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Old 10-24-2011, 10:46 PM   #1
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Spinal Fusions and SSDI

I had a 9 level spinal fusion and was denied at my hearing. My question is; Shouldnt I have been awarded at least 12 months closed period? The recovery was at least a year and im still on meds...does anybody know about this?? Im in between appealing this decision and starting a new claim...

 
Old 10-25-2011, 05:07 AM   #2
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Re: Spinal Fusions and SSDI

I don't quite understand your question 9 lv spinal fus. Can you expound? Are you saying that SS is saying that you were disabled but SS expected that you would not be disabled anymore after you had fully recovered from the fusion, thus denying your claim? Did they make the decision while you were still recovering from the surgery (disabled)? I don't know too much about back/neck problems but I would imagine after having 9 of your vertebrae fused, your mobility must be somewhat limited now.

 
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Old 10-25-2011, 08:05 AM   #3
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Re: Spinal Fusions and SSDI

I don't quite understand your question either - are you asking about partial/temporary disability? I do know a little about back problems and filing for SSDI ... my claim was for back problems too.

My attorney warned me that even though I met the listing, back problems were one of the most common reasons to file, and the hardest to win. The attitude seems to be, "so what if your back hurts - take an aspirin and go to work!".

It took me 5 denials over 2 1/2 years to win. In each denial letter, they said that even though I had serious back problems, they felt I could still work. In the judge's denial letter, he called me a fake, and was very cruel.

Do you have an attorney? What does he/she think? Hopefully they can tell you the chances and time frames of appealing and starting a new claim - and that should help you make a decision. Which ever you decide, don't give up!

 
Old 10-25-2011, 08:38 AM   #4
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Re: Spinal Fusions and SSDI

Well I had my surgery in Feb 2010...my hearing was Dec. 2010...and I didnt get a denial letter until Sept of 2011. So I guess their saying I recovered enough to work at least a sedentary job. My arguement is it took me 12 months to recover...and im still in pain. I think I should have been paid at least a closed period of pay...at the very least...and they have no records from my pain management clinic that I go to now, because I started going there in Jan of 2011...just after the hearing....Im just wonderig should I appeal this decision or should I start a new claim and argue I cant do sedentary work??? I think I have good chance at starting over and proving I cant do sedentary work...because Ive heard getting the Appeals Council to over turn a decision is very unlikely unless you have some new compelling evidence.

 
Old 10-25-2011, 08:42 AM   #5
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Re: Spinal Fusions and SSDI

Did you start a new claim to win yr case? Or did you win on and a appeal at some level??? And what was the basis of you winning??? Thanks for your reply also.

 
Old 10-25-2011, 08:48 AM   #6
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Re: Spinal Fusions and SSDI

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Originally Posted by gayle4102 View Post
I don't quite understand your question either - are you asking about partial/temporary disability? I do know a little about back problems and filing for SSDI ... my claim was for back problems too.

My attorney warned me that even though I met the listing, back problems were one of the most common reasons to file, and the hardest to win. The attitude seems to be, "so what if your back hurts - take an aspirin and go to work!".

It took me 5 denials over 2 1/2 years to win. In each denial letter, they said that even though I had serious back problems, they felt I could still work. In the judge's denial letter, he called me a fake, and was very cruel.

Do you have an attorney? What does he/she think? Hopefully they can tell you the chances and time frames of appealing and starting a new claim - and that should help you make a decision. Which ever you decide, don't give up!
Hi Gayle, I was wondering if u won yr case on a appeal or did u have to start over at some point? And what was the basis of u winning...and how did u meet a listing with back problems? Thanks for yr replies!!!

 
Old 10-25-2011, 09:22 AM   #7
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Re: Spinal Fusions and SSDI

Thanks for explaining 9 lv spinal fus. I think I understand. Initially, I was thinking the same thing Gayle was thinking....that you were seeking temp. disability for a period when you were disabled. But, you are also claiming that you are still disabled even after the fusion. Personally, I would start a new claim. Hopefully that one would be approved quickly like Gayle's second claim. Question? Are you any better, the same, or worse after the fusion?

 
Old 10-25-2011, 10:28 AM   #8
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Re: Spinal Fusions and SSDI

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Originally Posted by 9 lv spinal fus View Post
Hi Gayle, I was wondering if u won yr case on a appeal or did u have to start over at some point? And what was the basis of u winning...and how did u meet a listing with back problems? Thanks for yr replies!!!
Here is a link to the Social Security Blue Book page that lists the back problems:

http://www.ssa.gov/disability/professionals/bluebook/1.00-Musculoskeletal-Adult.htm#1_04

In my case, I have several discs that meet 1.04A, along with spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis and a few others. Take a look at the list - you probably meet at least one listing. Unfortunately, just meeting a listing does not guarantee you a win - you have to prove it is severe enough to keep you from working.

I appealed AND started a new case (you can no longer do that), and I won at the Reconsideration level of my second case. My first case is waiting for a Federal Court Date.

If you have an attorney, please speak to them about appealing or starting a new claim. If it were me (disclaimer ... I am NOT an attorney ), I would start a new claim. You are right that an appeal of the ALJ decision takes YEARS, and is difficult to win. But please speak to your attorney about it, if you have one.

