Frustrated!!!!

[jcsawyer]

I filed for disability in July of last year. I had my ALJ hearing in April. She said that I have "learned to live within my physical limitations" so that I do not need disability. Here's the thing isn't that something we all learn to do? If you are 10ft tall do you not duck when you enter a doorway or do you keep hitting your head as you walk through the door? She also stated that because I am not on narcotics all of the time that I don't seem to be in "that much pain" ,

I have two children who need me to care for them ummmmm.....I cannot be doped up all of the time. Nor can I afford all of my meds so she got on me about that. But with no money coming in how in the world are you supposed to get them? We have health insurance but that still doesn't help that one of them is still $150 a month.She told me that there are services for the indigent. That would be correct but I have insurance they will not touch me and hubby makes too much money for me to get medicaid. I have to have another surgery on my back but I cannot afford the $2500 the dr wants upfront since its a $75k surgery on my spine.

How can someone who sits at a bench all day truly know what I am going through? They cant. I hide a lot of what I go through on a daily basis because I don't feel the need to be a negative nancy all of the time but theres only so much a person can take.

They owe me backpay since 2010 as that is the date they are using as my onset date (seeing as how I was born with this i dont see how they can do that.) I have had to take a job here and there but they do not last as my back doesn't last. she said because I had attempted to work for two months that it was just a waste of her time and my RFC (residual functional capacity report) she all but said that was a joke. Said that the PT that performed it was not a " credible medical source" Ummmm what? She said that I didn't follow the directions of my dr by going for a CT scan or to a spine specialist. THEY had ALL of the paperwork for this I went for the CT in Nov it was a whopping $10k bill. If i didn't go to the spine specialist how did I know I had to have surgery on my spine as I have lost 4 inches in height in the past 5 years thanks to my rods failing that they put in back in 1983. I have an attorney but they do not seem to want to argue with people.

I am now sitting at the appeals council waiting for at the least 2 years for an answer. What do they expect someone to do while they wait? I am so frustrated that some people can just walk into their office and be like oh I broke my finger and they approve it but those who truly need it have to fight tooth and nail just to get it.

Sorry off my soap box now

[BigJohn]

I hear what you are going thru.

Recently I looked at my medical records and was surprised some of my Doctors
wrote me up for asking for pain meds.

I guess if a person has severe pain in their back because of two fractures,
had 3 screws put in the arch of one foot 3 months ago
and now has a cast on the other foot because of 3 fractures in that foot.........
they surely do not need anything for pain.

Oh, I forgot I had the top and bottom of one shoulder replaced
only to have that work ruined as a result of a truck hitting me head on while I was walking on the sidewalk.

I would say we are on the same boat.

I gotta go and bail some more water.

[Pjmax]

JC, did you have an attorney? From what I've heard, it's near impossible to get this done without one. My sister has MS, has been trying for disability for years, finally gave in and signed with an attorney, on contingency.

[Pandora]

I'm sorry you're having such issues with your SSD process, it is a pain to go through for sure.

It sounds like the ALJ is basing off of your past and current medical history, so it will be an uphill battle on appeal. If this is something you were born with, it appears the judge is taking that into account in a major way. Getting approved for SSD for a medical condition that one can "see" via xray / CT / MRI is much easier than trying to get approved for one that "isnt visible" (like fibromyalgia).

One major thing that the ALJ looks at is are you "fixable" - meaning will surgery fix your medical condition to a degree that you are seen as being able to be "gainfully employed". Their definition of "gainful employment" is the ability to work 4 hours a day. You must have your doctor(s) and their doctors agree that you can / cannot obtain gainful employment. If you've seen a spine specialist and PT, then standard procedure is for all medical records to be provided to the court as well as SSD doctors if they sent you to them (which is common). Did you provide your medical records in full? Have you been seeing doctors for this issue for years and continuing due to the pain of it - or - did you just start seeing medical doctors prior to applying for SSD? All of these things are taken into account and it doesnt end even if you're approved as you must go through reviews every 1-5 years depending on what the judge orders. During that timeframe (if approved and before your medical review) you still have to be seeing your doctors and must provide, in detail, medical records from date of SSD approval through date of review. Its a PITA but a necessary thing.

