2 SSDI questions...

Discussion in 'Fibromyalgia Main Forum' started by catmom50, May 20, 2006.

  1. catmom50

    catmom50 New Member

    1. How long after I am diagnosed can I file for SSDI. I am just newly diagnosed. Do I need to be seen by a certain number of doctors???

    2. I was told I can't collect SSDI if I haven't worked for at least 5 years in the past 10 years. Is this true?

    The reason I am asking these questions is we are financially strapped, and I just don't feel up to working. My husband is on disability due t work injury 15 yrs ago. I worked in nursing for 25 years.

    Thanks everyone.

    MM in Oregon




    [This Message was Edited on 05/20/2006]
    [This Message was Edited on 05/20/2006]
  2. thepkk

    thepkk Guest

    If you have been diagnosed with fm start NOW. They will turn you down and you will probably get turned down. Then get a lawyer. Be sure to see every dr your regular dr sends you to. the more the better. If you are over 50 rules have changed so it may not be as hard. When I turned 50 it wasn't long before I got it. If you worked then you worked for this. Get up to your social security office asap. Hang in there and get some food stamps it will help till the money comes.
  3. blizzybear

    blizzybear New Member

    USEALLY YOU HAVE TO HAVE BEEN SIX FOR SIX MONTHS, BEST TO SEE A LAWYER, IF TI IS A GOOD ONE THEY WILL TELL YOU RIGHT AWAY IF YOU HAVE A CASE, IT CAN BE A LONG PROCESS, IT TOOK ME TWO YRS BECAUSE THEY DENIE ALMOST EVERY CASE THE FIRST 2 TIMES. I HAD BEEN SICK FOR 6 YRS BY THEN. IT REALLY DEPENDS ON WHAT YOU HAVE WRONG, YOU NEED A VERY SUPPORITVE DOCTOR AND THEN A GOOD LAWYER. GOOD LUCK
  4. catmom50

    catmom50 New Member

    What do you mean I can go on his? Looks like I need to gather some info, is it better to call or go to SS office?

    I am 56 yrs old, have had this for at least 4-5 years. Only recently did a physiotherapist/ortho diagnose me. I am only this week going for my second appt with him. Other doctors thought I had arthritis. Do I talk to the doctor about this when I see him this week?

    In A Fog,
    Margie (Oregon)
  5. Tigger57

    Tigger57 New Member

    I saw my rheumy the other night and he told me it was time for me to file for SSDI. He said I should have done it last year, but I was too stubborn. I don't have the energy to be stubborn any more.

    I will apply, and I will contact the lawyer my rheumy recommended.

    I'm scared that I still won't be able to make it, but at this point, I don't see where I have a choice.

    Let me know how you make out.
    Hugs,
    Tigger
  6. swifter

    swifter New Member

    You need to be aware. I posted the following message in February of this year. I am still fighting for my SSD and I have written letters to my elected officals.

    Do you need a laugh?

    After fighting for 2 years for my disability, I was denied. I have Fibromyalgia, Trigger finger in both Thumbs, a bad right foot with Osteoarthritis, I wear two hearing aides, and my left foot now has a lump on the back of the ankle. Turned out to be Achilles Tendonitis, thank goodness it hasn't burst.

    SSD's statement says that I have the following residual functional capacity: a narrow range of light exertion work activity, including occasional climbing of ropes and ladders, as well as scaffolds and occasional crawling. What a bunch of morons. (By the way, I was an accounting clerk)

    They also said I seem to have an obsession with my problems, and a borderline personality disorder. This 17 page document
    is so full of mis-interpreted information and wrong information, Whoever put this document together should really be ashamed of themselves. How do they get by with a document so full of garbage?

    The Voc.Rehab. person said I could do filing? For those of you who don't know what Trigger finger is: Both of my thumbs were stiff, I couldn't move them, I couldn't pull up my underwear. The doctor told me I had Arthritis in the them and the lower part of the palm. I can't open jars, I drop things, and they hurt all the time. The document says I don't have Arthritis. The denial says that I have minimal hearing loss. I use the captioning on the Television, because I don't understand what they are saying. And it said that I only have one hearing aidm but I wear two. The whole document is full of lies. It said I refused a Sleep Apnea study, but all I said was I didn't have the money, over $250.00 with insurance.

