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Old 05-09-2011, 01:54 AM   #1
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Exclamation Freaking out over 3 yr ssdi review!

Its been well over 3 years since I started receiving SSDI. My case originally, like many, went all the way to the Admin Law Judge phase. I had the help of a lawyer as part of my benefits program from the company I used to work with. That benefit is no longer available. About 6 months ago I received a several page form to fill out detailing my current status. My situation, while common, has me very very worried. I just receive a brief letter from the State of California stating that my SSDI was under further review and that I had to list Dr's and treatments I have received. That is where the problem is. More on this later. Why the State of California. I am a college graduate and have read this thing several times. I don't get the connection. Are the sub contracting out work to the States?

My disability stems from a lifetime of back injuries that led to a 2 level cervical fusion and a 3 level lumbar fusion. It has been a few year since I have seen my neurosurgeon but he said my entire back was riddled with DDD and Spinal Stenosis and that at some point a thoracic fusion would be needed. Right now I am able to remedy the pain with meds but there is no way I could work. I can't stand for more than 20 minutes and can't sit for more than 30. I spend most of my time in bed reading and watching TV. I can't drive most days and because of the ultra sedentary lifestyle I have gained 50lbs.

During the 1st 5 years of all of this I sought every type of doctor I could to find out what was wrong with me and if anything could be done. I ran the entire gamut of the medical system driving them crazy and came to the conclusion that I suffer from chronic pain, severe depressive disorder, PTSD and super low testosterone. The mental and testosterone components were not part of the original filing. Since I ran out of options I am in a kinda holding pattern with my GP. I see him every few months for prescription protocol and discuss any new symptoms I might have. I was getting botox injections in '09 but I found them ineffective for nerve pain.

It is my understanding that to discontinue my SSDI I must IMPROVE in health status. I have a letter from my Dr stating that I will never work again and that I am permanently disabled. I am hoping to get this letter updated to reflect all current problems and that it will suffice. I am wrong? Would a printout from my pharmacy help since I take Methadone, Hydrocodone, Ambien, Xanax and Celexa.

It is ironic that my "mental disorder" has to do with "security" due to a horrible childhood and a vow I made to myself to kick, scratch and punch my way through college and not live in a world where we could be homeless at anytime. I became very successful and was doing very well when the accidents happened. Now, with this "threat" to my SSDI, I am literally freaking out. If we loose my income we are homeless. The carper has been ripped out beneath us. My wife was in the same industry as I was, which collapsed, and she is now working a low paying retail job with no benefits. We live paycheck to paycheck yet make too much for any extra assistance. I guess that is partly due to the fact the when I got hurt we decided to hold off on having children because we didn't know if I would be able to take care of one. So much for being responsible.

Sorry for the long post. I am venting. I see my therapist tomorrow and then I am going to try and get into see my GP to get the letter updated. In case it helps understand my situation better, I am 43 years old, 6'4 and 305lbs.
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Old 05-09-2011, 07:29 AM   #2
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Re: Freaking out over 3 yr ssdi review!

Have you filled out the form yet and sent it back to SSA? I would do this ASAP. If you see your GP every few months and he will attest to your disability, I don't think you have anything to worry about. The fact that you quit seeing the back specialist should have no bearing. Your GP is managing your care now.

 
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Old 05-09-2011, 04:02 PM   #3
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Re: Freaking out over 3 yr ssdi review!

Thanks. I see my GP tomorrow at 3pm to go over the whole deal. Its a shame because this Dr's office went from a small practice with 3 Dr's to a "Doc in the Box" in just a few years so he has double the clients. Because of that, I have to stay on top of him and his assistant to make sure they have the proper information. Half the time I feel like I am the Dr.

I also called his assistant today about the letter they once made for me that said I was completely disabled and would not ever work again. I asked if they could revise it with some new info and new date. I got some guidelines off a SSDI help site about what SSDI expects a person of my age to be able to do and I am going to try and get him to write that I can't come close. Things like sitting for 30 mins, standing for 30 mins, etc.. Heck, I spend most of my time in bed, couch or recliner. I can't even go to the store with my wife. When I do have a Dr's appt it takes everything I got and I have to take my max pain med allowance just to get through it because bouncing around in a car really sets me off. I know SSDI is just doing their job but you guys know that when your always in pain and depression sets in (ya, I'm in therapy), the last thing ya need is something to threaten your income. For me, because of my childhood, its a real stressor and this all has me wrecked.

