tdiu Got My Denial Letter...

[tdak]

Gee it only took them 9 months. They just make my head steam!!! I just can't beleive I was denied after all the crap I have gone through. They never even wrote all the medical conditions I wrote in the original application. They also wrote that I could do things frequently that I can't. I have no idea where they got that from. They just must have had their head up their ..... well you know where when they wrote the decision letter.

Ok. Now I want to appeal, because they really do have stupid errors, leaving out medical info and infor that I wrote. How do I go about doing this. Can I write them a letter telling them what they forgot and resending them the medical info that they have seemed to overlook. Can I resend them more medical info? I really didn't want to get an atorney this time if they were just relooking at everything then making another decision. Then if they said no, I could appeal with an attorney. I should be hearing anyday about my VA TDIU (unofficially awarded IU,as per VA rep). So, I am trying to wait to get my award letter so I can foward that to them showing I got total disability. any input would help, thanks.

Thanks,

Tamara

Edited July 15, 2007 by tdak

[tdak]

SSGMike,

The short of it was I worked up until 2 days before I had brain surgery in Nov. 05. and should have filed for SSDI then, but waited until the the following October when I was awarded my initial 60% from the VA. I was given mis-information about filing then. Once you KNOW are GOING unable to work for a year or more then you can apply for SSDI. If I had known this, I would have already been at the attorney stage, and hearing stage of SSDI by now.

As for my VA, I am waiting on getting awarded TDIU as of right now. So when I get that letter, hopefully, the SSA will take that info into consideration.

They do not have anything to do with each other at all. They are seperate parts of the government. One is the Veterans Administration and the other is Social Security Administration. The VA ususally takes I would say twice as long to process an inital claim, sometimes 3x's as long in the beginning. It all depends on where you live and how far back logged everyone is.

Why would you want to wait to file a claim for benefits for SSDI, they don't pay you for the first 6 months of the claim, so that is money you would be losing.

PS. questions are made to be asked.

Enjoy the day,

Tamara

[Josephine]

Tamara,

You have 60 days to ask for the re-consideration. Just do it yourself, You really don't need a lawyer to assist you with it.

If you want to wait until you receive your VA award letter that is fine.

Your surgery and care, is this by the VA or a private doctor?

You can go to the internet and go to Social Security Disability and download this form SSA-561.

I tried to paste it, but it is an Adobe Reader and I can't budge it.

It ask you reasons of why you do not feel that made a just decision, etc.

This would give you the chance to tell them just what they did wrong and turn in the new VA award.

I tried to paste it, but it is an Adobe Reader and I can't budge it.

Always,

Josephine

[luvHIM]

Tamara,

I read your thread and can understand your anger. I was denied twice and had to appeal. I was blessed to get an On The Record Review, which replaced my need for a hearing. I was awarded a fully favorable decision.

One of the points you made was the "evidence" that you enclosed with your claim. My question is whether or not your physicians completed the Functionability reports, undoutedly sent by the SSA? This is where and why most claimants get denied. Doctors are conveying one message to their patient and something entirely different to SSA.

Although, what you provided is necessary, it is much like the VA in that it doesn't carry much weight without the annotated support of your physicians in your medical records.

I am an established VAMC outpatient. I am fortunate to have some pretty awesome doctors. Since it was them who encouraged me to file for SSD because the VA was not compensating me (continued at 0%), I filed. However, I was denied because of my lack of knowledege about what the SSA considers to be "disabled." The VA and the SSA are on a different system when it comes to determining disability. In fact, your award letter from the VA can go either way. It can serve to go in your favor or not because the SSA doesn't base it's decision on what the VA might find disabling. One of the reasons is because the SSA looks at VA compensation just like they look at workmans comp. Neither of which declare an individual to be totally and permanently disabled.

My total and permanent disability from SSA was not awarded on the merit of my service connected disability. However, they (SSA) did use my VA medical records to help them make a decision in my case. It did not hurt that my pcp, rheum, ortho, and chronic pain management therapist/pharmacist had all noted in my records (quite lengthy) that I could no longer do the work I had been doing or any other job.

I will also say that age and work history are paramount because SSD is awarded on the basis that you have paid into the system and have worked to the degree that upon there calculations you can be paid SSD. Every case is different. But those who do not have the accrued work history are generally drawing SSI and not actual DISABILITY payments.

The other factor is the age median. After assessing the "Total and Permanent" factor, SSA then has an SSA attorney who is competent (used lightly) in interpreting your level of disability (per your age, education, work history) and how that effects your ability to make an adjustment to any work based on the national economy; and or whether or not it falls within the framework of SSA's medical-vocational rule.

