PROCEDURE FOR GETTING SSDI
Read and print the Social Security Ruling (pdf)) for Post-Polio Sequelae
Ask the Social Security Administration office to mail you the SSDI application form (SSA-3368-BK). Tell the SSA office you can't come in to pick up or fill out the forms because you "physically can't" make the trip.
There is usually a phone interview before or just after you get the forms. This is not a big deal. SSA just wants to briefly hear why you think you're disabled and collect general information. But get the name, phone number and address of the adjudicator working on your case, the head of that local SSA office and the head of the office where your case will be decided. You will be asking your Congress people to write to these individuals.
Before the phone interview and before you fill out the application form, make a list of work-related disabilities and symptoms. On one side of a piece of paper list the things you can't do that are job related (e.g., can't stay awake at your desk, can't focus attention, have to read the same paragraph over and over, can't lift or stand or carry). Then, on the other side of the page list the SPECIFIC symptoms that prevent you from doing the job related activities. FOCUS ON FATIGUE, physical, brain and muscle! Use the wording in the Social Security Ruling (e.g., "I can't focus attention because of severe fatigue; I can't stand for more than 5 minutes because of left leg muscle weakness; I can't walk for more than half a block because of loss of endurance"). Mention the number of time you have fallen and if falls have increased in the past year (Falls or "being unsafe" on your feet are required for Medicare to pay for PPS treatment. Medicare starts two years after you get SSDI). Mention times you almost fell asleep while driving. Be brief and clear in describing the symptoms and limitation. Remember: For every work- related problem, describe the symptom that disables you; for every symptom, tell what task it prevents you from doing.
Do illnesses, injuries or conditions" limit you ability to work? This is the only thing SSA wants to know. Avoid the kitchen sink approach. Don't list everything that has ever happened to you, polio-related or not. Limit your answers to illnesses, injuries or conditions" that limit your ability to work. The Ruling says "old records are not required," so you don't have to have records of childhood surgeries or even hospitalizations for polio. Also, do not include records of illness or hospitalizations you have had as an adult unless you have a condition that also limits your ability to work. If you are not disabled from work by allergies, an ulcer, a hip replacement, high blood pressure, osteoporosis, successfully treated sleep apnea, a heart attack -- even a heart transplant -- do not list those diagnoses, the medications you take for them, hospitals where you were treated, or the doctors you saw for them. Don't even list blood tests or X-rays you've had unless they directly relate to the "illnesses, injuries or conditions" that limit your ability to work. SSA reviewers will sometimes look at the first doctor's report -- maybe a note from your GP of 5 years ago -- that says "Had allergy shot. No other problems" and deny you SSDI for PPS because you have no disabling symptoms. If you have "illnesses, injuries or conditions" that do not limit your ability to work, SSA doesn't need to know about them. The more doctors and conditions and tests you list, the more likely it is that SSA will not even get all the reports, making the process take longer _than it needs to. The best thing you can do is list only one doctor -- your PPS doctor -- who knows about PPS and will write clear reports about your inability to work due to specific PPS symptoms referring to the symptoms described in the Ruling. Your doctor need to read the Ruling before writing the report for SSA. However, if you have PPS and then had a heart attack, and you now have limited stamina because of PPS and because your heart is not pumping enough blood, you have two conditions that together disable you from working. In this case, list your PPS doctor and your heart doctor. You can have several conditions that add together to cause a work disability. Also, it is important that each doctor write a report to SSA describing the your PPS symptoms and the impairments they cause. The report should also include the severity of any residual weakness, as well as the onset, pattern, and severity of any new physical or mental deficits. A description of current functional limitations and restrictions on physical and mental activity should be included.
List home related limitations in the same way as work limitations, e.g., "I can no longer do laundry, shop, cook, yard work, because of fatigue and muscle weakness. Now my husband/wife/children have to do these jobs." SSA wants to make sure you are limited on the job and at home.
Use the "In spite of..." argument. Mention assistive devices you use, especially new ones, and that you still can't work "in spite of" using these devices, making necessary changes at home and getting reasonable accommodation at work (e.g., "In spite of getting a long leg brace that I was able to discard _when I was 10 years old, using a wheelchair for the first time in my life, getting a stair-glide in my house, and sleeping for 30 minutes at lunch, leaving work early every day, my fatigue is still increasing and I fall asleep at my desk ").
