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Author Topic: Are there any medical issues are almost impossible to get Benefits for?  (Read 4011 times)

Mark

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I know that Fibromyalgia is tough to get Benefits for.  I know it is hard to get benefits period but are there any other disabilities that Social Security tends to always deny?

Trajector Media

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #1 on: January 05, 2010, 01:42:59 pm »
I think Disability tends to deny almost everything the first time unless it is something that is so apparent that it would be almost criminal to deny it.  Even then I have heard of people passing away before their cases are approved.  It is truly a sad state of affairs.

I agree with you, however about fibromyalgia, it is so hard to prove yet such a painful and debilitating disease.  I don't know why they have such a hard time understanding it. 
I speak from experience not expertise.

Mark

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #2 on: January 19, 2010, 11:11:44 pm »
I would think Mental Illness Cases are harder to prove as well.  Being they have not "physical"proof.  I would imagine they would require alot of Documentation from a Doctor and case history.

Doc76013

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #3 on: January 22, 2010, 12:10:53 pm »
I would think Mental Illness Cases are harder to prove as well.  Being they have not "physical"proof.  I would imagine they would require alot of Documentation from a Doctor and case history.

Mark, believe it or not IF you have the support of your team, ie therapist psychiatrist AND you have a history of problems in a social, work and personal area, its not as hard as one may think. The key is to document every issue and be open and very honest with your team, believe that they are specialists when it comes to sniffing out fakes and liars. IF you are truly affected mentally then I think your chances are just as good as if it is physical.

Good luck
Doc

knowsalittle

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #4 on: January 27, 2010, 09:54:44 pm »
   Are there any medical issues are almost impossible to get Benefits for?


Let’s have some fun with this question and answer it from the prospective of the disability determinations worker.

Yes there are many issues/allegations of disability that will almost never be allowed.  For example:
1 I cannot get pregnant/I am pregnant
2 I get hot when I work
3 I have gastric reflux

The above are actual allegations of disability that have been told to me by disability examiners. 

To continue the list in a more serious vein:
4 High blood pressure
5 High cholesterol
Conditions 4 & 5 can normally be controlled if treated and will not be considered disabling until they have severely affected vital organs such as eyes, kidneys, heart, or brain (stroke). 

6 I wear glasses
7 Blind in one eye
8 Deaf in one ear
See http://www.socialsecurity.gov/disability/professionals/bluebook/2.00-SpecialSensesandSpeech-Adult.htm#2_02 for rules on 6, 7, & 8.
9 Seizures (See http://www.socialsecurity.gov/disability/professionals/bluebook/2.00-SpecialSensesandSpeech-Adult.htm#2_02 ) It is rare that seizures cannot be controlled if treatment regimens are followed. 
10 ANY condition that has not required medical treatment/attention in the past 1 or 2 years.  (There are exceptions, for example; permanent conditions such as blindness, mental retardation, stroke residuals, etc. but for the most part, if the condition is not severe enough for the applicant to be receiving ongoing treatment, it will not be severe enough to meet the SSA definition of complete and total disability.  http://www.socialsecurity.gov/dibplan/dqualify4.htm )   There is no such thing as temporary or partial disability in the SSA law.  People who want temporary or partial disability can, and should, buy their own, private, policy. 
11 Any condition alleged by any applicant under age 50 that does not meet a specific class listed by SSA in the Blue Book.  http://www.socialsecurity.gov/disability/professionals/bluebook  (Note the Search Blue Book box – a great way to find specific conditions.) 
12 Any condition that depends upon subjective findings, such as pain (including back & fibromyalgia) or mental issues such as anxiety/depression. 

The reason that 60 -70% of applications are denied nationwide is simple: As indicated by the examples above, 60 – 70% of the people who apply for SSA disability do not have a medically diagnosed condition that approaches the SSA definition of disability.  The reason it takes so long for an application to be processed is the junk cases the disability examiner must deal with. 

