Advice regarding social security disability

[dwk]

Quick background: DW age 42 had a cervical fusion in September 04 due to several herniated disks and rt arm discomfort. While recovering from that surgery, enlarged lymph nodes in the rt axilla were found, after 4 weeks of testing, a diagnosis of occult metastatic breast cancer was made. Underwent axillary dissection, chemo, mastectomy, radiation therapy... during radiation therapy she got 3rd burns on her neck and chest. The burns became infected and she was septic. Admitted to the hospital to reopen mastectomy site, install drains and 10 days of iv antibiotics. Due to her illness and the infection -- she suffered an emotional breakdown and was admitted to a mental health facility. This year she went in for reconstruction, but the tissue graft failed. She is scheduled this fall to attempt another reconstruction -- followed by two minor surgeries.

We applied for SS disability this spring -- received a denial today.

Prior to her illness my wife worked as a patient care nurse in a local hospital.

The letter from SS states:

We have determined that your condition is not severe enough to keep you from working. We considered the medical and other information, your age, education, training, and work experience in determining how your condition affects your ability to work.

You said your are disabled because of Stage III breast cancer and depression. We realize that you have concerns about your health and that you do not feel that you are able to work. A careful review of your medical records shows that your ability to function has been affected by your condition(s), and that you are no longer able to perform your past relevant work. However, based on your age, education, work experience,and medical records, we have determined that you are able to perform other work. Therefore, your claim for disability is denied.

I realize this is a standard letter. However, it acknowledges that she is unable to perform in her role as a nurse. Maybe my wife could get a job as a Wal-Mart greeter -- but that's not the point. She is unable to return to her previous occupation.

In the past two years DW has undergone more than 8 surgeries, chemo and radiation and suffered an emotional breakdown. Even if she is denied permanent disability -- isn't she entitled to disability for the last two years.

Already set-up the appointment to see a disability attorney, but I'd like any advice from folks who have gone through this process. What is the best way to structure an agreement with the attorney?

I'm trying to keep the emotion out of this, but I do not uderstand the process or the criteria -- meanwhile we provide free medical care to all of the illegals...

Thanks!!!
dwk

 

[maddythebeagle]

Yuck...doenst sound like much fun You might want to do a search... I vaguely remember this topic coming up in the past...looks like you were the author of this one though...

http://early-retirement.org/forums/index.php?topic=7222.0

 

[MikeD]

I was told by my SS disability lawyer that SS always denies the first request for disability.

I am on SS disabilty due to vascular dementia. That's right, I'm demented. I have short term memory loss from years of diabetes. I was turned down, too, but the Unum disability insurance representative got me a lawyer specializing in SS disabilty claims. They are limited by law to charging no more than $4,000.00 for an appeal - so guess how much he charged for filling out some paperwork?

Mike D.

 

[rs0460a]

DWK:

I know what you're going through.  I had the same situation with my son, who is a high-functioning autistic.

We had the same "refusal" from SS (I think unless you have "no options", it's the standard answer), and went through a lawyer to press the claim (successfully).

I know that there are a lot of firm's that do "contingency work" (they get part of your check, if you're successful).  Luckly, in my son's case, we found an organization that acts as a resource for people like my son, and had a great lawyer who did not charge anything (before or after).  I did ask him how he was compensated, and he said that he did it as a "public service", and mentioned that part of his fee was returned by SS (I assume due to a successful plea).

It's not easy, but just keep plugging away.  With the disability claim, along with the Medicare work, it took close to three years to get everything "started".  Even today, there are annual reviews by SS on his case, but we can "defend" the situation.

Just keep plugging away - it's a long road...

- Ron

 

[rs0460a]

I have short term memory loss from years of diabetes. 

Mike -

Not to joke about it, but I'm also diabetic (Type II, for many years).  May I use your condition to explain to my DW why I never remember what she tells me  : ?

