anyone who asks.

http://www.butyoudontlooksick.com/boards/viewforum.php?f=32& amp;sid=b3e3c9999e3443b9a13b0ec832aba506

I hope this helps empower you as it did me.

The explanation she gives for "gainful employment" is awesome.  I didn't know that I had to prove that I could not make 0 a month in order to be considered disabled.  For me that means I must prove that I cannot work 20-25 hours per week and it sure helps to know their definitions.  I really feel empowered now and do have a company filing for me and doing the work.

Roxy, maybe take just a little time each day to journal how hard or impossible it is to do each little thing and after a couple of weeks you will have the basics for the matrix in case you need it.  I kind of got the picture that we hit SS with a ton of paperwork ourselves just to explain each and every little thing that we try to do.  Kind of the same way that they have a book just for the SSDI application.

I see that you use Enbrel and I am going to try it next month and sure hope it helps.

Take care Roxy and I am pulling for you.

Roxy, the thing about advice, certainly including mine, is that we can wrap ourselves up in a knot trying to follow it all and it's so hard to figure out what really applies to us and what is useful.

You wanted to know if it helps your case that you take a lot of meds. In general, that doesn't really apply. But in specific, it might. Since I'm not in the system any more I don't know the current rules for each disease.

It's possible that being on a specific medicine protocol could be an indicator of a disabling level of a given disease. Is that true for RA? I have no idea, but going by the "in general" rule, I doubt it.

I doubt this has changed: You don't hurt or help yourself by having a desire to work or a hope that you'll improve enough to work in the future. Your ambitions or lack thereof really don't play a part in the decision.

Built into the investigation and decision process is the question: can she work now and is she expected to be able to work for a given period of time in the future? They cover this question with data rather than intentions.

I always think about the example of individuals whose blindness or deafness meets the criteria for disability. These people are unable to perform a critical function required for most work in our economy, and are eligible for disability payments. But there are lots of blind or deaf individuals who are gainfully employed because they were able to find unusual work opportunities.

For those individuals, being on disability or not is a choice. They can be on disability, then find this job opportunity and choose to go off disability. They can go back on disability later if the job goes away. Or they can find this job opportunity and still choose not to work but to stay on disability. Unless things have changed a whole lot, this personal choosing doesn't affect their right to legal disability status.

By the way, I'm in no way comparing blindness, deafness, and RA as disabilities or personal experiences.

I took a look at the website Bonny pointed out. I didn't look thoroughly, but it does seem like there are some useful pointers there. Like all advice including mine, take it with a grain of salt and don't get too worked up about it. Some parts will be better than others.

Like, there was a post on that site saying something like you should take in a letter from your doctor saying you were totally disabled from doing any job. At least in my day, we basically ignored those statements like we'd ignore a note from your mother, and I expect that's true today. It's the data, not the disability opinion of your doc, that matters to the decision.

Also, like the example of the blind or deaf person, you're not required to be unable to do ANY kind of work. You're required to be unable to perform key functions required by a great portion of the jobs in our economy that your education and work history would qualify you to perform. That's not a legal definition, of course, it's my shorthand for how this works.

There was also something about how your chances of getting disability were bad if you hadn't been seeking medical treatment recently.

Hmm. On the one hand, lack of current medical data is a problem. On the other hand, this is why they send you for tests and examinations that they pay for--to get current medical data. It isn't the intent of the law to discriminate against those who have been unable to see a doctor lately.

Advice like this is good if it encourages people to get medical treatment who might be avoiding it, and it may be more likely that the necessary data gets developed for your case if it has been piling up from your medical care history instead of just looking at a snapshot when you go to the disability doc. On the other hand, I hate to see it scare people who haven't been getting regular treatment into fearing they won't get their disability. In most cases I don't think it's going to stand in their way.

There is some other advice there I would take issue with too. And there is some really sound advice, good stuff for preparing to make your best case.