Again, use symptoms described in the Ruling. If you work at a desk, brain fatigue will likely be the cause of your work disability. If you do physical work or type at a computer, physical fatigue, loss of endurance, or specific leg, arm, hand or muscle weakness may be the cause of your work disability. Stay away from mentioning any type of pain, especially back pain. It usually doesn't help to mention joint or muscle pain even when it is caused by work-related duties or is associated with muscle weakness, because it is almost impossible to get SSDI due to pain. Also, never mention depression, anxiety or medications you take for them unless these symptoms prevent you from working. Depression is an automatic rejection unless you live in a mental hospital.
In the "Remarks" section at the end of the application, briefly summarize your answers and describe your work disability as caused by your specific PPS symptoms, again linking each work limitation to a given symptom and using the wording in they Ruling. FOCUS ON FATIGUE, physical, brain and muscle! Also, mention long-standing polio "disabilities" that are not problems. SSA decides that you are work disabled based on your age, levels of skill and schooling. If you load trucks and graduated from the 8th grade, SSA won't expect you to go to college to get "sedentary" career if you are lover 50. But, if you are a college grad and have trouble walking, SSA will say you have the education and skills to do something that doesn't require walking. Some people with severe fatigue, but who have always used a leg brace, have been denied SSDI because SSA said, " Your leg has always been paralyzed and should not affect your working at a desk job." You should say something like, "The fact that I have always used a long leg brace and that my arm has always been weak has nothing to do with my disabling post-polio fatigue today."
The Ruling states that polio survivors' description of symptoms and limitations to their own physicians and psychologists are the primary factors when it comes diagnosing PPS and inability to work. An EMG and functional capacity evaluation have been removed from the evaluation process for PPS. The Ruling also states that only in "select cases, where severity of the impairment is unclear, an examination by a physician or psychologist who is knowledgeable about polio and postpolio sequelae is appropriate, if such a specialist is available." SSA can ask for what's called a "Consultative Examination" if there is not enough information in you're doctor's reports to determine if you are work disabled. However, many polio survivors find SSA sending them for a consultative examination to a neurologist -- or even a psychiatrist -- who knows nothing about PPS. SSA policy states that your treating doctor is the "preferred source" for the consultative examination, unless your doctor's records contain "conflicts or inconsistencies" or "prior experience indicates that the treating (doctor) is not a productive source of clear information." You have the right, and SSA regulations require, that you to go back to your own doctor for a consultative examination.
You took the time to vote, so put that vote to use. SSA gets very careful when they know your Senators and Congressperson are watching over their shoulder. Send letters (see LINKS above) like these and attach the Social Security Ruling with your application or if you are fighting a denial. Since it's the government mistakes do happen and you may get denied. If you are denied, read the reason for denial, which may be because of the adjudicator's not having read or misreading the Social Security Ruling. Find out the specific reason for the denial. Then do two things. FIRST, ask your Congressperson and Senators to ask for an Administrative Review of your denial to determine if the guidelines in the Social Security Ruling were followed and the latest policies about PPS were applied. Write your Senators and Congressperson:
Include copies of your letters to the Congressperson and the Social Security Ruling with your application. Call your adjudicator at the SSA office about once a month to see where things stand. It takes about 6 months for you to get your first check.
Send copies of your SSDI application, denial notice from SSA, the letters posted here from SSA and the Social Security Ruling to your Congressperson and Senators.__If you cannot get or are not successful with an Administrative Review appeal immediately. Discuss with your doctor the specific reason for the denial and asking him/her to also write a letter to SSA. You have a right to two local appeals and then a hearing before an Administrative Law Judge (ALJ). The ALJ's ruling can be appealed as well. If you follow this procedure, you won't need a lawyer even for the appeal. About 90% of the cases that come before the ALJs have their denials overturned, so there is a light at the end of the tunnel. __But, if you are denied at any stage you can choose to file a NEW application for SSDI. It will be as if the first application and denial(s) didn't happen. However you just have to find out your "last insured date." SSA only goes back 17 months from the filing date to establish the onset of disability and retroactive benefits. The money you get is based on the past 17 month of earnings. So if you file a new application and have been out of work for a while you will get less in SSDI benefits. |
Medical Services: Centers Of Excellence