Because the SSA disability process is not a disability process, not a medical process, not a medical process, but a legal process, due process must be followed.  It is true, and unfortunate, that some applicants die while waiting for a determination.  However, SSA cannot control life/death.  It can only control the process given them by Congress.

The common thread among the first three allegations listed above is than none had any medical records to support the claim.  The disability worker, by law, must every effort to find each and every applicant disabled.  Obviously, that cannot be done but every effort must be made.  This means that taxpayer money must be spent to pay for a medical evaluation, and often mileage to and from the examination, for each applicant who does not have current medical records.  Often more time is spent working on a case that has no chance of being allowed than on the cases that are allowed.  If SSA did not have to deal with the absolutely frivolous cases more time could be spent on those that are close and the allowance percentage would be much higher.

Yes, Mark, Newbie is correct.  Properly documented mental cases, those who, despite serious treatment efforts, cannot function well enough to perform gainful employment can be and are allowed the first time they apply.

Each and every case is different and depending upon the specifics may be allowed or denied.   I would be glad to answer specific questions the best I can with the understanding that anything I write is not SSA policy, only the best that I can research through my friends who actually perform disability evaluations.  Whatever I may write should be taken as a starting point and not the end of the story.  Every writer should do his/her own research and/or seek other help.  Hopefully, each person who reads questions/answers on this forum will be much better educated on what it takes to be considered disabled and better able to concentrate on presenting the major arguments that will help win approval.   

My postings will be based on my interpretation of the law. Argue with me if you like but, please; base your arguments upon your interpretation of the law as it is, and not upon what you think the law should/should not be. 

silent_one

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #5 on: January 28, 2010, 11:50:18 am »
   Are there any medical issues are almost impossible to get Benefits for?


My postings will be based on my interpretation of the law. Argue with me if you like but, please; base your arguments upon your interpretation of the law as it is, and not upon what you think the law should/should not be. 


I think it's great that we have someone here who works for Social Security.

gzusrox

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #6 on: February 08, 2010, 01:59:16 pm »
Back in 2007 ss sent me to a psychiatrist they picked out. He determined that i was unable to work due to depression. even though the psych they sent me to declared that, they still denied me.  I also have degenerative disc disease, fibromyalgia, my hip gives out alot and I cant walk, bursitis in hips, tmj, blood clots, obesity, diabetes, migraines and severe depression. now i know some of them do not qualify, but i heard that all of that together can cause overlapping issues.  I have fallen a few times and occasionally i have to use a wheel chair. 

Im curious as to what you think  knowsalittle. thank you in advance.

knowsalittle

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #7 on: February 08, 2010, 06:29:49 pm »
QUESTION:  Im curious as to what you think  knowsalittle. thank you in advance.

RESPONSE:  Wow!  Quite a list of problems that surely affects your ability to perform work functions.  As I wrote before “Each and every case is different, and depending upon the specifics, may be allowed or denied.”  
 
The first thing to remember is that the doctor, mental or physical, to whom SSA may send you, does not have any say in the determination of disabled/not disabled.  Any doctor who suggests the applicant will/will not receive benefits is doing that person a disservice as s/he will be looking at only one piece of the puzzle.  The "SSA doctor", or your own treating doctor, may declare you “disabled” or “unable to work” but this means nothing to the examiner working the case unless it is supported by a specific medical diagnosis and objective findings to support restriction of function.  Very few doctors have any idea what the SSA law requires and even those who may have studied the law will probably not have your whole record, medical and non-medical, to review.

Yes, the disability examiner will look at the totality of the medical impairments and how all of the impairments interact to affect function.  But remember, age, education, and past work must also be considered.    Each of the conditions you list can, in one way or another, restrict function.  The question remains, will the conditions prevent any type of work for 12 months, or result in death?  

Temporomandibular Joint (TMJ) Syndrome can be quiet painful and may cause, or increase, depression. Blood clots would not normally impact function unless one lodges somewhere and caused a stroke, blindness, heart attack, etc.  Yes, blood clots could even cause death, but until there is major organ damage there is, normally, not much loss of function.  

