Sunday, April 11, 2010

Social Security Disability: The Judge's Approval Letter

Notice of Decision: Fully Favorable

WOOHOO!

That is the feeling I got when my lawyer's office called me! A few days later, I received this letter in the mail. I got the idea to share this letter with you, as an addition to my last post, from another EDSer with a blog, Bunny. Again, for legalities, everything in this post is my opinion and you should seek legal council for legal questions or concerns. :) I will be changing some names and omitting some things, but this is the main bulk of my approval letter. Enjoy! Hope it helps you see what sort of things made an impact on the judge so you can win your case!

Everything in parenthesis is my own remarks, by the way.

Letter:

After careful review of the entire record, the undersigned finds that the claimant has been disabled from May 29, 2008 through the date of this decision. The undersigned also finds that the insured status requirements of the Social Security Act were met as of the date disability is established.

(This is REALLY summarized and shortened:)

Judge's steps -

Step One: Determine whether the claimant is engaging in substantial gainful activity (working and making above a certain amount of money, aka SGA, aka Substantial Gainful Activity). If an individual engages in SGA, she is not disabled regardless of how severe her physical or mental impairments are.

Step Two: Determine whether the claimant has a medically determinable impairment that is "severe" or a combination of impairments that is severe....if it significantly limits an individuals ability to perform basic work activities.  If the claimant does not have a severe medically determinable impairment or combination..., she is not disabled.

Step Three: Determine whether the claimant's impairment or combination of impairments meets or medically equals the criteria of an impairment listed...If it does not, the analysis proceeds to the next step.

Step Four: (Has to do with the claimant having the ability to perform any duties she did at all of her previous places of employment. If the claimant cannot do any of the past job functions, you go on to step five. If she can, she is not disabled.)

Step Five: Determine whether the claimant is able to do any other work considering her residual functional capacity, age, education, and work experience. If the claimant is able to do other work, she is not disabled. If the claimant is not able to do other work and meets the duration requirement, she is disabled...in order to prove that the claimant is not disabled at this step, the [SSA] is responsible for providing evidence that demonstrates that other work exists in significant numbers in the national economy that the claimant can do...

***

(Okay, so basically, they are going to go through four or five steps to determine if you are disabled, if you can or cannot work based on past work history, your illness, and jobs that are available in the current economy.)

***

(Below is what the judge summarized for me and my disability.)

Findings of Fact and Conclusions of Law:

1. [Danielle's] date last injured is December 31, 2012. (This basically means the last date you could apply for disability benefits. It is based on the last day you worked and paid into the system. You really don't need to worry about this date unless your date of injury/day you became disabled was a long time ago. Now, I know our EDS started a long time ago, ha!, but this counts from the 'day you became unable to work' which I discussed at length in the last post.)

2. [Danielle] has not engaged in [SGA] since May 29, 2008, the alleged onset date. (This just says I didn't make money/enough money to ruin my case since I applied. Basically, that I didn't work or work a lot during this time. I personally did work for 2 months. This was a big mistake. It was part-time and I called in sick a lot and then had to quit because my body just couldn't take it. The judge said this was 'an unsuccessful work attempt' - thank goodness! It could have really ruined my case. In fact, my lawyer said I might not win just because of this, which is why I stress so much about NOT working at all.)

3. [Danielle] has the following severe impairment(s): hypermobile Ehlers-Danlos syndrome (EDS); posttraumatic stress disorder (PTSD); affective disorder; and orthostatic tachycardia. The medical evidence of record reflects medical signs and findings establishing diagnoses [EDS]; [PTSD]; [BPD]; [POTS]. These impairments and their symptoms have limited [Danielle's] ability to perform the mental and physical demands of basic work activities, including understanding and carrying out complex tasks. Therefore, the undersigned finds that these impairments are severe.

4. (This one is mumbo jumbo saying that I don't have a disease or impairment listed on their automatic approval list, like a brain tumor. It does say the following though, which is important to note:)...mild restriction in activities of daily living, moderate difficulties in maintaining concentration persistence or pace, and no episodes of decompensation, each of extended duration.

5. [Danielle] has the residual functional capacity to perform sedentary work as defined in [legal codes]...except [Danielle] is not able to perform physical work activity on a sustained basis; and is unbable to do work that requires more than limited public contact.

(Okay, so this means the judge had to go through all 5 steps in making his conclusion. This part is REALLY LONG and it is the summary of question 5, continued from above. Let me take a break, get something to drink and rest my hands...this is tough on the wrists! Haha!)



