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Old 10-18-2008, 10:04 AM   #1
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My denial reasons...

I've condensed it to denials only: 4. The claimant does not have an impairment or combo of impaiments that meets or medically equals one of the listed impairments-this finding is supported by the opinoin of the medical expert who considered the relevant Listings.

5. I find claimant has the residual functional capacity to perform sedentary work. claimant is limited to standing/or walking for 2 hrs but sitting is unrestricted,stooping,bending and climbing stairs ocasionally, no climbing ladders and heights. She needs to be able to lie down during lunch break in her own car, and would miss two or three days a mo. due to pain. C is able to perform simple repitive tasks.
Ltr goes on to say he must determine if my symptoms are frm an underlying med. acceptable clinical and laboratory diagnostic techniques--that could reasonably be expected to produce the pain or other symptoms.--
I must make a credibility of statements based on consideration of the entire case.

(goes explaing my symptoms and ltrs frm co-wrkr,old job attendance, testimmony frm HB)--In all, a residual functional capacity for sed. wrk is warranted in this case. States my allegations are credible and findings support these complaints, they are not inconsistent w/other evidence.
however, the severity are not commensurate w.a finding of disability based on listings and do not support any limitations that are not more restrictive than what is already described. while it is resonable to expect her condition would result in certain amt of pain and funtional limitations, the degree in which the claiment,hb,cowrkr allege she is limited is not fully supported by the overall medical evidence.
RE: Fibro there is no evidence claimant has had persistance and unrelenting symptoms or that fatigue is debilitating, in fact the c reported her pain waxed waned. Moreover, phiysical exam showed transient tenderpoints.

Ltr states has considered the self assesment by c, and I find the c's own residual func. cap. assement is quite exaggerted in its limitations and unsuported by documented pathology.
The c attempted to prtray an inactive lifesyle and she said she most of her time lying down. There is no impairment documented which requires such a lifestyle and if it is trulu the way the claiment spends her time, it is a chosen lifestyle and not one reuired by any impairment in the record.
Stmnts frm HB and crkr not fully credible. They r not medical prof and lay witnesses they not competent to make a dx or argue the severity of symptoms. The c HB is sole support for c and therefore he has a financial interest seeing the c rec. benefits. There his opinion is not an unbiased one.
...those stmnts r not supported by cliniacl or diagnostic med. evidence, in fact, c admitted she drives and runs errands such as going to Postoffice or grocery store w/ou assistance.
After considering the evidence, c medically determinable impairments could reasonablybe expaected to produce alleged symp; however the c stmnts concernignintnsity,perst,and limitng effectsare not credible to the extent they r inconsistent w/rfc assment.C dx w Lupus,etc, she's on med for this condition, however c has cont'd to complain of flareups on a daily basis. In fact sub med. evi. symptoms were result frm fibro syndrome.
Ltr also states based on there SSD dr. exam, my phys.exam was normal, I can lift /carry 20 pounds occasionally, 10lbs frequently. Shw was able to walk on uneven terain etc...
Their med. expert testified he would not expect someone to miss wrk because of an objectively studied ailment but would be expect someone to miss 25% of the mo. due to pain.
....However given the c pain and side effects of med., I find c is limited to simple rept. tasks.
6. C is unable to perform any past relevant wrk.
(last paragraph), If C had the residual funtional capacity to perform the full range of sed. wrk, a finding of not disabled would be directed by Med-Voc. rule. Also, it states a review frm psychiatrist determined the c has no med. determinable mental impa, theres a 15pg report on this, i never seen that DR.

(the new DR's due to new ins. would not fill out any form, due to they do that anymore, so I never turned in what my limitations r frm my own DR).
Voc. expert said I would need to lie down during lunch brk and miss 2 days per mo. based on her knowledge,exp. and he accepted her test. to be credible.

I'm not sure if I should continue w/appeal, or should I go to old Rheumy/out-of-netwrk, and see if he can help me fill out an RFC form, see last time I seen him 2006, he stated range motion was ok, but a little pain. This was also used on my Decision. Sorry so long, I need oppinions plz.