I dont know what facility's you're using for CT scan, but if they charged you 10K for a scan, I'd be yelling from here to kingdom come! We just had an MRI done for hubby and it wasnt even $2000 - and that was if we didnt have insurance and had to self-pay (we have insurance however, so it was only $100). Here is a site that you can use to help determine costs if you have to self-pay:

http://health.costhelper.com/mri.html

A few things I wanted to mention, however - not all people that are on narcotic pain meds are "doped up all the time"; they function just like someone who is NOT on pain meds - matter of fact, you'd never know they were on pain meds unless they told you. Along those same lines, there are many medications that are non-narcotic that work wonderfully for pain control, sometimes better than narcotic pain control. If you're having problems with medication costs ($150 for a med when you have insurance seems very high for an out of pocket cost) - many times the manufacturing co. offers discount cards for name brand meds. Both hubby and myself get free meds due to discount cards offered that pay up to $50 towards our copays; they are free of charge. There's always generic meds as well - and ALWAYS ask what the cash payment not using insurance would be. There are 2 meds I get that are cheaper for me to self-pay through Wal-Mart ($10 for 3 month supply) than if I had went through insurance or mail order (exact same med would be $10 per month retail and $20 for a 3 month supply using mail order). Go figure. Doesnt make sense to me, but it is what it is.

As another poster mentioned - did you consult and use a disability lawyer for your case? That makes a world of difference as well.

It took me 18 months, 2 denials and an appt with the ALJ to get approved. I've gone through 3 reviews and am getting ready to come up again; its always stressful thats for sure.

[jcsawyer]

PJmax yes i have an attorney .

Pandora Thing is my issue is mostly visible and getting worse by the month. When someone who is only 32 looses 4-5 inches in height in a certain amount of years that should be a red flag. Surgery isn't a guarantee that it will fix anything it just will slow it down from getting worse. They have all my medical records from my DOB to now so I have not missed anything there. I have two doctors saying I do not need to work I have one doctor that says I should work no more than 20 hours a week with severe limitations. They had a hard time finding a job for me to do during the ALJ hearing. The facility I used was a trauma hospital here in charlotte,nc and it was one of the most defined CT scans you can get as I cannot go for an MRI due to the hardware I have attached to my spine already. Insurance didnt want to pay because I just had one 6 months prior by the same dr. And I realize that not all people that are on narcotic pain meds all the time are not doped up all the time but I would be as they cannot get a dose low enough for my size. I am 4ft3in and only weigh 65lbs on a good day. They did offer a discount on the first dose it was free but after that I had to pay tier 3 on my insurance. They do not come in generic or I would have had that already. One day they will make them in generic but right now they have not come out with them for three out of my five million meds I take. Cash payment would be more than my trustee payment for one LOL so I cant complain too much about the cost. It is such a pain. I had SSD and SSI as a child but no one told me when I turned 18 to file on my own as to avoid all of this so now that I found out I had it as a child and am getting worse it is necessary. The judge only had a 34% approval rating anyway and she was the only one that low here in the charlotte ODAR office. But not taking into account medical information and dismissing everything plus telling me that I lied when I had proof really just burns my buns. I by no means was lying about anything and just because I know what my medical issues are and am well spoken does not mean that I shouldnt qualify. Yes I sound intelligent talking but that doesnt mean that I am not in pain and have learned to hide it from others due to not wanting to be a negative nancy all of the time. Theres only so much of "i dont feel good" that my family can take. I am just so stinkin annoyed that it takes a full circus act to get it.

[Pandora]

They have all my medical records from my DOB to now.... I have two doctors saying I do not need to work I have one doctor that says I should work no more than 20 hours a week with severe limitations.

