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Has metastatic cancer – is this enough?

I have terminal colon cancer (stage 4) and the cancer has metastisized into the liver. I was operated on and
had a portion of my colan removed. I am undergoing Chemotherapy once a week. I was wondering if I would be elgible for Social Security Dissability benefits.

–Steve

Jonathan Ginsberg responds: Steve, thank you for writing – I am very sorry to hear about your health problems. Based on what you write, I think that if the SSA adjudicator has any sense at all, she/he should recognize that you appear to meet Listing 13.19 or 13.21. You can find the Cancer listing here. I would suggest that you print it out and take it to your doctor. Ask your doctor for a letter stating that you meet this listing.

This would also be a case that should qualify under the compassionate allowance rules.

The only issue, therefore, is whether you have enough credits to be insured for Title II disability.

Assuming you do, you should be approved at the initial application phase.

Best of luck to you.

–Jonathan

Numerous medical problems – why haven’t they approved me?

I’d like to know why it seems that people who never worked at all can apply and receive SSI benefits and thosethat have worked and applied for SSD are given months and sometimes years of the run around. I have numerous problems. I suffer from the effects of late stage cancer treatments, arm and shoulder trouble that has persisted for years, sarcoidosis, Can’t walk or stand for long periods and have vision trouble. My medical records and doctors reports have all been provided, I have gone to see one of their doctors and now I’m being told that I may need to be sent to another doctor. All these things are detailed in my medical history which is about 10 inches thick (no exaggeration). Does any of this sound as if they are leaning in my favor? What more can they be looking for? I have been waiting for 5 months.
Thanks, Raye

Jonathan Ginsberg responds: Raye, the overriding issue in any Social Security disability case is whether you impairment prevent you from working.  Often doctors treating medical problems like the ones you describe are focused more on diagnosis and treatment than on evaluating work capacity.

In my practice I almost always use “functional capacity” checklist forms designed to help treating doctors “translate” medical problems into specific work limitations.

For example, the cancer treatments may leave you fatigued.  If your treating doctor describes that fatigue in terms of poor concentration, poor reliability at work, a need to take frequent unscheduled breaks, then SSA has work limitations it can evaluate.

Similarly, your statement that you are unable to walk or stand “for long periods of time” is too vague.  Instead, why not a statement like “I cannot walk more than 50 yards without having to stop for breath and I can walk no more than 30 minutes total in a 4 hour period.”

The goal here is to identify specific work activity limitations.  The bottom line – you have to speak Social Security’s language if you hope to win.  SSA’s language is vocational in nature, not medical.  If you see your case in these terms, your chance of success is much greater.

–Jonathan

What is the one thing you can tell SSA that will disqualify you?

What is the single most negative statement you can make to Social Security that will likely result in your being denied?

–Donna

Jonathan Ginsberg responds: Interesting question – I have never thought of this before.  Obviously if you advise SSA that you are working that will most likely disqualify you from applying.  If you reference drug or alcohol abuse as a main reason that you consider yourself to be disabled, you will not recover benefits as no benefits are payable if drug or alcohol abuse is a “material contributing factor” to your disability.

I think that if you make statements to suggest that you do not want to work as opposed to not being capable of working would hurt you.  Also, statements that you are applying because you need to be off work to care for a disabled child or relative will hurt you.

Disability benefits for my 24 year old daughter…

I have a general question regarding social security disability benefits for my daughter. I will summarize what has been going on and if you can just give me an answer as to what her chances would be I would appriceiate it.

My daughter is 22 years old. She had fallen down and broken some areas in her back a while back. She was out of work for a while. Then she had gotten sick last September with something that no doctor could diagnose. She was tired could not move, her blood count was up to 22,000 which should only be 4000 to 6000. She was in the hospital both emergency and overnight 4 – 5 times during the end of September and through October.

