- January 2, 2024
- Posted by: legaleseblogger
- Category: Related News
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Personal Situation: Husband’s Disability and SSDI Application
My husband has been disabled since 2018, and his condition is quite severe. He is suffering from end-stage heart failure, has endured two strokes, and is dealing with numerous other medical issues.
His ejection fraction (EF) is below 30%, and all of his healthcare providers concur that he is not able to work. This information is thoroughly documented in his medical records.
Despite the fact that an EF below 30% is generally considered an automatic qualifier for Social Security Disability Insurance (SSDI), his case is still under review, and he is being required to attend an appointment with a Social Security medical provider.
AI Legalese Decoder: In this situation, the AI Legalese Decoder can be incredibly helpful in guiding you through the complexities of the SSDI application process. This tool can provide you with an understanding of the legal language and requirements involved in the process, ensuring that you are well-informed and equipped to navigate the system effectively.
Question: Attending SSDI Appointment and Medical Records
As my husband prepares for the SSDI appointment, I am uncertain about the protocol regarding the submission of his extensive medical records and letters from his doctors that clearly state his inability to work. Additionally, I am unsure if I will be allowed to accompany him to the appointment. Given his memory impairment from the strokes, he will likely struggle to articulate his medical history effectively.
AI Legalese Decoder: When it comes to attending the SSDI appointment and submitting medical documentation, the AI Legalese Decoder can provide valuable insight into the regulations and guidelines set forth by the Social Security Administration. It can help you understand the best course of action for ensuring that all pertinent medical records are appropriately presented and can elucidate whether you, as a caregiver, are permitted to be present at the appointment to provide support and assistance in communicating his medical situation.
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My only advice would be to be patient and wait for the results. No matter how bad his health is, every case needs to go through the approval process.
As many here have brought up these Medical reviews are a matter of law. They have to happen. DonÔÇÖt let them freak you out. Just because he is being reviewed does not necessarily mean he will be denied. Of course it doesnÔÇÖt mean he will necessarily be approved either but from your description of his condition it sounds like an approval. No guarantees of course. As far as being along for the evaluation look at it this way. You WANT the provider to see his degree of difficulty he has. This review doesnÔÇÖt happen in a vacuum, it is considered in conjunction with his medical records. I totally get why this is stressful for you, but donÔÇÖt jump to conclusions here. Let the process play out. Good luck.
I would recommend taking the studies to the appointment especially the one showing his ejection fraction as this will help the doctor see how severe his condition is before starting the physical. What they mean by automatic approval is that he meets a social security listing which in this case would be ssa listing 4.02, by meeting these requirements, social security automatically determines someone is disabled without going in to the other factors.
4.02 Chronic heart failure while on a regimen of prescribed treatment, with symptoms and signs described in 4.00D2. The required level of severity for this impairment is met when the requirements in both A and B are satisfied.
A. Medically documented presence of one of the following:
1. Systolic failure (see 4.00D1a(i)), with left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability (not during an episode of acute heart failure); or
2. Diastolic failure (see 4.00D1a(ii)), with left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater on imaging, with an enlarged left atrium greater than or equal to 4.5 cm, with normal or elevated ejection fraction during a period of stability (not during an episode of acute heart failure);
AND
B. Resulting in one of the following:
1. Persistent symptoms of heart failure which very seriously limit the ability to independently initiate, sustain, or complete activities of daily living in an individual for whom an MC, preferably one experienced in the care of patients with cardiovascular disease, has concluded that the performance of an exercise test would present a significant risk to the individual; or
2. Three or more separate episodes of acute congestive heart failure within a consecutive 12-month period (see 4.00A3e), with evidence of fluid retention (see 4.00D2b(ii)) from clinical and imaging assessments at the time of the episodes, requiring acute extended physician intervention such as hospitalization or emergency room treatment for 12 hours or more, separated by periods of stabilization (see 4.00D4c); or
3. Inability to perform on an exercise tolerance test at a workload equivalent to 5 METs or less due to:
a. Dyspnea, fatigue, palpitations, or chest discomfort; or
b. Three or more consecutive premature ventricular contractions (ventricular tachycardia), or increasing frequency of ventricular ectopy with at least 6 premature ventricular contractions per minute; or
c. Decrease of 10 mm Hg or more in systolic pressure below the baseline systolic blood pressure or the preceding systolic pressure measured during exercise (see 4.00D4d) due to left ventricular dysfunction, despite an increase in workload; or
d. Signs attributable to inadequate cerebral perfusion, such as ataxic gait or mental confusion.
