Reconsideration Phase - Never sent to an exam by SSA

[Hucast21]

Hey all,

I’m in the reconsideration phase of my SSDI claim. The weird thing is SSA hasn’t sent me to an exam, and the adjudicator already notified my attorney stating she will forward my file to the SSA doctors for review/decision.

I have plenty of medical history about my mental health disabilities ranging from in-patient hospitalizations to suicidal thoughts and attempts.

I’m just wondering has anyone been approved for SSDI for a mental health disability without going to an exam?

Edited March 6, 2021 by Hucast21

[broncovet]

At "my" social security hearing, the judge was there, my representative (non attorney) , myself, and a doctor was on conference call.  I assume the doc, who was not my doc, was hired by social security.  

It was a thorough, fair hearing.  My representative was very experienced.  She may know more than many rookie attorneys when it comes to social security law.  

About a half hour in, the judge stopped stuff and made me an offer:  

He will grant the disability if I agree to an Amended onset date.  

So, I asked the judge if I may confer with my representative privately and give an answer in 10 minutes.  Judge said, ok, went and got a cup of coffee.  

The rep suggested I accept the offer.  While it was a couple years less retro than what I wanted (she wanted more retro, too, she got 20 percent of it), she suggested that, since this was a "visiting judge" from another state, if I tried again with the local judge, I would be denied.  

So, I accepted the offer, and was awarded Social security disability at an onset date aboiut 2 years later than when I applied, but it was still a year or so retro.  

The rep told me that was a very fair offer, even generous..the local judges would not have been so nice.  

The doctor discussed my health issues as to why I can not work.  My rep was quick to point out that it was totally different to be able to accomplish "work type" tasks for an hour or 2, but not able to keep up with the stress of a 40 hour work week, week after week.  

The doctor agreed with the representative.  

I found out later, with social security, "you are given special considerations" if/when you apply for social security disability and you are "older".    I was over 55.

 

 If awarded social security disability over age 55 it costs the government less..much less than when you are 30.  

I did not make this up, here is the regulation:

https://www.ssa.gov/OP_Home/cfr20/404/404-1563.htm

Edited March 6, 2021 by broncovet

[Carl the Engineer]

There are 3 age considerations, 50, 55 and 60.

My wife never had an exam by SSDI.

The Judge offered my wife a deal, that after my wife reached age 55 (in 3-months) and no Medicare for 24 months from that date vs date of claim.  We accepted because we had private insurance.  But her checks went back to the claim date minus the 6 months, etc.

Saved us 12 months of the wait list.  At that time, WI was an 18 month wait to see the Judge.

Hamslice

 

[Punisher]

I'm going to jump in here, rather than start a new string.

I am 50 years old, 100% P&T VA.  Some of the more significant disabilities are PTSD (70%), Migraines (50%), and TBI (40%).
I have not been able to work since the beginning of 2019.

I applied for SSDI once I could no longer work and the VA actually did a great job breaking down how the mental health issues affect my ability to maintain gainful employment.  I had SSA perform the expedited application process as they're supposed to for 100% P&T vets.

Initial application was denied, giving false statements that I do not qualify for benefits because "you are not disabled under our rules." Under their "rules," it states: 

For Disabled Worker's Benefits:
You must have the required work credits (check), and your health problems must:
- Keep you from doing any kind of substantial work (check), and
- Last, or be expected to last, for at least 12 months in a row (check), or be expected to result in death.

The SSA never had me do a single exam with them, relying 100% on my VA records and exams. So, I appealed it with the "Reconsideration" process.  Once again, I never saw a single SSA doctor for any exams and they continued to exclusively go by my VA records.

My appeal was also denied, stating that they found the original decision to be "proper under the law."

So now I'm stuck going to phase 3, the ALJ Hearing.  I do not have a lawyer and I'm very cautious in hiring one, but recognize that one is finally needed.  I don't typically trust them, especially to remain proactive, and "IF" I eventually receive approval, am not super excited to hand over a large percentage to someone else.

Can anyone point me in the right direction on where to find a great lawyer who has experience working with 100% P&T vets?  Any other insights on this process will be very appreciated.

[pacmanx1]

1 hour ago, Punisher said:

Can anyone point me in the right direction on where to find a great lawyer who has experience working with 100% P&T vets?  Any other insights on this process will be very appreciated.

You should shop around some of the more experienced SSA lawyers, you see their commercials all the time saying if they take your case, you don't pay unless you win. 

[Carl the Engineer]

The Lawyer(s) or legal aide can only get 25% of retro with a max of $6000.00 by law.

My wife's retro was around $6000 and they kept around $1600.  They can charge some for supplies, etc.

Anyhow, it was way worth it.  

Pay them some, or get nothing,

Hamslice

We only had to pay $1400 once, but the checks keep coming every month, LOL.

 

[john999]

The SSA disability system is a racket.  Everyone must get fed including the judges, lawyers and all the rest.  You, the claimant, are the least of them.  I got SSDI about 20 years ago.  If you use a mental condition it is much easier.  I got it within 3 months of applying.  I was claiming PTSD/depression and I had two very good doctors.  I was 51 years old. It took two years to get TDIU from the VA.