 
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Old 10-25-2011, 11:23 AM   #9
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Re: Spinal Fusions and SSDI

I have had many spinal fusions and have been denied initial app in 12/2010 and denied at reconsideration 07/2011 and now wait for ALJ hearing. The SS denial letter states why they denied you, for me it was that they feel I am able to work even at my prior occupation and all other sedentary occupations. There are times when they approve for a closed period of time but that is more common when someone goes back to work and the attorney requests a review for a closed period. For someone who remains out of work and continues appeal levels of the claim, SS won't approve for a year just because your recovery took a year. They are looking for if you were disabled for a minimum of one year and expect to be disabled longer term.
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Old 10-25-2011, 11:36 AM   #10
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Re: Spinal Fusions and SSDI

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Originally Posted by BlueSkies14 View Post
Thanks for explaining 9 lv spinal fus. I think I understand. Initially, I was thinking the same thing Gayle was thinking....that you were seeking temp. disability for a period when you were disabled. But, you are also claiming that you are still disabled even after the fusion. Personally, I would start a new claim. Hopefully that one would be approved quickly like Gayle's second claim. Question? Are you any better, the same, or worse after the fusion?
Hi to answer yr question i am worse than before...they did the fusion to stablize the spine due to scoliosis...im always fatigued and in pain. Now my lumber is suffering from the fusion.

 
Old 10-25-2011, 11:48 AM   #11
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Re: Spinal Fusions and SSDI

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Originally Posted by SpineAZ View Post
I have had many spinal fusions and have been denied initial app in 12/2010 and denied at reconsideration 07/2011 and now wait for ALJ hearing. The SS denial letter states why they denied you, for me it was that they feel I am able to work even at my prior occupation and all other sedentary occupations. There are times when they approve for a closed period of time but that is more common when someone goes back to work and the attorney requests a review for a closed period. For someone who remains out of work and continues appeal levels of the claim, SS won't approve for a year just because your recovery took a year. They are looking for if you were disabled for a minimum of one year and expect to be disabled longer term.
Yea ur rite 12 months or longer...thats what im saying...they should say hey this surgery takes a year to recover then evaluate me and see im still gonig to pain management and say hey this guy has a long term issue. But my last rep did argue for a closed period and they still game me nothing...and yea theyre saying i can at least do sedentary work....im going to file a new claim and prove to them I cant do even sedentary work.

 
Old 10-25-2011, 12:39 PM   #12
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Re: Spinal Fusions and SSDI

I think back/spine problems are one of the most common reasons why people file for disability which makes it very difficult to win . I think filing a new claim is a very good idea, but i have heard you have to drop the first claim and not pursue it any longer because social security changed their rules.

 
Old 10-25-2011, 12:51 PM   #13
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Re: Spinal Fusions and SSDI

I wouldn't file a new claim until you've been denied at every level of appeal/hearing with SSDI. Filing a new claim won't get most approved sooner, it's just starting over from the beginning again. I am "in line" for an ALJ hearing. I've already been waiting since July. I can't imagine starting over and ending up farther back in line again waiting for ALJ.
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Old 10-25-2011, 07:37 PM   #14
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Re: Spinal Fusions and SSDI

@SpineAZ>>>>He has been denied at level 3 (ALJ) Spine. Would you still appeal and not start a new claim after a level 3 denial? That is a real tough decision since what usually happens is the claim gets remanded back down to the ALJ who originally denied you. According to Allsup>>>
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Level Four – Appeals Council. If the hearing ends in a denial, you have 60 days to ask for a review by the Appeals Council. At this level, the Appeals Council will review the disability hearing decision to determine if it was rendered properly according to the law. Only 2 percent of third appeals result in a favorable decision for the applicant. The SSA estimates the average time to receive a decision on this third appeal in 2010 was 345 days according to the SSA.
Quote:
Level Five – Federal Court. There is also an additional appeal available which is pursued by less than one percent of claimants -- Federal District Court (FDC). Approximately 70 percent of these are denied with a small amount receiving a decision in FDC that resulted in an award. The remainder of those are remanded (sent back) to the hearing level for an additional hearing.
To me, it seems like the odds are not very good after you have been denied at level 3. That is a tough call IMHO.

@Gayle>>>>>had you not been able to start a new claim why appealing your initial claim, would you personally have dropped your initial claim and start over? Did your attorney suggest to you to start a new claim while pursuing the initial claim? I was reading some old posts by someone named Executor and he said something that I have always suspected but can't really prove. I think there is a lot of randomness in the SSDI approval process. I see Spine's point of view. Starting over could mean another 2-3 years before getting another hearing before the ALJ if denied at levels one and two. This did not happen in Gayle's case. I think she was approved @ level 2 during her second claim. I have seen and talked to other people in other forums who have posted that they were not nearly as bad as other people and were approved @ level one. I personally know of one guy with just depression and one girl with fibromyalgia who were approved at level one. I honestly think like Executor said that they have to approve about 35% at level one or there would be a certain amount of public backlash. The guy with depression told me he expected to go the distance with SSA because he did not even have a long history of depression and was really surprised when they approved him in 6 months. It really makes me wonder. Look at Gayle here. They denied her initial claim but approved her second claim quickly. Why did they not just approve the initial claim at level 2? It's really crazy

 
Old 10-25-2011, 07:44 PM   #15
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Re: Spinal Fusions and SSDI

I'd ask my attorney what the options are. If federal court is the only option at this time then perhaps filing a new claim is the only option who's waiting for existing claim to go to federal court. A good SS attorney will take the most advantageous route.
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