(Here we go, number 5, continued:)


(This is the judge's words, unless I comment in parentheses:)

...Evidence indicated that [Danielle] complained of Ehlers-Danlos syndrome, depression, posttraumatic stress disorder, and orthostatic tachycardia. She insisted that her pain limits her ability to sit, stand, and walk for prolonged periods; and she reported that she experiences frequent migraine headaches, and constant and persistent pain. She maintained that she is unable to return to past work...is able to independently take care of her own personal needs and activities of daily living, with additional time to compensate for pain. She indicated the chronic pain affects her ability to sleep throughout the night. [She] reported that she requires braces for her knees, ankles, elbows and wrists. Additionally, she was prescribed compression stockings by her cardiologist. She stated that she was able to drive short distances, go out alone, and shop as needed. Additionally, [she] stated that she is able to complete light household chores. She indicated that she remained socially active with her boyfriend and mother. Because of the mental issues...she has difficulty accepting criticism from others, or handling stress and changes well. She maintained that she has a short attention span, and is able to follow most instructions. (Not all of this is quite as I said it, but he obviously got the point.)

She stated that she last worked from May to June 2009, but had to stop because of her impairments. She indicated that she is unable to work because of chronic dislocations of her shoulders. Additionally, she indicated that she has difficulty standing because of the chronic dizziness. She described her pain as possible and persistent. [She] stated she experiences chronic pain in her hands and shoulders. She testified that she has to wear wrist and finger splints because of constant pain. She also complained of PTSD secondary to physical and sexual abuse experienced as a child and teenager. [She] also reported...panic attacks and difficulty sleeping because of nightmares and flashbacks. She stated that she is unable to handle large crowds, and prefers to isolate. Additionally, [she] reported chronic fatigue secondary to EDS. Because of difficulty with her impairments, [she] was [prescribed] a wheelchair by her treating physician.

After considering the evidence of record, the undersigned finds that the claimant's medically determinable impairments could reasonably be expected to produce the alleged symptoms, and that [her] statements concerning the intensity persistence and limiting effects of these symptoms are generally credible (YEAH!).

[Danielle] has a significant history of hypermobile Ehlers-Danlos syndrome, and orthostatic tachycardia. Following a referral by [rheumatologist], [she] was diagnosed in August 2005 by Johns Hopkins Hospital geneticist Dr. Howard Levy (I know some of you were, too!!). [She] reported a history of chronic dislocations of her joints, and constant and persistent pain and discomfort. Although the least severe form of EDS, Dr. Levy indicated that [she] would experience significant pain and related symptoms, and indicated that this disease was progressive. He noted joint subluxability in her wrists and interphalangeal joints, on the right greater than the left; mild laxity of the left elbow; laxity in both shoulders; marked hip joint laxity; and arachnodactyly (What is that?! It means 'spider fingers'!). He recommended that [she] continue with physical therapy and exercise for strengthening, and continued use of the splints or braces for joint support. In addition to EDS, Dr. Levy indicated that [she] demonstrated significant arthritis and femoral patellar syndrome; and noted that [she] bruises easily.

In April 2008, treating physician [primary care doctor] referred [her] to [cardiologist] because of chronic chest pains and dizziness. However, a [MRA} reflected no evidence of aortic insufficiency. [She] continued to complain of postural lightheadedness, and a tilt table test revealed significant orthostatic tachycardia. Treating cardiologist monitored [her] symptoms from April 2008 through June 2008. Simultaneously, [she] received chiropractic care, but realized only some relief through manipulation and treatment. In May 2008 doctor's notes indicated that the claimant was mildly symptomatic, and [her] symptoms were reduced with treatment.

In August 2009, [Primary care doctor] opined that the evidence of record demonstrated significant limitations in the [Danielle's] ability to work. Based on genetic findings, psychiatric diagnosis, low bone density scan, positive tilt table tests, and treatment records, she opined that [Danielle] was unable to work because of her significant impairments. She indicated that [Danielle] experienced chronic dizziness and fatigue, and significant pain in her knees, hips, back, and elbow. [Doctor] noted that [Danielle's] shoulders, knees, and ankles easily dislocated. Because of chronic pain and fatigue, [her] ability to concentrate and maintain attention is significantly reduced. Additionally, [Danielle's] progressive EDS required the use of a wheelchair for prolonged ambulation. Similarly, treating physician [endocrinologist] echoed the assessment of [Primary care doctor]. She opined that the combination of physical and mental impairments significantly impacted [Danielle's] ability to return to work, or sustain full-time work on a competitive basis. Treating orthopedist noted that [Danielle's] EDS required physical therapy and exercises to relieve the symptoms, but indicated that all treatment was supportive only. She indicated that EDS was progressive in nature, and could not be resolved.