During this time they filled her iv with antibiotics and hoped it would work it did and by the end of october, she was better. She unfortunately lost her job once again. A few months later, she fell again and frctured some vertabrae in her back. She once again has been out of work. She has had a hard time keeping a job due to doctors appointments and injuries and sickness.

She has a history of anxiety and depression and ocd. She takes medications for these. She also has chrones disease, and she goes to pain management for her back. She has no insurance and we have been paying for her prescriptions etc but it is getting very hard. Due to her not working she gets even more depressed but to keep a job is almost impossible with all these issues she has. She has all her medical records etc and can give more information about her back etc problems, but before I mentioned this to her I thought I would write to see what her chances might be. Please e mail me back and let me know. I appreciate your taking the time to read this and respond.

– Marilyn

Jonathan Ginsberg responds: Disability benefits for younger individuals can be difficult to obtain. In order to present a successful case, you must prove that an individual cannot perform any job that exists in the national economy. There must be a marked restriction in almost every area of daily activities.

Additionally, your daughter must qualify for benefits. Before the age of 24, she must have earned 6 credits in the 3-year period ending when the disability began. For example, if she earned $3880 in one year, that qualifies her for 4 credits.
My recommendation would be to consult with an experienced Social Security Disability attorney in your area, to have the merits of your case evaluated. On our Social Security website, we have offered a links page where you can get a free case evaluation from an experienced attorney in your local area.

Please go to the website and fill out the form. An attorney in your area will contact you to provide you with some options.

The website is located at this link:
http://www.4socialsecuritydisability.net/

The form to fill out is located at this link:
http://www.submit-my-info.com/ask2.asp

Best wishes to you and your daughter.

– Jonathan

Timing of the Disability Process and First Interview

I’m assisting my wife in applying for SSD benefits. She has several disabling maladies including uctd (14.06), inflammatory arthritis 14.09), fibromyalgia and depression which will not likely meet affective disorder (12.04) criteria but is certainly a contributing factor according to both her rheumatologist and psychiatrist. I’ve started to use your guide and am quite impressed with the comprehensive array of forms and advice on completing them. One item lacking is detailed
description of the process flow of the application process. What forms will be required when? What’s the specific sequence and timing of each activity? I made an appointment to apply in person at the local office with my wife and all they sent was an SSA-3381 Medical and Job worksheet, a form not included in your book, and a list of things to bring e.g. birth certificate, W-2, etc. What else besides the 3381 will the interview encompass? Will they be completing the 3368 & 3369 during this session? Should I complete them beforehand? This type of information would be very helpful. – Bruce

Jonathan Ginsberg responds: Bruce, I understand that you (and your wife) are filing an application for disability benefits for your wife. You have already contacted Social Security and made the appointment for the application. The first thing I should tell you is that, although the Social Security Administration is the same, nationwide, sometimes the actual district office differ from region to region as to how they actually handle claims. The forms are all the same, however, some claims managers will require different forms at different times. Generally speaking, and by no means set in stone, I can give you a basic rundown of the process for handling your claim. The time frames again, will differ greatly from region to region and also will depend on work flow and case load for you specific area.

When you make your appointment for the initial application, the administration will send you the form or forms that they need completed along with a list of documents to bring to your appointment. You will complete the application for disability and an Adult Disability Report and a Work History Report, with information taken from the Medical and Job Worksheet. If you have copies of the forms (3368 and 3369) it would likely save time during the interview, if you have those completed beforehand. If your wife is having difficulty with fatigue and/or sitting for longer periods of time, this would perhaps be beneficial for her. (Keep in mind that the person who meets with you may make notes of personal observations in the file. For example, if your wife has pain from sitting too long and begins to “squirm” or needs to stand and walk or take a break, these observations could possibly be noted in the file. This is not always the case, but I have known of representative who make notations.) When your application is complete, it will be sent to a state agency for processing. This agency will differ from state to state, for example, in Georgia, this is handled by a division of the Georgia Department of Labor. The agency that your state uses, will be responsible for gathering all of your medical records and any additional documentation that they feel could be useful in making a decision on your claim. The medical records will be reviewed and determination will be made as to whether enough evidence is present to make a decision on your disability. If the person reviewing the records feels that additional information is needed, they have the authority to schedule an independent medical exam for you at their expense. In addition, they could send a form to another person (a person listed by you on the application as a person that they are allowed to contact) called a Function Report – Third Party, in which they will ask questions about the condition of the claimant. After all of this is complete, they will make the determination on your case. (Currently, in our state this is taking about 8 to 10 months. Hopefully it will be the standard 4 months in your area.)