With SSA it is not a simple matter of reviewing your forms and evidence you supply. It also has to do with whether or not your physicians are willing to state that it is a condition that is totally and permanently disabling. Does surgery, medications, time, and or other such factors play a role in your ability to work at a later date?

The other concern is that an approval of TDIU from the VA doesn't necessarily mean automatic SSD benefits and waiting too long before filing a Notice of Reconsideration may cause you to have re-file your claim for SSD altogether. From experience, you have to account for mail being delayed, forms/files being lost through mishandling or whatever. So, waiting on the VA could be risky. Some vets are awarded SSD based in part on attachments from the VA, but not always if the medical physicians are not supporting the claim.

I know too many people who have filed for SSD and had nothing but GREAT reports to give about their doctors. Only to discover when rubber met the road, their doctors failed to complete the functionability reports sent to them by SSA because they couldn't truly medically claim "Total and Permanent" disability on behalf of their patient. Their licenses are at stake, as well as other fines they can be subjected to for falsifying information.

So, it is not as cut and dry as I also thought it was when it comes to what SSA bases their decisions on. Now, when I filed I was already at 45 with over 25 years of work history and 16 years of education. I was denied initially and in my reconsideration. After I was denied at the reconsideration level, I filed my appeal and then educated myself. I asked for forms to be mailed directly to me and I hand carried them to my VA docs, who surprisingly...completed them. I got an attorney who could help me with lingo and with submitting letters from physicians outside of the VA. I was fortunate to begin seeing a rheumatologist outside of the VA, as well as the VA rheum and they were virtually stating the same thing in my records.

It is utterly amazing how many vets get either VA or SSA but not both. I am appealing VA's decision to continue me at 0%, for a condition that is totally and permanently disabling and has no cure. Everyone I've talked to (including VARO personnel) says it is absolutely crazy. But...

So, all I'm saying is that you might have to fight a little harder for the SSA than you anticipated. We cannot go by how things went for someone else. We have the VA to prove that statement as true. But if you know that you are unable to work again; you're up for the challenge...DON'T QUIT or GIVE UP...HANG IN THERE!!! Take the advice of the person who said to familarize yourself with the SSA website. Look through the medical guide for physicians to see exactly what SSA rates as disabling. Then prepare your case.

[tdak]

luv,

Thanks so much for the great response. I indeed have been through the ringer with many doctors. What I have listed as the SSA says I have is a short list of my conditions. I have Chiari I malformation, for which I had brain surgery. I have a titanium plate in my head, I had my first vertabrea removed and part of my second one. I still get headaches/migraines several times a week I am on medication for them 2x a day for now. I have instability in my head and neck, I have intracranial sintability and the Neurosurgeons consider me to be a failed chiari surgery case because my symptoms are basically the same as before the surgery. I have loss of use on the entire left side of my body, I have arthritis in my right knee, I have fibrobyalgia, chronic bronchitis & pneumonia, hypothyroidism, severe allergies chemical/contact and inhalants. I have neck and back pain constant, left ulnar elbow neuropathy and nystagmus, thrombophlebitis( I blow out superficial veins for no reason) and adema (constant swelling) in my left leg, oh and have tested positive for Lupus, and a severely elevated IgE level 6510 (normal is 120 and below) but they tell me its negative. I think that finishes my list. I see several different doctors from lung specialists to neurosurgeons to general to rheumo to immunologists. I had everything written down and I did submit all of my own documents along with whatever they got from the doctors themselves. It is pretty amazing that they forgot to add all that evidence even though I originally had it written it in the application. I was also looking at my denial letter and it doesn't look like they are giving me an opportunity to reconsider. They are however allowing me to "request a hearing". Gee how nice of them. I guess I should just get a lawyer now.

Thanks again,

Tamara

[luvHIM]

luv,

Thanks so much for the great response. I indeed have been through the ringer with many doctors. What I have listed as the SSA says I have is a short list of my conditions. I have Chiari I malformation, for which I had brain surgery. I have a titanium plate in my head, I had my first vertabrea removed and part of my second one. I still get headaches/migraines several times a week I am on medication for them 2x a day for now. I have instability in my head and neck, I have intracranial sintability and the Neurosurgeons consider me to be a failed chiari surgery case because my symptoms are basically the same as before the surgery. I have loss of use on the entire left side of my body, I have arthritis in my right knee, I have fibrobyalgia, chronic bronchitis & pneumonia, hypothyroidism, severe allergies chemical/contact and inhalants. I have neck and back pain constant, left ulnar elbow neuropathy and nystagmus, thrombophlebitis( I blow out superficial veins for no reason) and adema (constant swelling) in my left leg, oh and have tested positive for Lupus, and a severely elevated IgE level 6510 (normal is 120 and below) but they tell me its negative. I think that finishes my list. I see several different doctors from lung specialists to neurosurgeons to general to rheumo to immunologists. I had everything written down and I did submit all of my own documents along with whatever they got from the doctors themselves. It is pretty amazing that they forgot to add all that evidence even though I originally had it written it in the application. I was also looking at my denial letter and it doesn't look like they are giving me an opportunity to reconsider. They are however allowing me to "request a hearing". Gee how nice of them. I guess I should just get a lawyer now.