Before I was on SSDI and I was receiving State Disability and Private Disability (great work bene's), I lost my private disability because ONE Dr's mention in his notes that I was "Clear, Cognizant and Coherent" during my appointment. That cost me substantial money and now has me trusting NO ONE with this stuff!

Thanks so much for your help. I hope it goes how you think. Don't see what I would do if it didn't.

Bilbo.
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2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
Old 05-09-2011, 04:29 PM   #4
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Re: Freaking out over 3 yr ssdi review!

Did you appeal your group employer LTD denial? You have 180 days in most cases to do so, thus please consider it.

Are you seeing a Pain Mgmt doc ongoing? That will help with SSDI. All SSDI has to do is prove ability to work, not that you have improved from prior review, so they need to be sent anything and everything related to doctors notes, proof of pharmacy records to show med prescriptions were filled, support from Pain Mgmt doc, Neurosurgeon and/or Orthopedic Spine Surgeon, etc. I have an agreement with my OSS that he will see me 1-2x/yr ongoing to help substantiate disability.
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Old 05-09-2011, 05:33 PM   #5
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Re: Freaking out over 3 yr ssdi review!

Quote:
Originally Posted by SpineAZ View Post
Did you appeal your group employer LTD denial? You have 180 days in most cases to do so, thus please consider it.

Are you seeing a Pain Mgmt doc ongoing? That will help with SSDI. All SSDI has to do is prove ability to work, not that you have improved from prior review, so they need to be sent anything and everything related to doctors notes, proof of pharmacy records to show med prescriptions were filled, support from Pain Mgmt doc, Neurosurgeon and/or Orthopedic Spine Surgeon, etc. I have an agreement with my OSS that he will see me 1-2x/yr ongoing to help substantiate disability.
Sorry SpineAZ, you can see that I am very wordy but there are details that I left out. The LTD denial was back in 06 and then Benefit package I had was through Administaff. The LTD was through Cigna while Allsup had Lawyers working on my SSDI. I thought the lawyers would be helping me keep my LTD but since they were both subcontracted out through Administaff, they said they couldn't help me. I did appeal the decision with a mountain of paperwork stating that I couldn't work but they held onto that little phrase "Coherent, bla, bla" and actually found another Dr who said the same thing in a report. It was really rediculous. So I can talk for 20 minutes! I tried to explain that after the drive home from the Dr's office I had to lay flat on a bed. They denied me again. By this time I was really close to my ALJ hearing and my Atty pretty much assured me that all would be ok and it was. The Judge asked me two question (can't remember what) and closed my file and said "I don't even know why this file is on my desk, your approved". He looked really mad.

Fast forward to now which is nearly 5 years later for my 3 year review. I do not have a pain management Dr because over time we found out what worked and my GP was willing to handle it himself. I take 20mg Methadone twice a day and up to 4 10mg Norco for breakthrough. That will probably go up soon as my pain levels have risen. They do so throughout the year and we adjust. I also take Xanax 2mg up to 3x day (general anxiety disorder, major depressive disorder, PTSD and chronic insomnia). Ambien for insomnia and Celexa for depression. All of those are not part of my SSDI claim. In fact, only my cervical fusion and DDD and spinal stenosis in my thoracic spine was the basis for my claim. Since then I have had a 3 level lumbar fusion with Dynesis hardware and all the mental stuff developed. My Nuerosurgeon, whom I havent seen in 3 years said a thoracic fusion may be needed at some point...

I am a total type A personality and was in a very high intensity sales job where I was a shooting star. I am still dealing with the effects of not working. Our society puts such an emphasis on what we do for a living. We are what we do. You know the story. Your at a dinner party or BBQ and you meet someone new and the 1st thing they ask is "What do you do for a living". I have all kinds of clever responses but the reality on not being able to provide for my family and I am so disabled I can't do the hobbies I used to do like Golf and Photography (Wildlife Photog with BIG 5lb lenses I can't carry). Now I read, watch TV, talk on forums about my old hobbies but its all sedentary. I am so depressed.

Do you think that having my GP doing my pain meds is a bad thing? I did it to save money.

I put a phone call into the SDI person's number at the bottom of the phone because the medical info form they want me to fill out doesn't say how far to go back. I wanted to know if they even know about the lumbar fusion and all the various injections I have had (multiple facet, medial branch block, epidural, botox, and the evil radio frequency lesioning!). I read on another blog type SSDI help webpage that introducing new medical info, even if its related, will likely cause a CE or SSDI requiring me to see one of their Dr's. Any truth to that?

