For Cactus Lil - I called SSD to check on my app today

Discussion in 'Fibromyalgia Main Forum' started by Seagull, Feb 5, 2003.

  1. Seagull

    Seagull New Member

    actually, I had to call the Texas Rehab Commission because they were sent my app for disability determination (I'm in TX). I was calling my original Eligibility Caseworker to see if my PCP's records had finally been received by him.

    I was told that his last day was yesterday. Needless to say, I came a little unglued, because he had been with my case from the beginning and was only waiting to get the last of my records in order to send me for more doctor visits and testing (he had mentioned sending me to a psychiatrist!). The new caseworker looked up my file and said that my former caseworker had already made a decision on eligibility determination on it last week before he left. I really got unglued then, and asked her, "but, I thought he was sending me to more doctors?" She said no, that apparently he felt he had enough to go on to make a determination and did so. I asked her what the decision was and she said she could not tell me, but that it had been sent to their doctor for a final review and approval before going out to me, in about 2 weeks.

    So, does that mean he had approved my app before leaving and if so can the doctors still overturn it? I am now really on pins and needles.

    And to top off everything, my pcp just diagnosed me yesterday as also having Meniere's Disease (the violent vertigo attacks have returned, with all the symptoms of that disease) and has referred me to a neuro for further treatment options and testing. If my app for disability is turned down this time, will my newest records and diagnoses be permissable and considered in my appeal? Or will they think the new problems do not apply to the app? (I did state vertigo as one of the conditions I live with on my app.)

    [This Message was Edited on 02/06/2003]
  2. Seagull

    Seagull New Member

    bump, bump
  3. joannie1

    joannie1 New Member

    I really can not tell you what the decision may be. I just want you to know I know how flustrating this process is grrrr.... I hope that they have approved it and their doctor has to over see it and agrees though. If it was indeed stated in your disability claim they told me if new evidence was provided to let them know. it never hurts to call back and tell them you were diagnosed with it and see if they want the records.
    Best of luck and I will pray for a good outcome for you, keep us informed okay.
  4. Seagull

    Seagull New Member

    I did put vertigo as an additional symptom/condition on my app paperwork. And, when I spoke with the new caseworker I told her that my PCP had officially diagnosed it as Meniere's at this last Tuesday morning's appointment. So, I would hope that she will notate that on my files notes and maybe the groundwork was already laid for the additional consideration/appeal? What has me sick about this waiting is the way the Texas Rehab doctors are with sick workers. Generally, their philosophy is, if you can breathe, you can work. :-}
  5. Seagull

    Seagull New Member

    bump, bump
  6. Seagull

    Seagull New Member

    bump, bump
  7. Seagull

    Seagull New Member

    In answer to your questions,

    >> I am assuming that your PCP has already received a request from TX Rehab and have sent the records directly to them. <<

    Yes, I was told that they did receive all my records from all sources, including my PCP's which came in last week.

    >> You should have been given a contact name for TX Rehab, for the Disability Examiner handling your case, in the packet of questionnaires they send you. This person is the one who will be requesting any and all records and sending out the questionnaires, verifications, etc. <<

    Yes, I did have a very nice Disability Examiner who I spoke with several times after he had received my case file in December from SSA. I simply did not know that he was leaving his job so soon, which he did this last Tuesday. I was given the name of my new Disability Examiner, but was told that nothing more would be done at this point, because my first Disability Examiner had made a decision last week and the file is now in front of the doctors for a final review they said. They could not tell me what the decision was.

    >> Once it is turned over to TX Rehab, they handle everything from there and SSA does not do anything except wait for the determination and process the check if an award is granted. TX Rehab also works with TX MHMR, if there are psych issues to be investigated. <<

    Does this mean that if TX Rehab approves my app for disability then SSA cannot or will not overturn it? And, do they mail me a check or do I have to set up a direct deposit with my bank first?