Thanks again,

Tamara

Tamara, I am glad to be of help. I am so sorry to read that you have so much going on at such a reasonably young age. No one at age 39, or any age really for that matter, should have to deal with so many medical impairments.

I have taken the liberty of doing a little research regarding the Chiari I Malformation and it states as follows:

There are three primary types of CM. The most common is Type I, which may not cause symptoms and is often found by accident during an examination for another condition. Type II (also called Arnold-Chiari malformation) is usually accompanied by a myelomeningocele-a form of spina bifida that occurs when the spinal canal and backbone do not close before birth, causing the spinal cord to protrude through an opening in the back. This can cause partial or complete paralysis below the spinal opening. Type III is the most serious form of CM, and causes severe neurological defects. Other conditions sometimes associated with CM include hydrocephalus, syringomyelia, and spinal curvature.

Is there any treatment?

Medications may ease certain symptoms, such as pain. Surgery is the only treatment available to correct functional disturbances or halt the progression of damage to the central nervous system. More than one surgery may be needed to treat the condition.

What is the prognosis?

Many people with Type I CM are asymptomatic and do not know they have the condition. Many patients with the more severe types of CM and have surgery see a reduction in their symptoms and/or prolonged periods of relative stability, although paralysis is generally permanent.

What research is being done?

The NINDS supports research on disorders of the brain and nervous system such as Chiari malformations. The goals of this research are to increase scientific understanding of these disorders and to find ways to prevent, treat, and, ultimately, cure them.

Now, having posted all of that...here are two links for SSA

http://www.ssa.gov/disability/3368/3368guidetext.htm#top http://www.ssa.gov/disability/professional...e-Adult.htm#Top

The bluebook will give you some idea of what SSA considers to be disabling. Having looked at your recent post, what I would suggest is that you get your neurosurgeon and rheumatologist to write a letter, preferably in your medical records, stating your Residual Functional Capacity. Some of these forms can be downloaded from the SSA website.

I don't know what state you are in but it shouldn't matter. To get your claim reconsidered before having to file an appeal just call the SSA at 1-800-772-1213 or you can go in person to your local SSA office. Let them know that you have been denied in your initial claim and would like to Request a Reconsideration. Now, I must tell you that the process pretty much works like the VA, in that your request has to be accompanied by "new evidence." A supporting statement from your doctors would be "new evidence." If you are again denied during the reconsideration process, then you would file a notice to appeal. You can call the SSA at the 1-800 number above to do this. They will document the date and time as the date of your call, which helps with timely filing. They (SSA) will also send you the forms necessary to proceed with a Reconsideration and or Appeal. CALLING the 1-800 will get the ball rolling and keep you covered as far as filing in a timely manner. Plus, they (SSA) then becomes accountable to you and has a responsibility to get the forms or whatever you need to you in a timely manner.

I was reading over my decision letter awarding me the SSD and noticed that my rheumatologist's letter was given the most weight in SSA's decision to grant me SSD. However, if your neurosurgeon is deeming your surgery as a "failed" type case, it cannot hurt to get him/her to write something in support of this.

This has been pretty long already. So, this is my last question for you: Are you receiving your treatment at a VAMC or by private insurance?

[Josephine]

was reading over my decision letter awarding me the SSD and noticed that my rheumatologist's letter was given the most weight in SSA's decision to grant me SSD

Tamara,

I am so sorry that I do not know that much about your illness, but I do know that you have been through a heck of a lot more than my niece.

I spoke to her and I do know that she did have letters from a rheumatologist from Winston Salem, North Carolina.

It was her lawyer that placed the paperwork in for her for the Reconsideration. As I told you earlier. They were told that she would have her answer in less than six months and she did in 3 months.

Full 100% due to this illness and its' symtoms.

This would be in the State of Virginia. I do not know how laws are from State to State. There was no mention of her doing or even being able to perform light duty work.

Always,

Josephine