    The funniest part was when they said that I had other symptoms NOT Often Seen in Fibromyalgia: Headaches, Irritable Bowel Syndrome, Depression and Anxiety!!!!

    What a FARCE don't you think? Anyway Thanks for letting me explode. By the way, I am in Oregon.

    By the way I had Kaiser Permenente Insurance. I won't do that again. I found a great doctor in Portland,Oregon. I didn't have any medicial insurance and didn't see any doctors for 15 months. I have new doctors for everything and they are great and understanding. Hang in there.
  7. JLH

    JLH New Member

    This is legal references that have been used for applying for SSD/SSI.

    ESTABLISHING DISABILITY STATUS IN FM AND CFS

    42 U.S.C. § 423(d)4 defines “disability as “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months... For purposes of this subsection, a “physical or mental impairment” is an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.
    To emphasize the importance of signs and findings in the disability determination, 42 U.S.C. § 423(d)(5)(A) provides that “[a]n individual’s statement as to pain or other symptoms shall not alone be conclusive evidence of disability as defined in this section; there must be medical signs and findings,5 established by medically acceptable clinical or laboratory diagnostic techniques, which show the existence of a medical impairment that results from anatomical, physiological, or psychological abnormalities.”
    The Social Security Administration interpretation of the statute contained in SSR-96-4p reinforces this instruction. Although the Act and SSR 96-4p provide that a “symptom” is not a “medically determinable physical or mental impairment,” footnote #2 of SSR 96-4p describes the following circumstances under which what otherwise might be considered to be a “symptom” is really a medical “sign”:

    20 CFR 404.1528, 404.1529, 416.928, and 416.929 provide that symptoms, such as pain, fatigue, shortness of breath, weakness or nervousness, are an individual’s own perception or description of the impact of his or her physical or mental impairment. However, when any of these manifestations is an anatomical, physiological, or psychological abnormality that can be shown by medically acceptable clinical diagnostic techniques, it represents a medical “sign” rather than a “symptom.”

    SSR 96-2p completes the proof with the following definition of the statutory term of art, “medically acceptable”:

    Medically acceptable. This term means that the clinical and laboratory diagnostic techniques that the medical source uses are in accordance with the medical standards that are generally accepted within the medical community as the appropriate techniques to establish the existence and severity of an impairment.


    The medical standards that are generally accepted within the medical community as the appropriate techniques for establishing the existence and severity of fibromyalgia and chronic fatigue syndrome are detailed in various medical publications. See, for example, Wolfe, F. et. al.: The American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia: Report Of The Multicenter Criteria Committee. Arthritis & Rheumatology (1990) 33:160-72. See also the December 1994 revised working case definition of CFS established by the Centers for Disease Control: Fukuda, et.al. “The Chronic Fatigue Syndrome: A Comprehensive Approach to its Definition and Study,” Annals of Internal Medicine, (1994) 121:953-59.
    In a claim involving allegations of disability based in whole or in part on FM or CFS, it is the responsibility of the claimant’s representative to ensure that the claimant’s treating and/or examining physicians are aware of, and employ, the techniques for establishing the existence and severity of fibromyalgia and chronic fatigue syndrome as set out in the above-referenced medical articles and SSR 99-2p.

    NINTH CIRCUIT PRECEDENTS

    The Ninth circuit is the highest federal Court in the western states and its holdings control federal court decisions in Arizona. In Day v. Weinberger, 522 F.2d 1154 (9th Cir. 1975), the Ninth Circuit addressed the fact that disability may be proved by medically-acceptable clinical techniques.
    , “in concluding that Day was not disabled, as “disability” is defined in 42 U.S.C. § 423(d), the Hearing Examiner relied on three other factors. First, he noted that none of Day’s medical experts had been able, through the use of objective diagnostic techniques, to identify specific cause for Day’s alleged pain. Second, the examiner noted that during Day’s appearance at the hearing, she did not exhibit the physical manifestations of prolonged pain that are listed in a leading medical textbook. Finally, the examiner relied on his own observations of Day at the hearing and certain of Day’s own testimony in concluding that she remained capable of doing light work.