    >> You should be able to call TX Rehab Toll-free (800) 252 7009, and find out who the D.E. is that's assigned to your case. <<

    Already done in the beginning of all this. If you don't mind my asking, how long did it take for you to hear about your denial on the first app? And, if my Disability Examiner did deny my app, would it still have to go to the doctors for review before being sent to me? Thanks for all your feedback. :)
  8. Seagull

    Seagull New Member

    >> TxRehab is the sole Disability Determination Service acting for SSA and is the one who gives the thumbs-up or not. My understanding is that SSA goes strictly on their recommendations. <<

    That's a relief -- at least I will have to deal with only one bear and not both. :)

    >> Social Security Field Offices

    SSA representatives in the field offices usually obtain applications for disability benefits, either in person, by telephone, or by mail. The application and related forms ask for a description of the claimant's impairment(s), names, addresses, and telephone numbers of treatment sources, and other information that relates to the alleged disability. (The "claimant" is the person who is requesting disability benefits.)

    The field office is responsible for verifying nonmedical eligibility requirements, which may include age, employment, marital status, or Social Security coverage information. The field office sends the case to a DDS for evaluation of disability. <<

    Does "verifying nonmedical eligibility requirements" mean that they have already cleared me on that part, since they've sent my file to the DDS for further processing?

    >> State Disability Determination Services

    After completing its initial development, the DDS makes the disability determination. The determination is made by a two-person adjudicative team consisting of a medical or psychological consultant (who is a physician or psychologist) and a disability examiner. If the adjudicative team finds that additional evidence is still needed, the consultant or examiner may recontact a medical source(s) and ask for supplemental information. <<

    Does the disability examiner work independently from the consultant to arrive at his own decision first then send the file to the consultant for his opinion later? Or do they work together to arrive at a joint decision?

    >> The DDS also makes a determination whether the claimant is a candidate for vocational rehabilitation (VR). If so, the DDS makes a referral to the State VR agency. <<

    This I did not know. Do I have to accept that type of determination or can I appeal it?

    >> After the DDS makes the disability determination, it returns the case to the field office for appropriate action depending on whether the claim is allowed or denied. If the DDS finds the claimant disabled, SSA will complete any outstanding non-disability development, compute the benefit amount, and begin paying benefits. If the claimant is found not disabled, the file is retained in the field office in case the claimant decides to appeal the determination. <<

    What would be included in "any non-disability development? And which office sends the letter to the claimant about the approval or denial?

    >> Mine is still in the initial process, so I am not that far along. Sorry I could not be more help.

    Lane <<

    I wish you all the best in your efforts to get your benefits. And, you have been so helpful in sharing all this great info with me. Thank you so much.

    I did enclose a couple extra items with my forms, though, and hope they make the right impression on the right people (like the doctor consultants!).

    1) I enclosed color photos from before the car crash and after the car crash to show the adverse effects these DDs have had on my health and life. The "before" photos show me at my skinny weight, active and happy, enjoying my life and family and friends in different situations, like on vacation and at a backyard party. The "after" photos show me as I am now -- morbidly obese, using my scooter, sitting on the couch, and a close-up of my face showing the bags under my eyes and pale mottled complexion from lack of restorative sleep.

    When my examiner saw the photos, he asked why I sent them. I told him that I did not want to be a faceless claimant to the doctors or judge who might be deciding whether to approve me or not. I believe that old adage of "a picture is worth a thousand words". He told me that the photos were so shockingly clear on how these DDs have adversely affected my health and activities that he was putting them at the front of the file so that they would not be overlooked by whoever got the file next.

    2) Following a suggestion of the attorney quoted on this site, I enclosed 4 affidavits (from my mother, my husband, a friend who happens to be a firefighter/EMT, and my massage therapist), each giving eyewitness observations of how these symptoms and limitations have adversely affected my activities and life in detail.

    So, I hope that gives them enough to go on and that I get a favorable decision soon. At least, they won't be able to say, "oh, she's always been fat, lazy, and crazy, so we can deny her benefits". I will not give up trying to get what I know is rightfully mine.

    Thank you, again, for all your help and feedback on this. Have a soft and stressfree day. :)
  9. Seagull

    Seagull New Member

    bump, bump.
  10. Seagull

    Seagull New Member

    bump, bump.