Now you say that the review is just about whether you can work or not but other sites (I don't know if I can list url's here... last time I posted here you couldn't) say that its based on:

1. Improvement likely

2. Improvement possible

3. No improvement possible

Maybe I have those points confused with getting SSDI in the 1st place.

So, if that is the case, a letter from my GP stating that he is the Doctor in charge of my case and that there is NO WAY I can work and that I am totally and permanently disabled should work? I have a print out from my pharmacy showing all my medication for the whole year. Anything else I should do? Should I have my Psychologist add anything or is that a whole new can of worms?

Thanks so much. I am so stressed out that the xanax is barely helping. I want to crawl in a hole. Its been a whole year of these type of problems. I got bad advice from the private disability carrier way back in 05 about that tax status of the PRIVATE disability. They said it wasn't taxable! However, since my employer paid for the benefit IT WAS TAXABLE so I have been fighting the Feds and State about back taxes. They all want mountains of paperwork to determine if I qualify for hardship but I tell them if I could do that much paperwork I could actually work. They do care. Anyway, I digress.
Thanks for your help. Any advice is greatly appreciated.

Bilbo
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2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
Old 05-09-2011, 06:00 PM   #6
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Re: Freaking out over 3 yr ssdi review!

Oh, SpineAZ, I wanted to add or ask if I should list the neurosurgeon that did my lumbar fusion AFTER my SSDI approval? I havent seen him since 2008 and he would have no idea of my ability to work at this point. Seeing how I only have 10 days to do this report and send it back, it would be impossible to get an appointment with him and bring him up to speed. I also do not trust some assistant behind a glass window to handle this correctly. Should I just call and get the Medical Record Number or should I just let me GP handle all of it.

Also, the form I got is weird. Its not mention anywhere I look on the net. I even googled the form number and came up with nothing relating to SSDI. As I stated prior its from the State Of California- Department of Social Sevices!?!?! The Form is MSC-154???
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2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
Old 05-09-2011, 07:06 PM   #7
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Re: Freaking out over 3 yr ssdi review!

Quote:
Originally Posted by SpineAZ View Post
Did you appeal your group employer LTD denial? You have 180 days in most cases to do so, thus please consider it.

Are you seeing a Pain Mgmt doc ongoing? That will help with SSDI. All SSDI has to do is prove ability to work, not that you have improved from prior review, so they need to be sent anything and everything related to doctors notes, proof of pharmacy records to show med prescriptions were filled, support from Pain Mgmt doc, Neurosurgeon and/or Orthopedic Spine Surgeon, etc. I have an agreement with my OSS that he will see me 1-2x/yr ongoing to help substantiate disability.
I agree Spine. He should definitely appeal if it is not too late. I wish more doctors will realize the impact anything they say can have an impact on the patient's LTD income. Just a single comment like this is all it takes for the LTD carrier to cancel your claim. In my situation, I might have a few good days followed by a week or two of bad. No employer is going to hire someone like this plus of my age now also. I am almost 50 years old. I was really scared about going on LTD but realized in the end I had no choice b/c like most ppl, I could no longer continue working despite trying really hard. My body and brain simply said no.

 
Old 05-09-2011, 07:23 PM   #8
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Re: Freaking out over 3 yr ssdi review!

Blueskies, just want to be clear that my LTD benefits ended many many years ago and I did appeal just not with a Lawyer. I live in a very small podunk town in far Northern California and we couldn't find and LTD Atty, only SSI and SSDI. Plus, since I had Allsup doing all the SSDI info, I thought they would act on my behalf but they said there was a conflict of interest.

I only brought it up as an example. I don't blame the Dr. Heck, just because someone is clear and cognizant for 20 minutes while in front of you doesn't mean they can work. The same reports and notes listed my medical problems. I was a high valued target. They were paying me the MAX the policy would pay and they looked for any wiggle room they could find to cut me loose. Plus, I had just had serious surgery and was in a lot of pain. They duped me. To me its criminal.

Right now, my only concerns are my SSDI and this review that is oddly being done by SSDI via the State of California. I just want to know what I should say (include) and what not to. It seems to be a game and I want to win.

Thanks.
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Old 05-09-2011, 07:26 PM   #9
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Re: Freaking out over 3 yr ssdi review!