    The first two factors upon which the examiner relied provide little, if any, support for his ultimate conclusion. Disability may be proved by medically-acceptable clinical diagnoses, as well as by objective laboratory findings. 42 U.S.C. § 423(d)(3); see Stark v. Weinberger, 497 F.2d 1092, 1097 (7th Cir., 1974); Flake v. Gardner, 399 F.2d 532, 540-41 (9th Cir., 1968). And the Hearing Examiner, who was not qualified as a medical expert, should not have gone outside the record to medical textbooks for the purpose of making his own exploration and assessment as to claimant’s physical condition. Williams v. Richardson, 458 F.2d 991, 992 (5th Cir. 1972).”

    For three cases within the Ninth Circuit addressing FM and CFS see Reddick v. Chater, 157 F.3d 715 (9th Cir. 1998); Bunnell v. Sullivan, 947 F.2d 341 (9th Cir. 1991); and Irwin v. Shalala, 840 F.Supp. 751 (D.Or. 1993).

    In May 11 1998 Deputy Commissioner for Disability and Income Security Programs, Susan Daniels, wrote a memoranda to an ALJ who argued that the symptoms of FM should not be considered medically acceptable clinical and laboratory diagnostic techniques in support of the claimant’s application for disability determination:

    “Your letter states that fibromyalgia and CFS do not constitute medically determinable impairments within the meaning of section 223(d)(3) of the Social Security Act because there are no acceptable medical criteria by which these impairments can be diagnosed…. However, SSA has taken a definitive position that fibromyalgia and CFS can constitute medically determinable impairments within the meaning of the statute. As you noted in your letter, CFS was discussed in the process unification training in 1996-1997...This position is consistent with the instructions in Program Operations Manual System (POMS) DI 24515.075, Disability Digest No. 93-5, and Social Security Rulings (SSRs) 96-3p, 96-4p, and 96-7p, issued on July 2, 1996, which detail our policies as to how symptoms affect determinations of the presence of a medically determinable impairment, impairment severity, and the ability to engage in sustained work activity.

    Establishing the existence of a medically determinable impairment does not necessarily require that the claimant or the medical evidence establish a specific diagnosis. This is especially true when the medical community has not reached agreement on a single set of diagnostic criteria. ..Your argument based on the Rulings seems to misinterpret the explanation in Footnote 2 to SSR 96-4p, which explains our longstanding policy, consistent with 20 CFR §§ 404.1528(b) and 416.928(b), that some symptoms, when appropriately reported by a physician or psychologist in a clinical setting, can also be considered “signs” because sometimes these observations constitute “medically acceptable clinical diagnostic techniques.” This is true for mental impairments in general and for such widely recognizable disorders as migraine headaches”

    CONCLUSION

    FM and CFS are “real diseases" which lead to disability. The key to winning in front an ALJ is to have the physician meticulously follow the guidelines established by the American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia: Report Of The Multicenter Criteria Committee. Arthritis & Rheumatology (1990) 33:160-72. Thorough notes and commitment of the treating physician to assist the claimant in her quest for disability determination are of paramount importance.

  8. JLH

    JLH New Member

    The Disability Maze - Article re Filing for Disability

    Note: this article is about someone with arthritis applying for disability. The same can be applied to fibromyalgia or CFS.


    The Disability Maze
    by Amy Brayfield

    Disability cases are won and lost on the strength of the application. We'll help you through the process, step-by-step.

    Shawn Sluder knew it wasn't going to be easy to give up her job. She'd been an executive assistant for almost 10 years and loved the busy pace and constant multi-tasking her work required. But Sluder, 38, who has lupus and fibromyalgia, found herself struggling more and more to get her job done.

