SSDI & SSI Denial and Appeal Process

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NAUTICAL
New Member


Date Joined Apr 2008
Total Posts : 9
   Posted 4/8/2008 9:24 PM (GMT -6)   

New to forum and this wonderful world of MS! eyes

 

I have read some of the posts about applying for SSDI and the good comments from UppityCats and others.  Unfortunately, I have already submitted my application and have received a denial.  The denial basically states that based on the information in my file, I am not medically sick enough and can work.

 

My sister, who now is my representative, could not believe or accept this decision and had me request a copy of my file to see what was in it.  She was concerned that the neurologist I see is not a MS Specialist and thought this might be a factor.  In the interim, I have had increased problems both physically and mentally.  A recent MRI in March 2008 showed preexisting lesions larger and new lesions now present.

 

IN THE FILE:

-- State disability determination sent me for a psychological exam and their doctor recommends helping me.

-- There is a form with boxes X that I can stand and walk 6-8 hours a day, lift 50 pounds, operate machinery, withstand fumes, and other hazards (NO WAY!)

-- Sections for explanation of conclusions were not completed and many "none established" were checked.

-- Requests for things that are not relevant to the doctor (blood gas).

-- SSA intake officer saying everything was "normal" with our phone calls when they were not. Several times I called upset and have cried while on the phone with her.

-- Request to primary care doctor was returned to sender (wrong address) and it wasn't followed up (so no info from her).

NOT IN FILE:

-- Family never contacted for info.

-- State disability never returned any calls and when called supervisor for assistance was laughed at and treated rudely.

-- December, lost partial vision and had steroid IV treatment (called into state disability and SSA intake officer).

 

Should I address the above?  Anything that you think might be helpful to add for my appeal would be greatly appreciated.

 

THANKS!

 

P.S. I typed this in Word first, cuz the font size here is way too small for me to read well.  Please consider options for increasing font size.


Gretchen1
Forum Moderator


Date Joined Jan 2007
Total Posts : 3539
   Posted 4/8/2008 9:37 PM (GMT -6)   

Hey NAUTICAL,

I am sorry for all your troubles.  I can’t help you with your appeal, I am still working full time.  I am sure someone will come along and give you some suggestions. 

I wanted to welcome you to HW.  I know that the font size is a problem  and it has been brought to the attention to the administration.  Unfortunately there is nothing I can do there. 

Thank for posting and let us know how the appeal process goes for you. 

Love and prayers,


Gretchen       co-moderator MS board       diagnosed with MS July 2006


uppitycats
Veteran Member


Date Joined Jun 2005
Total Posts : 2135
   Posted 4/9/2008 6:07 AM (GMT -6)   
NAUTICAL said...

New to forum and this wonderful world of MS! eyes

 

I have read some of the posts about applying for SSDI and the good comments from UppityCats and others.  Unfortunately, I have already submitted my application and have received a denial.  The denial basically states that based on the information in my file, I am not medically sick enough and can work.

 

My sister, who now is my representative, could not believe or accept this decision and had me request a copy of my file to see what was in it.  She was concerned that the neurologist I see is not a MS Specialist and thought this might be a factor.  In the interim, I have had increased problems both physically and mentally.  A recent MRI in March 2008 showed preexisting lesions larger and new lesions now present.

 

IN THE FILE:

-- State disability determination sent me for a psychological exam and their doctor recommends helping me.

-- There is a form with boxes X that I can stand and walk 6-8 hours a day, lift 50 pounds, operate machinery, withstand fumes, and other hazards (NO WAY!)

-- Sections for explanation of conclusions were not completed and many "none established" were checked.

-- Requests for things that are not relevant to the doctor (blood gas).

-- SSA intake officer saying everything was "normal" with our phone calls when they were not. Several times I called upset and have cried while on the phone with her.

-- Request to primary care doctor was returned to sender (wrong address) and it wasn't followed up (so no info from her).

NOT IN FILE:

-- Family never contacted for info.