When the determination is issued on your claim, and if your benefits are denied, you must file an appeal, Request for Reconsideration (form 561) along with an updated Disability Report (form 3441) and a few signed authorizations to release information to Social Security, within 60 days from the date of the letter.

– Jonathan

It has been 8 months and I have not heard anything

I applyed in the end of July of 2005 and completed everything that they wanted and now it has been almost 8 months and still nothing I tried calling and she isn’t calling me back and haven’t recieved anything in the mail. –Jessie

Jonathan Ginsberg responds: Jessie, you don’t say where you live, but it appears to me that something is not right. First, after you apply, you should be sent a written acknowledgement of your claim. If you have not received this, then I would be concerned that your case file has been lost.

Second, the wait for an initial decision is usually three to five months. If it has been eight months, that is too long.

I would suggest the following. First, you should call SSA at 800-772-1213 to see if you are in the system. Confirm that they have your correct address and advise the telephone operator that you have not received anything about your claim.

Second, I would send a letter, return receipt requested, to your local Social Security office. If you have the name of an adjudicator, direct your letter to that person. Ask for a status update and also state in your letter that you have not received a denial notice of your initial application and that this letter should serve as your appeal of any such denial.

Finally, I would enlist the help of your Senator’s office. Every U.S. Senator has one or more staff persons who assist Social Security claimants. Sometimes a phone call or letter from your Senator can get the process moving. If SSA has lost your file, you will want to ask them to “rebuild” it while honoring your original filing date.

–Jonathan

Applied 6 months ago – still waiting…

I applied for SSD pension almost 6 month ago and have still no answer. Howe long can SSA try to starve you out. I`m also from Germany and ask myself what`s going on. I know there is a treaty with Germany caled totalisation agreemebt. When I went to SSA and applied for supplement SSD they told me I got enough credits (28) to get disability. That`s all good, but when howe long can they let me suffer so my sittuation is getting just worse? That`s exactly what the Insurance company (workcomp) already tried in the last 4 years. It wold be great if somebody can give me an answer. Thanx in advance. –JD

Jonathan responds: Joachim, thanks for your email. Unfortunately, you are discovering what most disability applicants know – the Social Security system is in crisis. It has been my experience that the typical wait for a decision at the administrative level is about 3 months – if it has been 6 months, I would be concerned. On the web site for my disability book I posted a link to a government report showing that the average case processing time is 3 years, of which SSA employees spend about 7 working days.

SSA has been known to lose files and this is a warning sign. I would suggest that you call the SSA field office that sent you an acknowledgement of your claim being filed to verify that your file is being worked on. You might also want to send in copies of your medical records (sent registered mail, return receipt requested).

It is not clear from your email if you currently live in Germany. If you live in the U.S., I would ask your Senator or federal Congressman for help as well. I also wonder – if you have any medical records from Germany, there may be a translation delay.
In my view any correspondence with SSA should be made in writing with return receipt requested. The bottom line – do not assume that SSA is looking out for you – you need to confirm that they have your file.