    After six months of collapsing onto her couch at night, running through all her time off and more than one breakdown in the office bathroom, Sluder had to accept the fact she couldn't keep doing her job. She took her doctor's advice and filed for disability. Four months later, she was denied.

    "As frustrating and embarrassing as it is to have to file for disability, it's about 10 times worse to have your claim denied," says Sluder. Almost 24 months after her initial application, Sluder is still fighting her way through the Social Security Administration (SSA)'s appeals process.

    She isn't alone. Of the approximately 1.5 million Americans who file for disability benefits every year, 65 percent are denied on their first try. Even people who aren't rejected often feel confused and overwhelmed by the process, which seems arcane at best and tortuous at worst. For people like Sluder, the system can seem designed specifically to batter their already fragile emotions, making a difficult situation even worse.

    "There have definitely been times when I feel like the SSA thinks I'm just trying to get a free ride," says Sluder.
    There's no magic spell to make applying for disability benefits suddenly easy, but you can reduce your frustration - and maybe even increase your chances of getting a fast approval - by understanding the process before you apply, says Bob Keck, an attorney with the national disability advocacy firm Allsup Inc.



    Alphabet Soup

    Scanning your disability application may bring on a headache as you try to make sense of the myriad forms with their alphabet soup of options. Is the Disability Report the same as the Symptom Questionnaire? What remarks go in section 9? And does the SSA really think you can finish this paperwork in the half-hour estimated completion time named on the application?

    The answer to that last question, at least, is no, says R.M. Bottger, a former Social Security disability specialist. "We used to joke that anybody who could actually fill out that disability report in half an hour automatically didn't qualify for disability," says Bottger.

    The application can be intimidating, but it's important, says Keck, who encourages his clients to focus most of their energy on the Disability Report. "The SSA uses the information in your application to evaluate your case at every stage of the process. Even on appeal, they'll compare the testimony you give on appeal to that first application."

    For someone with arthritis, the application can be even more important, says Bottger, because of the variation in arthritis symptoms. "Every case is different, but you have a pretty good upfront understanding of what limitations a person in a wheelchair has. Arthritis is different -- there's no 'basic' effect of arthritis. The burden is on the applicant to show that his arthritis is disabling."
    This may be why the application for disability is such a dichotomy: on one hand, a just-the-facts, fill-in-the-blanks form; on the other, a personal and infinitely variable story of the effects of arthritis on your life. It's important to keep both aspects in mind when you're filling out your application, says Keck.

    The emotional component is often most difficult. Most people with arthritis focus on staying positive, but working on your disability application means focusing on the things you can't do. Be too stoic or Pollyanna-ish, and your case manager won't have all the information she needs to evaluate your case.

    "I think that's where I went wrong," Sluder says. "I spent so much time trying to figure out how to keep doing things that I didn't want to say I couldn't do something."

    People like Sluder who've adapted their routines because of arthritis may no longer even notice the accommodations they've had to make. Keck recommends inviting a friend to watch you do a few household chores. "Seeing how your arthritis affects one task, it's easier for you to see the accommodations you make in other tasks, too," he says.

    It can be emotionally taxing to spend a lot of time dwelling on your limitations. Try not to work on your application for more than a few hours at a time -- it's OK if it takes you a week or so to complete it - and keep in mind the reason you're going through the process at all is to get the support you need to live a better, healthier life.



    Inside the Application

    Bottger and Keck agree that the part of your application that deserves the most attention is the Disability Report, a 16-page, nine-section form in which you describe your arthritis (or other illnesses), its symptoms and effects on your work."

    When I denied an application, it was because it lacked compelling medical or vocational evidence. The disability report is where you can give that information," says Bottger.

    The secret to success is simply knowing what information your SSA representative is really looking for in each section, says Keck. We asked our experts to take us through the Disability Report, section by section, to help you make the most of your application.



    Section 1 -- Information About the Disabled Person

    Why they're asking: The SSA needs this basic information -- your address, Social Security number, etc. -- to contact you and request case information. The SSA also uses it to see if you qualify for special programs based on your age or weight.

