Filing for Disability - What are my first steps?

Discussion in 'Fibromyalgia Main Forum' started by chris350, Oct 7, 2005.

  1. chris350

    chris350 New Member

    Hey Guys,

    As much as I hate to I am going to have to try to get Disability. I tested positive for Lupus once. I am being treated for Fibromyalgia. I live in Memphis, Tennessee. I have been reading that many of you have been lucky in the sense that you were not turned down several times. Just wondering if any of you have any tips or suggestions.

    Chris350
  2. suzetal

    suzetal New Member

    SSD is Federal and is the same all over the US....I won after 2 denials than had my hearing a few weeks ago and won...I wish right from the get go I had known what I needed.

    I saw 3 ruemys that all wrote in there report that I had all 18 tender points.Also my GP SHE IS AWESOME supported me 100% At the end of her report she point blank said unable to work until further notice .

    My neurologist also supported me.And so did my shrink.

    In the beginning 2 try I did not have all of this had I had it I would have gotten it right off the bat...For the hearing I also got a letter from my former employer plus my last eval that were excellent :} They really help.

    Hope I helped a little.If you have any more ???? just ask.
    Check out there WEB Sight SS.gov

    Sue
    [This Message was Edited on 10/07/2005]
  3. Kathryn

    Kathryn New Member

    going to my doctor and telling him that I just couldn't keep working any longer. He had been trying to keep me patched up for nearly 10 years, and totally agreed with me. In fact, he said he didn't understand how I was able to keep going as long as I did.

    I next went to my boss and told him I wanted to fill out the papers for a medical retirement. He agreed that it was in everyone's best interest, and said the papers would be ready in a few days. He also said that he would do all that was possible to help me with SSD.

    Immediately after leaving his office, I went to SS and picked up the packet. They said to phone when I had them ready, and they would schedule a phone interview.

    All went according to plan, and I was approved on the first application.

    Kate
  4. JLH

    JLH New Member

    Tips for Winning a Fibromyalgia Disability Case

    by Jonathan Ginsberg, Attorney - Atlanta, Georgia



    In a disability case, you need to prove one thing - that you are not able to work. If you remember nothing else about Social Security disability, remember that your capacity for performing work is the only thing that matters to a Social Security judge.

    Your ability to perform an easy job - the main issue.

    Your underlying medical condition - fibromyalgia or any other medical problem, is only important to the Social Security Judge if your symptoms limit you from performing a job 8 hours a day, five days a week. Thus, for example, I have won cases in the Atlanta hearing offices in which my client’s medical problem was a moderate, functional heart defect, but in this client’s case, her anxiety about her condition was so severe that she could not concentrate at work. Similarly, I have seen judges deny cases in which a claimant had three herniated discs, but was able to function in a minimally demanding job because of an unusually high pain threshold.

    In most cases, the judge’s decision really boils down to his/her decision about whether you could hold down a simple, sit down type of job that requires no training, that allows you to sit, stand and adjust your position and is not production oriented.

    In fact, in most hearings, the Judge will call a “vocational expert” to testify about work you have done in the past and about simple, minimally demanding jobs that exist in the national economy.


    Comprehensive Medical Records - a key to winning

    As a claimant’s lawyer, my job is to identify medical records that suggest work limitations. In many cases this means I need to review all of the medical records, then create a functional capacity checklist that includes both the limitations associated with your particular case and the impairment categories used in Social Security cases. We then ask your doctor to complete the checklist for submission to the Judge. Note that we do not ask the doctor to decide if you are “disabled” - that is a legal decision for the Judge. Instead, we ask your doctor to help “translate” his medical conclusions into specific work limitations.


    What is the Judge thinking?

    There is a perception that Social Security disability cases based on fibromyalgia are difficult to win. It is true that some judges have a problem acknowledging a medical syndrome (not a “disease”) that cannot be detected by a blood test and that can have a wide range of symptoms. Click here for the clinical definition of fibromyalgia as set forth by the American College of Rheumatology. Nevertheless, my experience has been that you can get creative in offering a Judge a theory of disability.