Bilbo, why did you not consider hiring an ERISA LTD attorney after you appealed your LTD and lost? Many will work on a contingency basis. I hate to hear when this stuff happens to ppl. Just one comment from a doc like this is all it takes. I talk to another guy on another forum and CIGNA did the same thing to him and this guy truly can not work. This is so bad and so wrong IMO. The reality is giant insurer's like Cigna, Metlife, and Unum are in the business to make money, not to pay out claims IMO. They will pay the claims but they also look for the smallest things to cancel IMO. This is done wrongly b/c often many times, the claimant really can't hold down full-time employment b/c of his/her disability. The stress of this just makes your medical condition worse IMHO. I really wish all medical doctors were more compassionate and sympathetic to patients on LTD and SSDI. Your financial health is literally in their hands.

 
Old 05-09-2011, 07:32 PM   #10
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Re: Freaking out over 3 yr ssdi review!

Quote:
Originally Posted by Bilbo View Post
Blueskies, just want to be clear that my LTD benefits ended many many years ago and I did appeal just not with a Lawyer. I live in a very small podunk town in far Northern California and we couldn't find and LTD Atty, only SSI and SSDI. Plus, since I had Allsup doing all the SSDI info, I thought they would act on my behalf but they said there was a conflict of interest.

I only brought it up as an example. I don't blame the Dr. Heck, just because someone is clear and cognizant for 20 minutes while in front of you doesn't mean they can work. The same reports and notes listed my medical problems. I was a high valued target. They were paying me the MAX the policy would pay and they looked for any wiggle room they could find to cut me loose. Plus, I had just had serious surgery and was in a lot of pain. They duped me. To me its criminal.

Right now, my only concerns are my SSDI and this review that is oddly being done by SSDI via the State of California. I just want to know what I should say (include) and what not to. It seems to be a game and I want to win.

Thanks.
Thanks Bilbo. I did not see this post before I posted my previous reply to you. Curious, how much were you getting from Cigna? My DI carrier also is using Allsup to help me apply for SSDI and I don't want to have the same thing happen to me. I am preparing myself now just in case. Did Cigna cancel you before or after you won SSDI?

 
Old 05-09-2011, 07:46 PM   #11
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Re: Freaking out over 3 yr ssdi review!

Quote:
Originally Posted by BlueSkies14 View Post
Bilbo, why did you not consider hiring an ERISA LTD attorney after you appealed your LTD and lost? Many will work on a contingency basis. I hate to hear when this stuff happens to ppl. Just one comment from a doc like this is all it takes. I talk to another guy on another forum and CIGNA did the same thing to him and this guy truly can not work. This is so bad and so wrong IMO. The reality is giant insurer's like Cigna, Metlife, and Unum are in the business to make money, not to pay out claims IMO. They will pay the claims but they also look for the smallest things to cancel IMO. This is done wrongly b/c often many times, the claimant really can't hold down full-time employment b/c of his/her disability. The stress of this just makes your medical condition worse IMHO. I really wish all medical doctors were more compassionate and sympathetic to patients on LTD and SSDI. Your financial health is literally in their hands.
Blueskies, you are correct. Cigna and the other big guys don't care about the client. They care about the bottom line. I truly believe their CSR's are paid a commission to "kill" clients policies. That is how it felt when I worked with them. Countless fax from my own fax machine (I had a home office) got lost or never received even though I had the confirmation it went through. I worked in the wholesale lending business and I knew the paper game. Unless you are face to face you can hide behind a voicemail system and fax machine.

Why didn't I get a ERISA LTD? I am not kidding you when I say we (my wife and I) called 30+ local attorneys looking for help and NOT ONE knew what to do. We even did dozens of Google searches and came up with nothing. Everything was SSDI or SSI. I am no dummy. I am college educated so I know how to get things done. We simply could not find anyone to even look at the case and believe me, it was a slam dunk. You also have to take into account that I was very disabled at the time and taking upward of 240mg of Avinza (24 hr time released morphine) and I wasn't exactly highly functioning. I could only really function mentally a few times a day.....

I really appreciate your take on this but it doesn't help to look back and realize there were things that I could have done. Heck, that just makes me more depressed. I need to focus on the hear and now and deal with this odd review. I still do not understand why its coming from the State of California??? Do they farm out work when they are backed up. The form number is NOWHERE on the internet. I am confused.
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Old 05-09-2011, 08:02 PM   #12
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Re: Freaking out over 3 yr ssdi review!

Quote:
Why didn't I get a ERISA LTD? I am not kidding you when I say we (my wife and I) called 30+ local attorneys looking for help and NOT ONE knew what to do. We even did dozens of Google searches and came up with nothing.
I know this is now water under the bridge Bilbo but you can put in ERISA LTD attorney (google) and come up with many lawyers who represent claimants on LTD. Technology now makes it possible to hire one of these guys anywhere in the Country. I actually called up and talked to the Erisa law group in California and I am in Ga. for a free consultation. I told them that I might need their services in the future. I hope I don't but you must always prepare for the worst case scenario. How long were you on LTD before Cigna cancelled you?