 
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Old 10-18-2008, 11:57 AM   #2
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Wallis86 HB User
Re: My denial reasons...

I've heard it can be near impossible to receive benefits with a dx of fibro because of the elusive nature of the disorder. You cannot quantify physical pain or fatigue, so disability lawyers cannot make an adequate case. I've heard of many people going through the same thing as you. I do not have fibro and am not on disability, despite significant physical disability (I'm overwhelmed by the process right now), but I do understand how difficult it is to live with chronic pain and fatigue and hope ou can get the aid you need.

 
Old 10-18-2008, 12:22 PM   #3
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Re: My denial reasons...

Are you saying that their denial was based on their doctor's opinions and not your own doctor's?

All the reasons that were stated for the denial only came from their doctors? Well that doesn't seem right or fair.
Didn't social Security look at your own doctor's documentation and his opinion?

Perhaps I read it wrong, but that is what I got from their decision for the denial. To me that would not give them the "true" picture of what is wrong with you. Or even the true picture of your prognosis. If that is true and your own doctor was not consulted at all, then I think you got screwed.

I cannot remember what all needed to be sent in with your application, but wasn't there a form that you signed that would allow them to get information from your doctor.

I saw that you switched doctors for insurance reasons and that this new doctor no longer filled out social security forms. But wouldn't they still talk to or request documentation from you old doctor.

If I am way off the mark on my understanding of your denial, I'm sorry. And I'm sorry that you were denied. As for what you should do next, I guess that to me depends on if have a doctor who go to bat for you and back you up on your statements, your husband's statements and your co-worker's statements. I think without a good doctor who will support you, you may have problems getting a approval.

What do you want to do next? Or is everything still swimming in your head from all of this jibber jabber and you haven't been able to get yourself focused yet on the next step?

I hope and pray that you will someday soon have a positive answer so that you can concentrate on your health.

Take Care,
Chris

 
Old 10-18-2008, 07:31 PM   #4
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Re: My denial reasons...

I would keep fighting. SS wants you to give up....That's why they have the system they do....They bog you down with denials and string the whole process out. SS wants applicants to give up. Don't! Keep fighting for the benefits you think you deserve. Also, the more medical documentation you can accumulate, the better. It's all about documentation.

Good luck.

Ex

 
Old 10-19-2008, 07:03 AM   #5
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Re: My denial reasons...

I am in a similar situation too. I was denied once and now i have a lawyer and waiting on the appeal. Got to be a tuff bird with all this.LOL I will be so GLAD when it's over.Its a long haul, but it will be worth it in the end !!
Karen

 
Old 10-19-2008, 07:51 AM   #6
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daph10 HB User
Re: My denial reasons...

I am convinced they want u to give up. It took me over 3 years to get ssdi and it was for RA. Good luck and don't give up even though u may want to. It is worth it in the end.

 
Old 10-19-2008, 08:03 AM   #7
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Re: My denial reasons...

I agree with the others - DON'T GIVE UP!

You have to hang in there and fight. I know how hard it is when you get those denials. You think to yourself, did they even look at my medical records? I have had two denials, and am now waiting for a date wit the ALJ.

 
Old 10-20-2008, 11:09 AM   #8
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Re: My denial reasons...

It does sound mostly like decision was based on ther experts. I did give authorizations to get my current/past DR's records, of course but I already had turned most of the most important ones.

The new Rheumy that I seen w/my new ins. this yr, I only had seen him once and he was terrible, he didn't believe I had Lupus, I was there for the back pain I was and still having, I told him 3DR's have done the Lupus panel, along w/symptoms confirmed I did, he insisted I don't have it, no explanation as to why he thought that, he even made me cry in there after asking me to decide what kind of "narcotic med. I wanted", I don't know your the DR. He ended not giving me anything for my back pain, he said 100's of people have back pain. He did not do any other testing's for back to see what is causing my back pain. I made a complaint to the hospital.