In reviewing [Danielle's] records in September 2008, DDS consultant Dr. Michael Cole noted the examinations that indicated that the claimant had significant joint laxity and subluxability. Although physical examination results were fairly normal, consultative Dr. Seth Tuwiner (This is the doctor the SSA made me go to who poked me in the knees, said I should go back to school and that I was fine. The entire appointment lasted like 5 minutes in length.) noted some impairments of fine motor coordination. He opined that [Danielle] was able to stand and walk  4 hours out of [an] 8-hour workday (umm...WHAT?!); but had no manipulative or postural limitations (yeah right!!). He indicated [Danielle] was capable of lifting and carrying up to 10 pounds. However, Dr. Cole, noted that Dr. Tuwiner's assessment did not fully consider [Danielle's] vulnerability to joint dislocation, chronic pain, and orthostatic tachycardia. (Thank goodness one of the SSA doctors was using their head!) Therefore, Dr. Cole opined that [Danielle] was capable of sedentary work; but was restricted in all climbing, frequent balancing, and occasional other postural activity. He further opined that [Danielle] should avoid all exposure to hazardous machinery (LOL! You think?), or working at unprotected heights. In a subsequent review of [Danielle's] records in January 2009, DDS consultant Dr. Leopold Moreno affirmed Dr. Cole's assessment as written.

(This paragraph contains private mental health notes, so I am skipping it.)

(The next paragraphs are by two doctors hired by the SSA as well. They contain personal info I am not posting either. However, the significance of these paragraphs is that both doctors, Dr. Walter and Dr. Lake describe how neither my physical nor mental impairments would present a problem in my ability to work. Lovely.)

(So, moving on...and this is where the judge weighs ALL of the info and summarizes his decision...)

The undersigned (the judge) gives the well-supported assessments by [Primary care doctor and Endocrinologist] GREAT WEIGHT, as the evidence indicated that the progressive nature of [Danielle's] physical impairments significantly impact her functional abilities, which are expected to deteriorate over time. In combination with her mental impairments, [Danielle's] functional abilities are significantly eroded (nicely put!), and further limit her ability to sustain regular, full-time work. The undersigned gives minimal weight to the assessments by Drs. Cole and Moreno (Woohoo! That means what my doctors said was WAY more important than what the SSA doctors said!), as subsequent evidence supported [Danielle's] allegations of significant limitations in functionality. The undersigned also give little weight to the assessments by Drs. Lake and Walter (Again! Phew! That could have really damaged my case if he believed what they said to be true!), as the combination of physical and mental limitations, when considered as a whole, significantly affect [Danielle's] ability to perform even minimal tasks.

(And...here it comes...drumroll....)

Therefore, after careful consideration of the evidence of record, the [Judge] finds that [Danielle] has the residual functional capacity to perform sedentary work as defined in [legal garbage codes] except [Danielle] is not able to perform physical work activity on a sustained basis.

***

That pretty much sums it up. :) So, I hope that if you get to this point in the process, that this will be of help to you and even perhaps your attorney. I know reading Bunny's really helped open my eyes to how much they delve into your life and how they will scrutinize every last particle of your being to try to prove you wrong. A lot of cases that are won really depend on which judge you get, from what I have heard. I happened to luck out and get a great one. When the hearing was over and the tape recorders had shut off, he told me that during the whole process he couldn't help but look at the rings on my hands - his WIFE wears them, too, for her rheumatoid arthritis! How funny! Perhaps that little connection helped me! Now, I hope this is of help to you.

A few more tips:

  • If you do go to 'court,' it will be a hearing and it isn't as scary as it sounds. It is a small room with a judge, your attorney and a few other people there to help. Some of them were doctors (probably to discredit anything I was saying if it was wrong, and also to explain medical lingo to the judge if needed), the SSA representative speaking on behalf of those who denied the first two applications, etc. They give you plenty of time to say what you need to. And, there was a box of tissue if you got emotional about any of it - I needed it!
  • If you do win your case, don't expect your money to start flowing in. It normally takes a few months to get your decision back from the courts, so you won't even know for a while if you have won or lost. You will not be getting your back payments any time soon. It took me 7 months before I got mine. And, even then, they give it to you in chunks, not all at once.
  • Just to clarify, 'back payments' are monies owed to you from the time you originally applied all the way to the time you are approved. They will owe you for this. However, your lawyers fees come out of this. Also, don't forget about that five month chunk that they 'don't count' - you won't get anything for that.
  • And, again, you aren't eligible for 2 years to get on Medicare...plus 5 months...so, 2 years and 5 months. Gotta love that 5 month thing!