Last edited by BlueSkies14; 05-09-2011 at 08:03 PM.

 
Old 05-09-2011, 08:14 PM   #13
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Re: Freaking out over 3 yr ssdi review!

Quote:
Originally Posted by BlueSkies14 View Post
Thanks Bilbo. I did not see this post before I posted my previous reply to you. Curious, how much were you getting from Cigna? My DI carrier also is using Allsup to help me apply for SSDI and I don't want to have the same thing happen to me. I am preparing myself now just in case. Did Cigna cancel you before or after you won SSDI?
It was a while ago but remember getting checks every two weeks for $2400 or so plus the max state disab. I got SSDI about 5 months after being canceled. I now remember thinking back then that Allsup, who was handling the SSDI case, may have tipped them off that I was sure to be approved. Allsup has a 90% victory percentage. Both Allsup and Cigna we contracted out by Administaff which was the company the start-up I went to work used for HR and Benefits.

Remember I was looking for an Atty back in 2005.
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Last edited by Bilbo; 05-09-2011 at 08:16 PM. Reason: added detail

 
Old 05-09-2011, 08:27 PM   #14
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Re: Freaking out over 3 yr ssdi review!

Does the letter with the forms indicate it is in relation to your SSDI? What type of questions are they asking for? How long is the form packet?

If it's asking for doctors you are currently treating with then you can only list current providers. I believe you mentioned some mental health issues, are you regularly seeing a counselor, social worker, psychologist or psychiatrist?

I'm concerned that you are only seeing your GP/PCP. SS would expect treatment with specialists for any condition requiring specialty care or monitoring. I have to see my Pain Mgmt doc monthly as I am on long acting meds (Ms Contin) along with Percocet, soma, and neurontin. I also see my orthopedic spine surgeon at least twice a year so he can continually evaluate me and when needed produce records for LTD or my Individual private disability or my pending SSDI.

Do you have your original SSDI approval letter that states exactly what conditions they found disabling and have any new significant conditions arisen in the last few years SS needs to know about.
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Last edited by SpineAZ; 05-09-2011 at 08:29 PM.

 
Old 05-09-2011, 09:12 PM   #15
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Re: Freaking out over 3 yr ssdi review!

Spine, the letter is very weird. It does not say SSDI but it does say on the 2nd page:

"Earlier, you were notified that your disability case would be reviewed. At that time you provided the Social Security Administration with information regarding your continuing disability review including your current address, phone number, and medical treatment sources. Your disability case has been sent to us for medical development and evaluation. We will process your case as quickly as possible. In order to ensure a quick and accurate evaluation we are giving you the opportunity to inform us of anynew information about your case. Return this form in the enclosed envelope within 10 days from the date of the letter. If you fail to return this form within 10 days of the date of this form, a decision may be made based on the information already in your file and we may not be able to determine if you are blind or disabled. In addition, if you are currently receiving benefits, your benefits may be stopped."

That is a word for word, verbatim recreation of the main letter. The bold is their emphasis. It goes on to give me two options:

Please complete the section below, checking off all those that apply.

() There have been no changes to the information I've already provided in regards to my address, phone number and medical treatment sources.

() There is a correction to my address and/or phone number as indicated below.
My new address/and or phone number is:
________________________________
________________________________
________________________________

Notice the second option has nothing about medical???

The last page says:
I have received treatment from additional medical sources as out lines below.

Full name of the doctor or medical facility___________
Address and phone number_______________
Approximate date of treatment___________
Type of treatment received______________
Medical Record Number__________________

These 5 "questions" continue 5 times on the page. The page ends with another statement of the importance of me returning it on time and my case number. Then they typical thanks yous and a phone number to call with any questions. Its a Sacramento number and the person is listed as a Disability Eval. Analyst III

Everything else, including the front page is all State of California- Department of Social Services - Edmund G. Brown Jr., Governor
562 CA DDS Roseville
PO BOX 30729
SALT LAKE CITY, UT 84130-9845

There is another code on the top of the 1st page: S62/MMYEPE and then the State of California seal which you can barely read.

Its very bizaare. The State of California doing a Disability Analysis for the SSA and having me send it to Utah???? ***? FYI, I have no pending business or benefits with the State of California.
__________________
2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
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