If you are in the process of making application I would suggest you quantify your, mostly, subjective restrictions.  (The same would go for anyone applying for benefits.)

Start by clearing up the inconsistencies.  You state you cannot walk, but you also state you “have fallen a few times and occasionally…have to use a wheel chair.”  This suggests you can walk, at least, some of the time.  One of your statements is, obviously, incorrect.  

If, in fact, you do have degenerative disc disease, bursitis in your hips and are obese you probably do have problems walking.  Questions:  How severe?  How frequently?  On your “good days”, how far can you walk?  Who prescribed the wheel chair?  Why?  Does this doctor have X-Rays to support your not being weight bearing?  How often and under what circumstances do you use the wheel chair?  How long are you confined to the wheel chair before you can walk again?  Diabetes and obesity can cause fatigue.  Do you have shortness of breath?  How often?  What activity brings it on?  Have you had a pulmonary function study done?  Have you been prescribed supplemental oxygen?  

Fibromyalgia and its accompanying pain are very subjective and almost always involve depression.  Is your depression being treated by a general practitioner, a pain management specialist, or a mental health practitioner?   With what success?

If you are at some stage in the disability application process, I would suggest you start documenting the, mostly, subjective complaints you have by keeping a journal.  Use the questions above as a starting point for the journal.  

Yes, combinations of physical, and physical and mental conditions can be combined and a determination of disabled can be rendered – at the initial level, or at some stage in the appeals process.  However, there are no simple answers, especially in complicated cases like yours.  

NOTE:  It would not surprise me, however, if you were to state that you had been allowed at the reconsideration stage or by the ALJ.  Especially at the ALJ level, subjective complaints can be weighted more heavily.  It is also possible that during the interim between the original determination and the final decision records may have shown your condition became progressively worse.  

gzusrox

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #8 on: February 08, 2010, 09:41:55 pm »
Thanks for getting back to me. I will try to answer everything.

I have not kept employment very long due to my depression. Usually just a few months or weeks. Im not sure what my longest job was, but it has been years since then.

I am in appeals process, been denied twice.

Most of the time I walk, sometimes very limited or not at all. I try to walk, but if I go grocery shopping, soon after my hips start acting up or one gives out and I almost fall. At that point I make an effort to get home, as I know I wont be able to stand or walk much longer.  I have used a wheel chair at places of business at times when I cannot walk. No dr has prescribed me one. If I have muscle pain and my hips are acting up I am down for a few days to a week at a time. Our old house had hardwood floors and so I just used my office chair as a means to get around. Our place now has carpet, so I hang on to the walls when I have trouble walking, even then it is difficult.

The x-rays I have had done dont show anything wrong with my hip. But it feels like it pops out of joint. I have an mri from when I had surgery on my neck and they replaced a disc. I had an mri a few months after that showing I have a torn disc in my lower back. Dr told me if I didnt lose weight I would eventually need surgery.

I dont have any problems breathing or anything like that. I have however had irreg heart beat and arrythymias. I had to wear a 24 hour holter monitor. I have also been to a heart clinic, but they couldnt find anything wrong. so along with the blood clots I am also on coumadin for the arrythymias.

I am currently on 2 different meds for depression and they are not working. I have tried many in the past with no results. Currently my gp is treating me for that. However, I do have an appointment with a psychiatrist in a couple weeks.

I have just started keeping a journal since dec of 2009. thats when I found out I should be doing one.

I also forgot to mention I have insomnia and daily headaches and or migraines.

I noticed when I went through all the paperwork from ss that they had drs look at my case that I have never seen. is this normal? I forget what they were called, functional capacity? maybe even ones on depression? I didnt quite understand them and they had more than one dr write up the forms.

Thanks so much for your help!

gzusrox

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Re: Are there any medical issues are almost impossible to get Benefits for?
« Reply #9 on: February 08, 2010, 09:44:44 pm »
Sorry prob not appeals. waiting for hearing.