This DR's notes were included in Denial Ltr, he stated I was there for stomach pains, etc, he didn't mention my back at all, stated he found no basis of my DX was unknown. (Does this prove, that he didn't believe I had Lupus and my other SX?), on ltr it states I did have transient areas of muscusketal tenderness,but otherwise were benign. I

These DR's I go to don't accept walkins, by the time I go in sometimes I feel a little better, My primary I gave her list of symptoms she glances over it quickly and baiscly said nothing, I felt like what a waste of time. My old ins. I could go in when I was actually feeling terrible and this DR. did write down my symptoms on charts, includes mostly everything I told Judge.
These charts weren't even metioned on Denial ltr. This HMO ins. I have is terrible, I'm the one insisting to plz let me see a GI dr., they didn't want to that.
Sorry so long, I'm going to call my atty. right now and see if we can appeal.

Thanks

 
Old 10-20-2008, 03:08 PM   #9
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Re: My denial reasons...

I discovered, when I received my denial letter, that SS didn't even contact my neurologist. HELLO? I have a neurological disorder! It's called adult-onset Epilepsy! They only went by the ER report, the EEG & MRI, both of which showed "abnormal" yet I was still quickly denied.

It sounds like, based upon your post, that you were seen by one of "their" doctors and not your own. I am only at the initial appeals stage so haven't been asked to be seen by one of "their" doctors and I believe you can appeal their decision once you see them...so don't lose hope.

If you don't have a lawyer, get one. Now. And do not give up. As everyone has stated, they want you to give up. But don't.

 
Old 10-21-2008, 09:31 AM   #10
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Re: My denial reasons...

I am so sorry you were denied. This is exactly the reasons I have never applied - have been off of working for 4 years now - I do have fibromyalgia/chronic fatigue syndrome since 1997 dx. It is a very unforgiving illness and from what i read on your post - yep it does wax & wane in its severity and winter or cold weather makes it the worst. I have always felt that as long as i have the proper meds to help me through the day, i can and do function at home with the impairment but it is no where near a normal functioning at all. I can get up at 4am, yet still not be ready to go anywhere by 11am due to fatigue and a fatiguey type deep achiness and stiffness. I do find the longer i do nothing the stiffer i do get. so I find myself alot of times just walking around the house piddleing yet never making a decision on what i should get done because its all so overwelming to do now. whats the point to this? well i know of no employer that is going to tolerate these needs we have. missing only 2-3 days a month for pain/fatigue that is this illness is just not correct. there would be many more days than that i know. As well as missed time for doc appts every single month as required by the medicine laws. we cannot do a sustained activity for very long before we have to stop to rest or re-group. our minds are no longer quick to function (brain fog - and it's not caused totally by meds). Stress makes us even more worse in symptoms. and there is no way i could do a store clerk type job as just going grocery shopping gets my back and legs something fierce. I would not be able to stand for more than 1hr consistantly. sitting i would require a heating pad absolutely and would have to be able to get up and walk around some or stretch out my muscles and change position. the fact that most fibro patients don't get the treatment they need (pain relief & fatigue help) will cause the depression - not the opposite like what docs and ads on tv want you to believe. Its a viscious circle and many of us just give up and give in to the disease. With you having Lupus and Rumatoid - well that makes it even worse yet. I think you should get your own docs files, and appeal as I do know that there are many people with this illness that get ss. For me, like a couple others on here - it is just too overwelming for me to deal with and i know i would just shut down and flare up big time even trying to mess with it. so i don't. good luck to you

 
Old 10-21-2008, 10:43 AM   #11
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Re: My denial reasons...

Thanks for the replies. Yes, this illness does have more bad days then good days. I will clean the bathroom it takes like 3hrs total, after taking breaks in btwn. I will only do this if I feel good, like when I get a burst of energy but then I will pay greatly for it the next 2 days, this iwhen I must lay down to aleviate the muscle pain.

I cld my attny, asst. states they have not rec'd the unfav. Ltr, when they do, then it will looked at by another attorney to see if they feel they should continue.
Well, if they don't accept I will appeal myself b4 the 60 days r up.
I should know somthing by next week.

 
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