- Ron

 

[dumpster56]

Quick background:  DW age 42 had a cervical fusion in September 04 due to several herniated disks and rt arm discomfort.  While recovering from that surgery, enlarged lymph nodes in the rt axilla were found, after 4 weeks of testing, a diagnosis of occult metastatic breast cancer was made.  Underwent axillary dissection, chemo,  mastectomy, radiation therapy... during radiation therapy she got 3rd burns on her neck and chest.  The burns became infected and she was septic.  Admitted to the hospital to reopen mastectomy site, install drains and 10 days of iv antibiotics.  Due to her illness and the infection -- she suffered an emotional breakdown and was admitted to a mental health facility.  This year she went in for reconstruction, but the tissue graft failed.  She is scheduled this fall to attempt another reconstruction -- followed by two minor surgeries.

We applied for SS disability this spring -- received a denial today.

Prior to her illness my wife worked as a patient care nurse in a local hospital.

The letter from SS states:

We have determined that your condition is not severe enough to keep you from working.  We considered the medical and other information, your age, education, training, and work experience in determining how your condition affects your ability to work.

You said your are disabled because of Stage III breast cancer and depression.  We realize that you have concerns about your health and that you do not feel that you are able to work.  A careful review of your medical records shows that your ability to function has been affected by your condition(s), and that you are no longer able to perform your past relevant work.  However, based on your age, education, work experience,and medical records, we have determined that you are able to perform other work.  Therefore, your claim for disability is denied.

I realize this is a standard letter.  However, it acknowledges that she is unable to perform in her  role as a nurse.  Maybe my wife could get a job as a Wal-Mart greeter -- but that's not the point.  She is unable to return to her previous occupation.

In the past two years DW has undergone more than 8 surgeries, chemo and radiation and suffered an emotional breakdown.  Even if she is denied permanent disability -- isn't she entitled to disability for the last two years.

Already set-up the appointment to see a disability attorney, but I'd like any advice from folks who have gone through this process.  What is the best way to structure an agreement with the attorney?

I'm trying to keep the emotion out of this, but I do not uderstand the process or the criteria -- meanwhile we provide free medical care to all of the illegals...

Thanks!!!
dwk

Man I really get fired up with these idiotic responses from SS!

My wife is in a similar situation, many medical issues, has been an ICU nurse for 22+ years and cannot do it anymore . She has a form of late onset muscular dystrophy, and literally has a hard time walking by the end of the day.

She will however NOT apply for SSD because she is afraid of the rejection possiblities and says she will wait the 8 years until she turns 62.

I support her choice but people who really need the help like your wife are given additional stress by a plain stupid system.

 

[Mary E.]

You might try researching at www.prairielaw.com. They have various message boards and probably have one on SS. My DH is disabled and was accepted by SS after a six month waiting period. He also is covered by worker's comp. We used the message boards while we were wading throught the worker comp red tape.

 

[Helena]

DWK:

I had the same situation with my son, who is a high-functioning autistic.

- Ron

My son is also autistic and has seizure disorder.
No problem getting SSI... but I know of others
who had to appeal and were successful.

 

[Lakewood90712]

As with most all insurance , public or private, if any big money is involved, Deny and Delay is standard. 

This is not a do it yourself thing, if you want to be sucessfull , you  will need an atty. with this as his/her specialty.

I had a workers comp. claim many years ago with a former employer, (very large co.)  They had recenty switched from self-insur to a major w.c carrier.  An official with my employer at the time warned me " You are in for a real fight. They deny all claims hope you will give up" 

It was true.  I did not use an atty. , and did prevail, but it took a great deal of effort and willpower to not give-up.

Get an atty . and keep up the pressure.

 

[Martha]

Peoples comments about the frequency of initial denials are correct. See an attorney that does disability work for a living. They know the ins and out of the appeal process and how to make the case to an Administrative Law Judge.

When I was in law school (too many years ago) I worked for legal aid on SSD and SSI appeals. I couldn't believe situations where people were turned down. At least back then, if there was a mental health component to the disability, you were about guaranteed to be turned down.

Generally the attorneys are paid on a contigency basis. It used to be 1/4 of your back pay, up to a certain maximum that changes from time to time. Money well spent. It isn't simply filling out some forms.