    Not too long ago, for example, I represented a fibromyalgia client before a Judge who called a psychiatrist as an expert witness. The Judge granted benefits on the ground that my client’s “fibro fog” was equivalent to a chronic state of anxiety - a psychiatric condition. Two weeks later, I tried a different fibromyalgia case before another Judge in the same hearing office - this Judge awarded benefits (correctly in my opinion) on the basis of a combined impairment - recognizing the combined effect of fibromyalgia’s impact on my client’s physical and mental condition. Yet a third Judge in this same hearing office granted another case on the basis that my client’s condition was equivalent to an orthopedic condition - severe arthritis.

    Obviously, I am most interested in winning cases for my clients, although I do find it interesting that some judges must really struggle to find a legal basis to award benefits. Further, I think it is fair to say that judges in big cities like Atlanta are probably more likely to see fibromyalgia patients supported by knowledgeable physicians and long treatment histories.

    Fortunately, even if judges don’t understand the condition, many will honor the opinion of your treating physician, especially if you have a long and continuous treatment record (the legal term for a thorough medical history is a “longitudinal treatment record”).


    Focus on all of your symptoms

    I find that it is important to focus on fibromyalgia symptoms other than just generalized body pain. Remember, judges see claimants every day complaining of “pain all over.” These cases are not fibromyalgia, but pains caused by arthritis, obesity, poor nutrition, mild diabetes, etc.

    Judges are people, and they tend to discount complaints they here again and again. As you may know, fibromyalgia often produces other identifiable symptoms, including loss of balance, digestive problems, irritable bowel syndrome, slurred speech, vision problems, depression, swelling, memory loss, cognitive loss, fatigue, sleeplessness, etc.

    Many fibromyalgia patients get used to living with these symptoms and fail to mention all of them to their doctors or to the judge. One technique I recommend to my clients is to obtain a calendar and keep diary notes about how you feel and what symptoms you experience each day. Make lists. Ask for your spouse’s or children’s observations. It has been my experience that judges may not want to grant your case based on overall body pain, but may feel more comfortable focusing on your digestive or balance problems. Make the judge’s (and your lawyer’s) job easy!

    You might find it helpful to read a Judge’s decision in a fibromyalgia case. This case involved a 38 year old woman with an extensive job background who suffers from fibromyalgia as well as numerous gastrointestinal and other complications. Note that the Judge focuses on my client’s work history and that she is very credible because she has been seeking a medical solution to her problem. This file is in Adobe pdf format. Click here to read two of my recent favorable fibromyalgia decisions.

    Deciding on a start-date for your disability

    I also have found that many of my fibromyalgia clients were ambitious and hardworking in their careers and jobs. Subconsciously or otherwise, many Judges realize that few claimants would trade the money and job satisfaction of a challenging career for the fixed income offered by Social Security disability. I therefore usually encourage my clients to testify about what they did before they stopped work, how they tried to hang on, even while fighting increasing levels of pain and fatigue, and how they would greatly prefer their former way of life.

    You may also be able to “push back” the starting date for your benefit payments if your last few weeks or months of work were not in the nature of “competitive employment.” For example, if your boss allowed extra absences or changed your job description, the judge may find that you did not engage in competitive work activity. Similarly, if you previously applied for benefits, received a denial, then tried unsuccessfully to return to work, you may be eligible for months or years of past due benefits. Issue related to amending your onset date are beyond the scope of this article, but should be evaluated.


    About Jonathan Ginsberg - Jonathan is a practicing Social Security attorney in Atlanta, Georgia, and he is the publisher of two "how to" Social Security help books - the Disability Answer Guide (how to fill out adult Social Security disability forms) and the Child SSI Guide (how to fill out child Social Security disability forms). His comments and opinions about "Tips for Winning a Fibromyalgia Case" should not be considered legal advice as every Social Security disability case is different and depends on your individual case information.
  5. JLH

    JLH New Member

    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.