Okay, I have to go rest my hands and wrists with some ice. I also may take a few days off before I do another post. This took a lot out of me! :P I hope you all are having a great day and enjoy your week!

xo
dani

9 comments:

Eddie said...

We could use your help. My better half is just starting this journey with EDS after being told by many doctors (and I wouldn't have believed this if I wasn't there) had told her she was CRAZY. No kidding. I'm sure you understand that. We did finally get a diagnosis by Dr Osborne through the Mayo Clinic (yes, that Dr Osborne who wrote all the papers). This whole process is ridiculous. She can't carry a mug of water for her wrists will dislocate. Ugh.. Thank you for all you have posted. It will help, but we have so many questions...

Anonymous said...

I also have eds,osteoarthritis,osteomalacia,fibromyalgia, central pain processing disorder, idioventricular rhythms, parowysmal ventricular fibrillation, paroxysmal ventricular tachycardia,ventricular tachcardia, supraventricular tachycardia, bradycardia, hypotension, syncope, mitralvalve prolapse, endometriosis,hypertrophic uterus,a bone pubic bone and need a hip replacement and pacemaker. BUT I have been denied disability numerous times. after the judge denied me i filed an appeal and also filed a new claim and got denied. I keep appealing them but i have had no luck. When the doctors put an estimate date of death on record, you should be able to get disability. I am weak, i break bones easy, i dislocate easily, and my heart is giving out. I have been reading your blog for quite some time and i am happy for you that you were approved. I am at a lost as to what to do about my case though.

Anonymous said...

i forgot to mention i have degenerative disc disease, facet joint degeneration, bone spurs, scoliosis...i always forget things. all this and no approval for disability

Patty said...

Thank you for sharing and congratulations on the happy ending to your fight. My hearing was yesterday. By the way, a brain tumor doesn't automatically get you disability, I have 12 of them and still got denied twice. I am happy to say though, my hearing went VERY well. The judge approved me on the spot. You are right, Hearings really are not scary. I was on another site called ssdfacts.com it is really good, you could look up the statitistics for your area, hearing offices and even the judges so you know how long things usually take and what percent of people your judge approves. There is also a blog forum with topics for every step of the process. People share their stories and experiences. It's a great place to get advice. They all said that hearings are not scary but how can you help being nervous.

Becky said...

Danielle, I don't want to waste your time--I think I read your post thoroughly, but the letter mentions your endocrinologist and I don't see mentioned the condition for which you were seeing him/her. Can you elaborate on what brought you to see an endocrinologist?

Again, apologies if my answer is there and I've missed it.

Thanks!
Becky

www.tarragona-3d.com said...

It can't work as a matter of fact, that's what I suppose.

Jan Dils said...

Filing for an SSDI claim can be overwhelming. And there’s no assurance that we can get approved the first time we file it. But once we do get approved, the experience is all worth it. And I’m glad that you got it. This may be years late, but still, congratulations! And I hope you’re still enjoying your benefits until now.

Jan Dils

Patricia Briggs said...

Well, it must've been quite a relief to know that you are eligible to receive disability benefits. The process is both emotionally and physically draining, and the waiting game can be quite frustrating. Anyway, thanks for sharing your tips and experiences. It will definitely help those who are in line to file their claims. All the best!

Patricia Briggs @ Source Brokerage

Chrystie Cottier said...

Hi Danielle,

I am a fellow vegan, pot friendly, EDSer, in Seattle. I severely injured my back at work last year and have been unable to sit down or work for the last six months. I didn't realize that I had EDS until about two weeks ago, but I have never been so sure of anything in my life. My entire medical history finally makes sense! I am going to see an EDS experience doctor on Tuesday and will probably get my official diagnosis.

I need to find a lawyer who has experience with EDS to handle my LNI case. I am hoping that you might be able to share the name of you lawyer that handled your disability case? Thanks very much in advance!

I hope that you are doing as well! If you would like another vegan zebra friend in Seattle, I would love to meet you as none of my friends really understand what it is like to be in chronic pain. It seems like we have loads in common. I even happened to be eating brazil nuts as I read your post about being one:) Thanks again.

Cheers,

Chrystie