Social Security Disability Insurance:
what one patient learned
(contributed by Calvin Fey, an AN patient who is in the process of becoming a Disability Determination Consultant)
About 3 months ago I ordered about $300 worth of manuals published by a legal book publisher on all the successful SSDI rulings in various appealed cases, and a volume on how to set up a legal practice specializing in SSDI claims, just to see how the legal profession does it. It's mind boggling, but at the same time very interesting. I am glad to be able to share what I've learned.
I will start out giving a general overview of my personal situation, my experience, and the results of dealing with the Social Security system. Then explore the specific, practical steps, of applying for SSDI. I can't really get too specific because that would involve the medical nuances of each case, but I hope this info is practical and helpful.
The purpose of this story is to help other AN patients who are applying for SSDI. It is in no way a guarantee that you will be successful, but the one thing I can guarantee is the following information will greatly increase your odds of a successful outcome. I guess you'd say I have firsthand experience of the process.
2. My story
My name is Calvin Fey, and I am a AN patient from Louisville, Ky, and 47 years of age. I have had two very large Acoustic Neuroma's in which I opted for microsurgery. One in 1983, in San Antonio, TX, and the other for a recurrent AN in December of 1998, at the House Ear Clinic in Los Angeles. Both surgeries resulted in many complications, which you can read about on the Seattle Acoustic Neuroma Group (SANG) site.
I consider my surgery successful; because of the seriousness of my AN, I feel lucky to be alive, and not be paralysed or incapacitated. After my surgery, I spent over 2 months studying the Social Security Disability system. I learned that over 70% of applicants were denied at the first levels of the SSA system. Honestly, I was hoping that that wouldn't be the case in my situation, but it seems that the deck is stacked against AN patients from the very start.
After my decision to apply for SSDI, which was in February of 1999, I got all the required paperwork done, submitted it to the SSA, and was approved at the end of April 1999. From the time of application to the award date, the time frame was two months. I have spoken to several SSA agents, and I was told this is very rare. Other people with much more serious legitimate medical problems go through the bureaucratic nightmare, and spend months, even years going through the application process, claim denial, hearings, appeals, etc. and eventually just give up.
So why was my case approved so fast? All I can do is speak from experience as an AN patient. This may sound overly simplistic, but in my opinion, the bottom line is having a good understanding of how the SSA system works. If done properly, I honestly believe you can eliminate months, even years, from the process. It takes a lot of hard work, support, and documentation from your doctors. In my case, by the time I finally submitted everything to the SSA, I was completely worn out. If you can't, or aren't willing to do the work, I think this is where a good attorney, or a good SSA representative specializing in SSDI claims would enter the picture to do this for you.
I contacted several attorneys in the beginning, but they all told me to apply first, and after I was denied they would represent me. I didn't like the ones I tried to deal with when it came to SSA, perhaps I just contacted the wrong ones. I realize theirs is a business, to be profitable, and I understand that. But I felt they were just interested in making a few bucks off a person's misfortune. I had a hard time with the proposition of giving them up to 25% of my benefits for something I could do for myself. Not that a person doesn't need an attorney if the case goes to a Federal Appeals Court, but that is way down the road, and one of the last steps in the process.
3. SSA's definition of disability
Overall, my experience with the SSA was positive. I really believe it is a fair agency, and works hard to approve legitimate claims. However, because many of the claims are frivolous, the agency has a general mentality of skepticism and tries to find a way to deny initial claims. First off, you have to understand the SSA's definition of disability, their definition is:
The inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or to last for a continuous period of not less than 12 months.
A person must not only be unable to do his or her previous work but cannot, considering age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy.
The above applies to the following categories of people:
a nonblind disabled worker, a blind worker under age 55, a disabled adult child, a disabled widow, widower or surviving divorced spouse.
where blindness is defined as follows:
central visual acuity of 20/200 or less in the better eye with the use of a correcting lens, or tunnel vision of 20 degrees or less
For a blind worker aged 55 or older, the definition of disability is a little different:
The inability because of blindness to engage in any substantial gainful activity requiring skills comparable with those in any gainful activity in which he or she previously engaged with some regularity and over a substantial period of time.
Before 1991, a stricter disability definition applied to disabled widow(er)s. A widow(er) needed to have a disability severe enough to prevent him or her from engaging in any gainful activity.
Here is an excellent link to the SSA Disability information page: http://www.ssa.gov/odhome/odhome.htm
4. Qualifying for SSDI
At first glance, you would think you had to be a vegetable to qualify for benefits under that definition! However there's good news, that isn't the case. In my opinion, as I stated before, you just have to understand the process, and truly have a legimitate claim.
In my experience, AN patients can experience many qualifying problems that conform to the above definition of disability. Some examples would be:
ataxia, imbalance, eye complications, paralysis, motor function complications, coordination, chronic pain and suffering caused by nerve damage, deafness, etc.
Just one of these issues may not be enough of a claim to qualify for benefits. Many patients, including myself, suffer from a combination (very important) of these issues.
The SSA has a "List of Impairments" from which medical determinations are made. Understanding these impairments, and completeting your initial application with the goal of satisfying the requirements of the "List of Impairments" is very, very, important. Also, it must be supported and documented in your medical records. I will cover this section more extensively later, but for now, let's get on to more practical matters!
5. Contacting the SSA
As soon as you believe you may qualify for benefits under the SSDI program call the SSA office in your area and request an application. This is important. At this point the agency will create your file and mail you a claim application, and set up an interview date. The interview can either be done in person at their offices, or over the phone. In my case, I was interviewed over the phone.
When you are interviewed the primary questions are this:
My feeling is this, give them the least amount of information possible during the interview, just the basics so you avoid any conflicting information when you actually submit your application and documentation. The application is where you get very detailed. When you do the initial interview with SSA really all that you need to be sure of is your onset date. As fas as the medical questions, employment questions, they are pretty general and straightfoward. Like....when did you last work? What is your medical condition? I just told them when I last worked, and that I had a brain tumor. That seemed to satisfy them.
Many folks believe that you have to have all your records and documentation in order before you should contact the SSA. This is false. Do it ASAP! Why should you do this? Well... SSDI benefits can be awarded up to 12 months in arrears based upon the onset date of your disability. The sooner you get the ball rolling, the sooner you may have a positive result. Also, the further back you can claim your onset date, the larger the retroactive benefits are, that you will receive.
What I'm saying is this, say you didn't apply until 1/2000, however, you can prove that your onset date of disability is 1/1998. SSA will first allow for a mandatory 5 month elimination period, which would be 6/1998, and then would calculate your benefits from 6/1998 to 1/2000 and pay you those retroactive benefits in one lump sum. Also, in most cases, these benefits are tax free income.
My experience with the onset date is that they are pretty liberal. My onset date was 6/98, however, I didn't actually terminate from my job until 10/98. In my case, I really didn't know what was wrong with me and I still worked partially, off and on. SSA didn't seem to care what my employment records said, and actually they were very helpful in determining my onset date. There is a limit of hours a person can work partially, and still not be considered by SSA to be gainfully employed, but I just can't remember the actual figures.
6. Filling out the application
Now some folks believe that the more unintelligent, and handicapped you sound to the SSA, the better chances you have of being approved. I disagree with this notion. I did just the opposite. By the time I submitted my application and all the supporting documentation it looked like a professional had prepared the case. I really believe that an attorney couldn't, and wouldn't have done it any better! They were probally wondering....WHO IS THIS GUY!
To be continued....©
Last Edited: Friday, November 01, 2002