    What you should know: This section asks you to provide a personal, or non-work, reference familiar with your condition. Think carefully about who you choose, says Keck. The best choice is someone who's seen the impact of arthritis (or your other illnesses) on your life and who is close enough to share your struggles with. It's OK to pick a family member. Give the person you choose a heads-up that the SSA may contact her about your case, says Keck.


    Section 2 -- Your Illness, Injuries or Conditions and How They Affect You

    Why they're asking: The SSA needs to understand two things to evaluate your case: what your condition is, and how it affects your ability to work. This section connects the two.
    What you should know: Both Keck and Bottger recommend answering this important section last.

    The key here, says Keck, is to break down your job, task by task, to explaining how your condition limits your ability to do it. Say you're a customer service representative, and part of your job is filing order records. To do this, you must label folders; kneel, reach, bend and stoop to file; occasionally carry 10- to 15-pound boxes of file folders to restock your supply; etc. Break down each task into its specific components, then explain how arthritis (or your other illnesses) makes each one a challenge: kneeling, reaching, bending and stooping are painful because, for example, osteoarthritis (OA) in your hips and knees makes bending at the knees and waist difficult. Do this for every task.


    Section 3 -- Information About Your Work

    Why they're asking: Knowing what tasks your job regularly requires helps the SSA decide how your arthritis (or other illnesses) affects your ability to do that job.
    What you should know: Remember your job title doesn't necessarily reflect your actual responsibilities, says Keck. One insurance customer service representative may do little more than field incoming calls; another might stock office supplies, visit claim sites and do the office filing. Explain the specific responsibilities of your position. Keep in mind, too, that the more specialized your position, the more likely it is your representative might believe you can continue working -- in another position, says Bottger. If your job is highly specialized, highlight its more universal facets, such as sitting, standing, walking, carrying, bending, and so on.


    Section 4 -- Information About Your Medical Records

    Why they're asking: You can provide copies of your medical records, but the SSA requests its own copies from your doctors, using the information in this section.
    What you should know: Make sure all the information is correct so your application doesn't get delayed, says Bottger. He also recommends writing in each doctor's specialty on the space beside his name, even though the application doesn't ask for it.


    Section 5 -- Medications

    Why they're asking: Before granting disability, the SSA confirms you've tried medical intervention.
    What you should know: List your current meds, plus all medications you've tried, whether they worked or not, says Keck.


    Section 6 -- Tests

    Why they're asking: The SSA looks for a test to confirm your diagnosis - for rheumatoid arthritis (RA), it's usually a blood test; for OA, an X-ray.
    What you should know: If you have a form of arthritis, such a fibromyalgia, that doesn't have an accepted diagnostic test, make sure your medical records include tests to support your condition's symptoms, says Bottger. The presence of several symptoms that aren't debilitating on their own can be considered debilitating when they co-exist.


    Section 7 -- Educational/Training Information

    Why they're asking: Understanding your education and professional experience helps the SSA determine other jobs you might be able to do.
    What you should know: This section is important for borderline applications, says Bottger. The more specialized your experience, the less likely it is that the SSA will recommend you try another form of employment before reapplying.


    Section 8 -- Vocational Rehabilitation, Employment or Other
    Support Services Information

    Why they're asking: The SSA considers what steps you've tried to continue working.
    What you should know: The younger you are, the harder it is to prove you can't work at any job, says Bottger. People younger than 55 must show that they can't work even at a mostly sedentary job. Participating in a vocational rehab program can show the SSA how your limitations really do impair your ability to work at any job. And -- of course -- there's always the chance that a rehab program might be able to help you find a job you can actually do.


    Section 9 -- Remarks

    Why they're asking: As big as the application is, you might run out of room on some sections. Section 9 lets you continue information from other sections.
    What you should know: Many people find they need more space to list their medications and on-the-job challenges than the form provides, and it's better to continue in section nine than to leave out important information.


    The Aftermath

    Most disability applications are determined within five months. If your claim is denied, you may start the process over by appealing for reconsideration. If it's accepted, you may wonder, "What's next?"