Jonathan

Diabetic husband has been struggling for years – has hearing in a few weeks

my husband has juvielle diabetes, depression, numbness in feet, and he can’t do the same work he used to do he has to see a judge in a couple of weeks. He put off getting a lawyer. He has alot of mood swings and can’t hold any job he’s only been able to hold a job for 8 months or fewer and up to a year in the last 15/20 years. He has stomach problems by digesting his food. What do you think about him winning his case? Does he even have a chance by your opinion? –Angie

Jonathan Ginsberg responds: Angie, thanks for your email and I’m sorry to hear about your husband’s issues. Based on what you write, I think that he has a good chance at getting approved for benefits. Here are a couple of thoughts….

First, you need to find out if he is “insured” for Title II disability. As a rule, he needs to have 20 covered quarters out of the last 40 quarters. As there are 4 quarters in a year, that means he needs to have worked for 5 out of the last 10 years. The way the system works if he has earned around $3,000 in a calendar year, he gets credit for 4 quarters. You can find out if he has enough quarters for Title II disability by filling out a form 7004. It is important to know if he is covered because if he is not, he would only be eligible for SSI. And SSI can be offset by your earnings, assets and other factors.

Assuming he is covered, he needs to apply. That’s easy and free – call 800-772-1213. The next step is to build a winning case. Although he can hire a lawyer at any step in the process, in most cases there is not much a lawyer can do until SSA denies his claim. Some folks even wait until the second denial (reconsideration) before hiring a lawyer. I have written a book about winning at the initial and recon levels – see www.disabilityforms.com. My book and course explain how to fill out the forms using the terms and approach most attractive to Social Security.

My book is designed to help people at the initial and recon stages – if you have to request a hearing, I’d say you are better off with a lawyer. My disability lawyer referral link is here. If you hire a lawyer at this late date, your lawyer may (or may not) want to ask for a continuance to make sure that the file is updated.
The way you win is to find a treating doctor who will support your argument that your husband would not be a reliable worker because of unscheduled absences caused by any physical or mental health limitations. The technical term for this is “residual functional capacity.” In other words, what capacity for work remains after you take into account the limitations caused by his medical problems?

One word of caution – I have found that Social Security tends to see things in black and white. Part time work that generates income can confuse the issue – SSA often concludes that if you can work Job XYZ part time then you could probably work a less demanding Job ABC full time.

And finally, I think that your husband may be better off focusing on one of his conditions as the primary reason he cannot work. I have found that SSA is more receptive to a clear theory of disability based on one major problem than disability based on numerous problems.

–Jonathan

SSI recipient having trouble with Medicaid

My nephew has SSI and is having problems with his medical bills being paid. Medicare said he has Medicade and Welfare said no, he has Medicare so no one is paying his medical bill and his bill are getting higher. Who is to pay? They said to get in touch with SSI. Why? –Betty

Jonathan responds: Betty, if your nephew is getting SSI, he is automatically eligible for Medicaid, not Medicare. Medicaid should be paying the bills. I would suggest that you call your local Social Security office as well as the State Medicaid office. Realize that Medicaid is a State operated program that receives funding from the federal government so you will need to call both the State Medicaid office as well as your local SSI (Social Security Administration) office. Sometimes, your federal Senator or Congressional representative can be very helpful in cutting through the red tape.

–Jonathan

What are the rules for my trial work period?

Hi, I have been disabled for a few years now and am thinking about returning to work, I would like to stay under the amount necessary to continue my ssd ? How do I do that? and do I report the income to someone at ss?AND what if I want to TRY returning to work full time? –Valerie

Jonathan Ginsberg responds: Valerie, the answer to your question can be found in SSA publication 05-10003. Basically it provides that for 2005, you can earn $830 per month without being considered “substantial gainful activity” ($860 per month for 2006). If you have never tried to work before you have a 9 month “trial work period” where you keep your benefits no matter what you earn. If you earn less than $590 per month ($620 for 2006) it does not count as one of the 9 trial work period months. You must report all earnings to Social Security. You can call your local SSA office or SSA’s national number -800-772-1213.

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