-- State disability never returned any calls and when called supervisor for assistance was laughed at and treated rudely.

-- December, lost partial vision and had steroid IV treatment (called into state disability and SSA intake officer).

 

Should I address the above?  Anything that you think might be helpful to add for my appeal would be greatly appreciated.

 

THANKS!

 

P.S. I typed this in Word first, cuz the font size here is way too small for me to read well.  Please consider options for increasing font size.

Is your sister a lawyer? If not -- you need to get a lawyer to work through the appeals process for you. You attempting it...even with your sister as "representative"..will not likely work. Look for a lawyer who has experience with social security disability claims, and make sure they are "certified" by the social security administration. While that may sound ilke a conflict of interest, being certified means they can only request a small percentage of your first check (once you get approved), and nothing if they are not successful.
 
There are several issues you need to address right now -- get the medical records from your doctor yourself, MAKE COPIES and keep them in a safe place, and have them ready to be resubmitted.  Get a current exam and make sure the doctor DOCUMENTS your increased disability. Get copies of those records, MAKE COPIES (see above).
 
I'm a bit confused by your discussion about the "state disability" person. Why are you calling them? I don't know how they might fit in to this picture...but in any case, a lawyer can sort that out and get an opinion from them in writing if that is necessary.
 
The fact that your doctor is not an MS specialist really isn't a problem.  Even primary care doctors can diagnose MS. What IS a problem is that apparently the paperwork from the doctor never made it to the social security office, and without that documentation, they'll deny your claim outright.
 
Once the SS department denies a claim, it's tougher and tougher to get it processed without an attorney, or at the very least, without someone with LOTS of experience in the bureaucracy, to get this done.  Find an attorney.
 
 
...I am not a doctor, nor health professional, and don't pretend to be one, here.....


Gretchen1
Forum Moderator


Date Joined Jan 2007
Total Posts : 3539
   Posted 4/9/2008 7:42 AM (GMT -6)   

Ahhhhhh I was hoping to see our resident expert answer here!!!!  Thanks Uppitycats, I have missed you!  With your years of experience with MS and your work with people with disabilities, you really are our expert.  Thank you for taking the time to post.

Love and prayers,


Gretchen       co-moderator MS board       diagnosed with MS July 2006


NAUTICAL
New Member


Date Joined Apr 2008
Total Posts : 9
   Posted 4/9/2008 3:33 PM (GMT -6)   
Thank you for the advice.

I was calling the state disability people because the forms says to call them if you have difficulty completing the forms and that they would help. The direct contact person never returned any calls and federal SSA told me to call his supervisor for help. The supervisor told me that he didn't have time to help me fill out all those forms and that I should find someone else myself (he was very rude and condescending).

Paperwork from my Primary Care doctor did not get sent to SSA cuz they sent request to wrong address.

Paperwork from my Neurologist did make it to SSA. The problem is it was just evaluation notes from appointments. It documents how I am THAT DAY... walking talking fine, etc. It does not take into consideration that the only time I see him is when I am "okay" and able to drive. There is no documentation for all the canceled appointments due to problems with walking or vision. There is no documentation of "phone counseling" when I have been in terrible pain and he just phoned in pain prescription for me. There is no documentation of my crummy everyday life.

I am in the process of switching neurologists and going to a MS specialist. This decision was made because although my current one is somewhat sympathetic, he seems to have no clue about MS and its symptoms. For example, he told me my pain was not MS, cuz MS does not cause pain. That my hearing problems were not MS, cuz it doesn't cause hearing problems, etc. and when I had vision problems had to research what to do about it.

Also, the way I feel and the recent MRI with larger and new lesions seem to indicate the MS meds is not working and I want someone more knowledgeable to help me. I was diagnosed with relapsing and remitting, but I do not feel this is correct.

What I have learned about MS is not from him (but because of him and others responses to my symptoms). It's from the wonderful power of the internet!! I found the MS society, other sites, including this one and have educated myself. My problem is that it has taken me a LONG time to do this.