    Filing for disability can be so time-consuming and emotionally draining that you don't have time to deal with the implications of not working. In a society where people define themselves by their careers and many view "disability" and "laziness" as synonyms, it's hard to cope with the personal and social pressures of being unemployed. No wonder 40 percent of people report feeling depressed after being awarded disability benefits.
    Sheryl Cohen-Alexander, 48, who applied for disability in 1990, wasn't prepared for the sadness she felt when her application was accepted. "It finally hit me what being on disability really meant."

    Cohen-Alexander didn't want to sit around feeling sorry for herself. Cohen-Alexander has the right idea, says Keck, who asks his clients to plan for their lives post-disability and to stay active during the application process. "It can consume you if you let it," says Keck. "So don't let it."


    Are You Ready for Disability?

    Ask yourself these questions before you decide to file:

    • Are you working? You must have been unable to work for at least a year or show that you won't be able to work for at least a year before applying for disability. If you earn more than $810 each month, even if you can't work full-time, you're not eligible for benefits.

    • Does your arthritis (or other illnesses) make it impossible for you to do basic job tasks? Your arthritis (or other illnesses) must be severe enough to limit your ability to perform the basic tasks that most jobs require, such as standing, reaching, sitting, carrying and walking.

    • Do your limitations keep you from doing your specific job? If you can continue to do your job, even if you're in pain while you're doing it, you're not eligible for disability benefits.

    • Are there any other jobs you can do? Just because your arthritis (or other illnesses) keeps you from continuing work as, say, a construction foreman, does not automatically mean you can't do a more sedentary job. The SSA will consider your work history, age, education and physical limitations to determine what other work you can perform.

    • Does your diagnosis match the Social Security Administration (SSA)'s medical listing? The SSA's Blue Book lists the criteria for disability for all medical conditions. For rheumatoid arthritis (RA), for example, the Blue Book says applicants must show persistent pain, swelling and limited joint mobility to qualify.


    The Appeals Cycle

    Insider Tip: Apply in Person

    Are You Ready for Disability?

    Only about 35 percent of applicants are APPROVED for disability benefits on their first try. If you're denied, you enter another maze: the appeals process. If your initial application is DENIED, you can file for reconsideration.


    Reconsideration

    Reconsideration is basically just resubmitting your application, but you should take the opportunity to make sure you're being as specific as possible on the sections describing your condition and limitations. Your claim can be APPROVED or DENIED. If it's denied, you can appeal.


    Administrative Judge Law Hearing

    At this local hearing, you can give testimony in person. The judge can APPROVE, Deny or REMAND your case back to reconsideration. If it's denied, you can appeal.


    Appeals Council

    You must appear before the Appeals Council in Falls Church, Va. in person. They can APPROVE, Deny or REMAND your case back to the Administrative JUDGE. If the council denies your claim, you can appeal.


    Federal District Court

    As a last resort, you can appeal outside the SSA's jurisdiction in Federal District Court. This is your final appeal -- if your claim is denied here, you have no more appeal options.



  9. JLH

    JLH New Member

    1. How long after I am diagnosed can I file for SSDI. I am just newly diagnosed. Do I need to be seen by a certain number of doctors???

    ----> It doesn't matter how long it's been since you were diagnosed, and you don't need to be seen by a certain number of doctors. All it takes if for the Social Security Adm. to agree with the answers on your application and agree with your doctor's answers and paperwork (your records) that he/she has submitted to them if you are totally disabled and unable to work.



    2. I was told I can't collect SSDI if I haven't worked for at least 5 years in the past 10 years. Is this true?

    ----> This is not true. You can not collect SSDI if you have not worked enough to earn the required amount of work credits that they require to obtain SSDI. Go to the SSA website and read more about their disability requirements.


  10. 69mach1

    69mach1 New Member

    go to that great site to answer myths about ssdi/ssi


    and go to ssa.gov

    easier to apply in person...they will send you packet in mail to fill out...

    just go do it...

    jodie