I understand your frustration. I think part of the problem is that you stated you were classified as not being able to work as a backdate to 2010. You're giving medical records from birth to now - unfortunately it doesnt work that way. Another issue is getting doctors to agree - are these doctors that have been seeing you since you were younger for the same issue - or doctors you just started seeing? You have to have a continual medical history with a doctor that is on-going thereby supporting your claims.

Insurance didnt want to pay because I just had one 6 months prior by the same dr.

your doctors office should have gotten pre-approval or at the very least checked to see if you were eligible. If they didnt, then you could have called directly. Very important to check as you obviously found out. You can also use different facilities; many doctors recommend going to a certain facility as they get "kick backs" by doing so - the choice is ultimately yours. Still - $10K for a CT... overpriced by quite a bit.

And I realize that not all people that are on narcotic pain meds all the time are not doped up all the time but I would be as they cannot get a dose low enough for my size. I am 4ft3in and only weigh 65lbs on a good day.

you only weigh 65 lbs? Have you gone to a nutrionist or had counseling to help you in gaining weight? Is there a medical or physical reason you weigh this little? At that weight you arent likely to be able to do anything; as an example most anorexics are dead by the time they hit 70 lbs (I'm not saying you're anorexic, I"m just using that as an example). I pray you are getting help for whatever the issue is.

The judge only had a 34% approval rating anyway and she was the only one that low here in the charlotte ODAR office. ......I by no means was lying about anything and just because I know what my medical issues are and am well spoken does not mean that I shouldnt qualify.

Unfortunately you're stuck with the judge in your district and in appeals, the judges opinion matters greatly. Again its having the continual care and backing by your family doctor and whatever specialist you've been continually seeing for your medical issues. one thing I will tell you is that if you go into ANY medical situation be it a doctors office or in front of the ALJ, once you start using medical terms and telling them what is wrong, they totally shut down and start "labeling" you in their mind. Its great to be knowledgeable of your medical conditions, however.....your medical records should speak for themselves vs. you "telling" a doctor what is wrong. Its hard to get things across sometimes, I understand - believe me, as I've walked out of many "experts" offices myself, but the difference was I had the medical records (and tests) proving otherwise. Its a tough spot to be in, so I totally get what you're saying.

Since you said you have a disability attorney - did he/she not discuss with you the probability of getting approved for SSD based on what you provided in your current medical records? Is your condition on the approved SSD listing? It sounds like your attorney didnt really fight for you very hard if you had to defend yourself to the ALJ continually. Usually your attorney will present your case, then any medical experts from SSD (if you saw them), and then the ALJ asks you questions.

Hang in there.

[Pandora]

just caught something: you said 2 drs stated you "don't need to work" ....and another stating "no more than 20 hrs..."

There is a major part of the problem; big difference in a doctor stating you dont "need" to work vs. you "cannot" work.

I'd also fire the SSD attorney you currently have and see if you can find another willing to take your case. You may need approval from the court as all SSD lawyers must be approved first, as you know. Dont fire him/her until you've found another though..

[jcsawyer]

[QUOTE=Pandora;603835]I understand your frustration. I think part of the problem is that you stated you were classified as not being able to work as a backdate to 2010. You're giving medical records from birth to now - unfortunately it doesnt work that way. Another issue is getting doctors to agree - are these doctors that have been seeing you since you were younger for the same issue - or doctors you just started seeing? You have to have a continual medical history with a doctor that is on-going thereby supporting your claims.
The only reason for the med records from birth till now is because it was requested by the ALJ. These are doctors I have seen since I became an adult. I went to the shriners hospital for cripple children until I was 18. I have always had continued medical history given the 40 operations I have had.


your doctors office should have gotten pre-approval or at the very least checked to see if you were eligible. If they didnt, then you could have called directly. Very important to check as you obviously found out. You can also use different facilities; many doctors recommend going to a certain facility as they get "kick backs" by doing so - the choice is ultimately yours. Still - $10K for a CT... overpriced by quite a bit.
The dr didnt check as it is the only facility like that here that is a level 3 trauma center and could give the detail he was looking for.