Gretchen1
Forum Moderator


Date Joined Jan 2007
Total Posts : 3539
   Posted 4/9/2008 4:27 PM (GMT -6)   
You certainly sound very frustrated.  I am sorry that your doctor is so unsympathetic.  I am glad you are going to go to an MS specialist.  That sounds like a great idea.  Just so you know, you will progress with MS even if your meds are working.  I would ask your new neurologist what he or she thinks about whether or not your meds are working.  There are no meds out yet that stop the progression totally, they only slow this down. You are going to develop new lesions until those meds are created/found/discovered.  I would also discuss the type of MS you have with the new neuro.  Most people are initially diagnosed with remitting/relapsing MS.  That means you have periods when you are just dealing with residuals from early flares and then there are times when you are relapsing (flare)  and you have either a severe increase in residual symptoms or brand new symptoms.  If you are diagnosed with either primary progressive or secondary progressive then you are no longer flaring, but having a slow but steady increase in symptoms.  Again, this is something to be discussed with the new neuro.  Good luck with that and let us know how you are doing and what the new doc says.
 
Love and prayers,
Gretchen       co-moderator MS board       diagnosed with MS July 2006


uppitycats
Veteran Member


Date Joined Jun 2005
Total Posts : 2135
   Posted 4/10/2008 4:26 AM (GMT -6)   
NAUTICAL said...
Thank you for the advice.

I was calling the state disability people because the forms says to call them if you have difficulty completing the forms and that they would help. The direct contact person never returned any calls and federal SSA told me to call his supervisor for help. The supervisor told me that he didn't have time to help me fill out all those forms and that I should find someone else myself (he was very rude and condescending).

Paperwork from my Primary Care doctor did not get sent to SSA cuz they sent request to wrong address.

Paperwork from my Neurologist did make it to SSA. The problem is it was just evaluation notes from appointments. It documents how I am THAT DAY... walking talking fine, etc. It does not take into consideration that the only time I see him is when I am "okay" and able to drive. There is no documentation for all the canceled appointments due to problems with walking or vision. There is no documentation of "phone counseling" when I have been in terrible pain and he just phoned in pain prescription for me. There is no documentation of my crummy everyday life.

I am in the process of switching neurologists and going to a MS specialist. This decision was made because although my current one is somewhat sympathetic, he seems to have no clue about MS and its symptoms. For example, he told me my pain was not MS, cuz MS does not cause pain. That my hearing problems were not MS, cuz it doesn't cause hearing problems, etc. and when I had vision problems had to research what to do about it.

Also, the way I feel and the recent MRI with larger and new lesions seem to indicate the MS meds is not working and I want someone more knowledgeable to help me. I was diagnosed with relapsing and remitting, but I do not feel this is correct.

What I have learned about MS is not from him (but because of him and others responses to my symptoms). It's from the wonderful power of the internet!! I found the MS society, other sites, including this one and have educated myself. My problem is that it has taken me a LONG time to do this.
You should look in your community, or if  (like me) you live in a small town, look in the next larger community, for the National MS Society local chapter.  If you can't find that, then go back to the website -- www.nmss.org   --and call their toll-free number. They have experts on staff that will help you either fill out the forms correctly, or refer you to a lawyer in your area.
 
I can't emphasize this enough: Get a lawyer. Once you've been denied, it is EXTREMELY difficult to work through the appeals process on your own.  I suspect a major factor in your denial is the fact that the reports from your doctor did not get to them. As I said before, it really doesn't matter that you were or were not seeing an "MS specialist". What DOES matter is that they did not get an accurate picture of your disability (the missing doctor reports).
 
But again -- at this stage of the process, you need a lawyer. Don't waste time trying to figure out what went wrong -- spend that time getting it set straight. And you do that by getting someone with experience and expertise dealing with the social security department -- an attorney or disabilities advocate -- to get you through the process.
...I am not a doctor, nor health professional, and don't pretend to be one, here.....

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