Applying for Disability; Notes To Myself

Here are my personal notes on the topic of applying for disability.

Kevin's Dissected Aorta - visible intimal flap

This is not legal advice. The information here is only my recollections of what helped me apply for and receive Social Security Disability Insurance (SSDI) on the first attempt..

First of all let me say there are no 'tricks' or 'loopholes' to obtaining disability benefits.  Social Security has specific written protocol for determining who qualifies.  You either qualify or you do not.

Second, you must truly have a disability that will end in death or keep you out of the work force.

As a builder of custom green roofs I could no longer safely work atop buildings, climbing ladders and lifting super sacks of soil media in 100F degree heat.

As a lawyer by education I realized the first time my mind went totally blank for an extended period when writing a report that I could not honestly act as the best advocate for my clients.

Add to those issues dissected ascending and descending aorta, serious kidney disease as a result of dissected renal arteries, cognitive issues from two open heart surgeries and being on the heart-lung machine for long hours and other issues, pain, fatigue and the many other maladies those of us who have survived aortic dissection experience.

As my doctor said, "your number one priority is to stay alive right now, focus on physical therapy, your diet and new lifestyle reality."

If I had to apply all over again here is the approach I'd take:

Retain A Well Recommended Disability Attorney

• Can save you lots of time and headaches
• or, cause a lot of aggravation if your retain the wrong advocate without strong disability experience

I was intent on filing my own application because I thought I could tell my story better than anyone else and be my best advocate.

Preliminary Research 

• Read the disability guidelines for Social Security Disability Insurance here, most commonly referred to as the SSA's Blue Book.
• Watch the seven part SSA Video series on the Disability Process linked here.
• Read the SSA's Evidentiary Requirements linked here.
• Read through the SSA's cardiovascular protocol linked here.

1. Guide your doctors through their diagnoses of your conditions.

• Learn to speak out about what hurts and how you feel.
• Other than blood work or imaging/testing the only way doctors can document what you are capable of is through their assessment and by what you tell them.
• Before each visit write out a detailed list of what hurts and how you feel.  Make sure to specifically address each area of bodily concern.  Kidney pain is especially of importance to those with dissected renal arteries or descending aorta dissection. Neurological issues matter too!
• Make sure your list is included in their written medical record.  Many times medical records are cut and paste by the doctor or nurse.  Insist your records are customized with your input!
• Ask that a copy of each visit medical record  be mailed to you.  Correct any inconsistencies or omissions.

2.  Collect All of Your Medical Records As Far Back As You Can Get Them!

• Consider all your records to be relevant, even those five or ten years old.
• Older records can help establish and document chronic conditions.
• Arrange your records in three ring binders with tabs chronologically. Neatness and organization is paramount.
• Scan and archive all the documents on DVD or CD, making multiple copies of the finished record disk.

3.  Correlate SSA's Blue Book cardiovascular section's relevancy to your medical records.

• For Dissection cases SSA probably will start with Section 4.10 "Aneurysm of aorta or major branches" - link here.
• Sec. 4.10 states "due to any cause (e.g. atherosclerosis, cystic medial necrosis, Marfan Syndrome, trauma) demonstrated by appropriate medically acceptable imaging with dissection not controlled by prescribed treatment (See H4.006)" qualifies for disability.
• H4.006 states "When does an aneurysm have “dissection not controlled by prescribed treatment,” as required under 4.10? An aneurysm (or bulge in the aorta or one of its major branches) is dissecting when the inner lining of the artery begins to separate from the arterial wall. We consider the dissection not controlled when you have persistence of chest pain due to progression of the dissection, an increase in the size of the aneurysm, or compression of one or more branches of the aorta supplying the heart, kidneys, brain, or other organs. An aneurysm with dissection can cause heart failure, renal (kidney) failure, or neurological complications. If you have an aneurysm that does not meet the requirements of 4.10 and you have one or more of these associated conditions, we will evaluate the condition(s) using the appropriate listing."
• Your application Must meet the standard of Sec 4.10 and H4.006 above.
• Many people assume a stable descending dissection is a 'shoo-in' for disability approval yet this condition does not meet the published standard.
• It is critical you document that your dissection is causing restricted blood flow to one or more of the organs detailed above.  
• In most dissectees this is true yet doctors and/or applicants fail to communicate this to SSA.  Sometimes the information may be in the application but buried so deep the SSA medical reviewer misses it.
• Dont Stop with Sec 4.10 or H4.006!  Read through the entire Blue Book and list any condition qualifying for disability in addition to your dissection!
• There are many 'conditions' listed in the Blue Book.  Don't short yourself by failing to read through these and leaving these qualifying conditions out even though they are applicable to your medical condition.
• Many applicants expect SSA medical reviewers to complete a detailed analysis of your condition to the qualifying conditions in the Blue Book.  Some reviewers are quite thorough.  Depending on work load some may not be quite as thorough or unintentionally fail to see a very important correlation.  Its up to you to be your best advocate.

4. Apply early!

• Submit as complete and thorough an application as you can but apply quickly once it has been medically determined you are disabled.
• The date of your application is usually considered the award date for retroactivity once appeals have been finished and you receive your award letter.  A years worth of application submittal delay can add up to ten or twenty thousand dollars.
• You are better off with a denial on a complete application (of course proceeding with appeals) than you are waiting for months to finish your application.  Apply early.

5. Try not to stress.  The process takes time.

• The SSA application process can be stressful.  Consider it a long term, step by step effort that will be worth the end result.
• Realize Medicare will be delayed in most cases for two years after approval of disability or until you reach SSA retirement age.
• If you feel it is moving too slow, write and call your state and federal elected representatives.  Their job is to represent you.  I have seen excellent results with concerted communications to a congressperson or senator (both state and federal).

6. Finally.....

• Realize that this effort is about communication.  Many applications are denied due to incomplete applications.  Moreover failure to communicate needed medical documentation to SSA leaves SSA in a position of no choice but to deny.
• You must communicate all your qualifying blue book issues to your doctor.
• Your doctor must document these issues in appropriately acceptable medical records.
• You must ensure SSA has these relevant for qualifying medical records and that the qualifying issues are highlighted somehow!
• Never give up.  Its all a journey, one where we get there sooner or later....

Cheers!  Kevin.