you only weigh 65 lbs? Have you gone to a nutrionist or had counseling to help you in gaining weight? Is there a medical or physical reason you weigh this little? At that weight you arent likely to be able to do anything; as an example most anorexics are dead by the time they hit 70 lbs (I'm not saying you're anorexic, I"m just using that as an example). I pray you are getting help for whatever the issue is.
Yes I have never weighed over that unless I was pregnant then I went to a whopping 105lbs LOL. I was born I had Failure To Thrive and have never been able to gain weight (anorexic I am not......I ate two boxes of snickers ice cream bars this week alone LOL) I think I have just a super fast metabolisim. No one in my family is overweight by any means. My sister is 5ft 7in and is only 120 lbs. They have checked and rechecked and checked again my thyroid to see if that was the issue but that is not a problem. Im just little by nature apparently.



Unfortunately you're stuck with the judge in your district and in appeals, the judges opinion matters greatly. Again its having the continual care and backing by your family doctor and whatever specialist you've been continually seeing for your medical issues. one thing I will tell you is that if you go into ANY medical situation be it a doctors office or in front of the ALJ, once you start using medical terms and telling them what is wrong, they totally shut down and start "labeling" you in their mind. Its great to be knowledgeable of your medical conditions, however.....your medical records should speak for themselves vs. you "telling" a doctor what is wrong. Its hard to get things across sometimes, I understand - believe me, as I've walked out of many "experts" offices myself, but the difference was I had the medical records (and tests) proving otherwise. Its a tough spot to be in, so I totally get what you're saying.
There are 6 ALJ's in Charlotte. I by no means began telling them they were wrong. I just answered their questions truthfully and with the knowledge that I have of my condition. I have letters from two of my doctors labeling me as fully disable as an adult and one as a child (the doctor that did my original surgery as a child). Ive always used medical terms to describe my issues as that is how I was taught to do so that I cannot help. All I did was re-iterate what was in the records themselves.I have seen all of these doctors now since I was 18 years old and I am 32 now and it all is the same from when I was a minor just has progressed worse and whats funny is the ALJ even states in the paperwork that she noticed the differences from childhood to now and said that my disability is noted as a serious disability in SSDs eyes but feels that I have learned to live within my physical limitations.
Since you said you have a disability attorney - did he/she not discuss with you the probability of getting approved for SSD based on what you provided in your current medical records? Is your condition on the approved SSD listing? It sounds like your attorney didnt really fight for you very hard if you had to defend yourself to the ALJ continually. Usually your attorney will present your case, then any medical experts from SSD (if you saw them), and then the ALJ asks you questions.

The attorney I have said I have an 85% chance of winning my case and thought it would be no questions asked given all of the documentation and how well laid out the case was. The judge that I had was the one that told a guy with a walker that he could go be a walmart greeter even though he couldnt stand for long. So she is tough to get through to. The others are male and are easy judges to get approved through. I feel they didnt fight at all for me either and I had more backing from a congressional stand point than I did from an attorney stand point.

Hang in there.

[jcsawyer]

[QUOTE=Pandora;603839]just caught something: you said 2 drs stated you "don't need to work" ....and another stating "no more than 20 hrs..."
The two that stated I did not need to be working are my spine doctors and neuro doctor. The other stating no more than 20 hours a week is my primary care doctor who I only go for yearly physicals and if I get sick during the year.

There is a major part of the problem; big difference in a doctor stating you dont "need" to work vs. you "cannot" work.
In the letters it does state I cannot work I just wrote "need" in my post

I'd also fire the SSD attorney you currently have and see if you can find another willing to take your case. You may need approval from the court as all SSD lawyers must be approved first, as you know. Dont fire him/her until you've found another though..
I only wish I could find another attorney to take the case. However, none in the area will take it now that it is in the appeals councils desk. They all tell me to start over and loose all my back pay. Frankly I cannot afford to loose that much backpay. They all have looked over the ALJs notes and stated that she needed to really look at the case instead of looking just at me in the room. Several feel that it should have been an open and shut case with no problems.