I didn't see the thing about proving you can't earn 0 a month or whatever. Sounded a bit bizarre to me, but that could be because in my role I didn't handle the financial eligibility requirements--like whether you had paid into Social Security long enough or if you qualified for SSI by having the exact income limitations for your household. When the case came to me, that stuff had been handled.

You're in the system and they're dealing with your medical and vocational stuff. I feel pretty sure that stuff has been handled for you too. If you're worried about it, call your disability rep back and get it clarified.

Like you say, you're in the process, you've done what you can and it sounds like you're in good shape process-wise.

Thanks RK.  Now it is just the waiting game.  We need the money so bad, I am praying I get it first shot as it is not that much and I don't want to give an attorney a percentage.  If I get denied, I guess that is what I will have to do.

You all have been so helpful.  Now I had better engage the patience I was supposed to have learned from RA.  Patience, patience, patience GAINFUL WORK”
THE “WHY” OF THE DENIAL BY SOCIAL SECURITY

The “yardstick” – “gainful work” - used by the Social Security Administration can be summarized as follows:

Are you able to perform any gainful employment for which your age, education, and job history equip you to perform, that can earn you the Social Security’s minimum monthly income amount (0 in 2006).

To better understand this “yardstick”, let’s take a “gainful work” job like an entry level clerical position, which might pay per hour. 0 divided by per hour equates to a minimum of 83 hours that needed to be worked in any given calendar month. As there are 173 “workable hours” within a calendar month, 83 hours equate to about half time, or, stated another way, about 20 hours per week. AND, since the Social Security Administration is well aware of the ADA (Americans with Disability Act) requiring Employers to make “reasonable accommodations” to allow disabled employees to continue working, they firmly believe that you, the disabled person, can work with a perspective employer to “create” a workable environment for yourself for only 20 hours a week!!

The following story, related to me by a Federal Magistrate who serves as a Social Security Hearings Administrator, rendering decisions on SSDI claims appeals, graphically explains how difficult it is to document and “to prove” the inability of many people with disabilities to “meet” this Yardstick.


Mrs. Smith appears before the Social Security ALJ with her attorney to appeal her denial of SSDI eligibility. The SSALJ asks her to describe her day. Mrs. Smith provides the following information.

“Hello your Honor. My name is Mrs. Mary Smith. I’m here to appeal the Social Security Administration’s decision that I am not disabled. I fully believe that after you hear about my day, you will agree with me that I am disabled.

1. First of all, I get up in the morning, get dressed, and have a little breakfast. Then I go outside – if the weather is good – and do some gardening.
2. Then, I have to take a rest for a while; at lunchtime, I have some lunch. Then, I rest and watch a little TV while doing some crocheting. After a while, I need to take a nap until dinnertime.
3. I cook dinner for my husband –I have to sit while working, I can no longer stand, and he has to do the dishes and clean up.
4. We spend time together, then go to bed.

That’s my day, your Honor.”

Thank you, Mrs. Smith, says the SSALJ. Based on your testimony, I find that you are not disabled; appeal denied.

WHY was she denied, you wonder? Well, I asked the SSALJ who related this story to me, and this was his logic.

1) Her physicality is such that she can kneel to do gardening for a period of time.
2) Her small motor skills, cognitive skills and vision are sufficiently good for her to do crocheting.
3) Her small motor skills, cognitive skills and vision are sufficiently good for her to follow recipes and cook.
4) As Mrs. Smith is in her 40’s; as she has a BA in English; and, as her work experience demonstrates a series of significantly more responsible jobs, I find NO EVIDENCE that Mrs. Smith can NOT perform gainful employment.

The SSALJ’s logic here is the key to understanding SSDI eligibility “justification documentation”. He made his decision because there was no “connect the dots” evidence to prove that Mrs. Smith COULDN’T perform gainful work -employment; therefore, she can. THE RESPONSIBILITY FOR PROOF – FOR CONNECTING THE DOTS – BELONGS TO THE APPLICANT YOU!