Good luck to you and your wife and be patient.

 

[haha]

I had a friend, since died, who specialized in this area of law. He was a real crusader, seeing all the obvious cases of dire need that were turned down.

I think overall he did well for his clients.

Ha

 

[tednvon]

Hello,
I am a social worker in large university hospital in Orthopedics. I have worked with many many people going through this process. Of course, appeal immediately. In my experience, an attorney is the most help if you are denied a second time and then go to a hearing.

One suggestion that has not been mentioned that I have seen work is to call your congressman's office and tell them the story. They can sometimes shake things up more than you may think. IMHO, you must believe ABSOLUTELY that you deserve SS and can prove that you just cannot work a 40 hour week no matter how motivated you are. Be specific with the congressman about why you cannot work...pain, tired, can't focus, can't sit or stand, must lay down and rest, etc.
On the appeal it is very important that you prove to SSDI that spouse cannot work a 40 hour week. SS looks at "gainful employment" not NO employment.
Use terms like,
"I must rest at least 2-3 times a day for a minimum of 45 minutes at a time."
"I need frequent breaks to lay down for just a short period "
"My medication causes me to fall asleep 2-3 times during an 8 hour period."
My physician has told me that I can expect to be absent from any possible work 5-7 days a month due to pain, fatigue, depression.

Give this a try...good luck...Ted

 

[rs0460a]

My son is also autistic and has seizure disorder.
No problem getting SSI... but I know of others
who had to appeal and were successful.

Just a response (info).  My son had worked while in high-school/college, so he is under SSD (rather than SSI).  Being that he worked (along with getting his B/S in Computer Science), SS could not "understand" why he could not get/keep a "normal" job.  Needless to say, the older he got, the underling "conditions" related to his autism (such as not being able to hold a conversation) did nothing to help his case.  Evenually, he (and the lawyer) did succeed (also after we paid for a lot of "private support work" <such as his testing with a nuro-phychologist>).

He's now working in a sheltered workshop, where he does not have to have much verbal communication, and is doing fine.

Also, he did have seizure's (age 10-15), but that has gone away (he's currently 36), so there is a chance your child will "grow out" of it (hope springs eternal..)

Don't mean to "hyjack" the conversation, just to show that there are different "avenue's" to get some support frrom SS.

- Ron

 

[dwk]

Thanks for all of the advice.

dwk

 

[shorttimer]

First of all, I am very sorry you have had to go through all this.

I am going to a hearing soon fighting the insurance company, I am trying first on my own. It is workers comp and I did return to work (in pain). They have thrown up every roadblock and delay tactic and there was no dispute about the injury. They have been sarcastic, sometimes mean and I think very irresponsible. I gave up trying to get them to return a phone call. I did everything every MD told me to do to get better- and I was hurt by no fault of my own. Fortunately I recovered enough I don't need to go your route. Social Security disability is set up to cover those that are truly disabled. It is unbelievable that the combination you described doesn't qualify.

Sometimes you have to hire an attorney, but I would do a websearch first and gather all the info you can. You have taken enough of a financial and emotional hit.

 

[riskadverse]

I have a friend with severe physical problems due to gunshots to his head. I'm not sure he could be a WalMart greeter. He was denied SS the first time in a similar type letter. I wrote a long letter explaining the problems and requesting a reversal of the decision. Luckly they did reverse the decision and he thinks my letter made the difference. I'm not sure it was my letter, but as others have said, the first letter is an automatic denial. Appeal and good luck!

 

[MikeD]

Mike -

Not to joke about it, but I'm also diabetic (Type II, for many years). May I use your condition to explain to my DW why I never remember what she tells me : ?

- Ron

Hey, have at it. I am a type 1 diabetic since age 6 and I'm now 52. Back when I was at work I would ask a co-worker a question and forget both the question and his answer during the walk back to my office. I also have higher-level cognition difficulties. If something is even slightly complicated it takes me about four times as long as it used to for me to understand it. Since I was a real-time programmer this was not acceptable at work so, voila! - disability.

Mike D.