ThatÔÇÖs what they do. ItÔÇÖs no big deal. Bring as much documentation as you can. All your expenses; even eyeglasses, etc. if itÔÇÖs an health issue with an automatic approval, it wonÔÇÖt be a big deal. YouÔÇÖll have to go back every few years for a review. But itÔÇÖs cake. I have a few illnesses that make it auto for me, itÔÇÖs been a while since they have asked for a review.
Get a few different echo results and send them in or take them to the appointment. Sometimes it’s shocking how little the DDS get from doctors.
I was permitted to accompany a family member for their consultative exams for the CDR. I am this individualÔÇÖs representative payee.
Get an attorney to help you navigate Social Security. Trust me it will significantly improve your winning your case. Find a local attorney, the national outfits are terrible. The attorney fee is capped and will be paid out of the back pay you will be awarded after you win. Doing this without an attorney is a very bad idea.
There’s no such thing as automatic approval. The reason why he’s being evaluated is because his medical records do not support an approval or denial
No it’s not appropriate for him to bring medical records. The examiner is going to conduct tests and record their own results. They will not review anything he brings in.
You can go a it him but he will be examined alone so you won’t be allowed in the room.
You can go but you won’t be allowed to speak to the doctor. Medical records and documentation are very helpful in these cases, so yes, take them. Expect that the doctor may want time to review them. Or will ignore them totally. Depends.
Expect that he will be denied at first and you’ll have to appeal. Keep meticulous notes and a file with everything. Get in the habit of requesting and keeping medical visit notes, hard copies of test and procedure reports, everything, including a detailed list of his meds. If he sees any kind of doctor, you need hard copy notes/reports.
It’s a pain in the butt. It’s not a quick process. And once he gets it, expect 2 years before he can use Medicare unless he’s 65+.
Breathe. And good luck.
I just went through the health evaluation. Bring the paperwork. They can make copies & add it to help his case. I brought mine & was told they are glad for it as not many bother to bring this.
Personally I would make a copy of what your doctors say and give them to the Doctor who looks at him to view, not the front desk people.
Whether you go in with him or not, record the visit. If they allow you to video it great but they probably wonÔÇÖt so record it (this is legal in most states but not all). Medical reviewers donÔÇÖt work for you and since this is not a dr/pt relationship they donÔÇÖt have your best interests in mind! They will lie on the paperwork I guarantee it so record it!
>Is it appropriate for him to bring all of him medical records and letters from his doctors saying he is unable to work?
Dont think so. Those are submitted to them prior.
Requiring an exam means they dont feel claimant has sufficent evidence to make a determination based off of what they have received. You can check with them seperately to verify they have all avail records.
[exam SSA](https://www.ssa.gov/disability/professionals/bluebook/general-info.htm)
Who needs a ss #?
Automatic approval ONLY means his claim is not subject to a work review. ThatÔÇÖs it. He still has to go through an accelerated claims process to prove his conditions. DDS will request medical records so you donÔÇÖt HAVE to take them to the appointment, but you can if you want to try to accelerate it even further. Otherwise, they will have to wait for his medical records to be returned by his providers, and they still may request them and wait for the most recent updates. Rest assured, his claim WILL be faster than others, but they canÔÇÖt just take your word for it. They have to see the med records.
1. HEART ISSUES- Be sure to go to the cardiologist every 6 months and make sure your husband is honest about all of his heart symptoms and related side effects. He needs to *repeatedly* talk about these complaints, energy levels, shortness of breath, etc during every visit medical appointment, because the doctor will write it in his records, and then SSA will read those records. SSA will also review treatment recommendations, prescriptions, and they will know if your husband is compliant with his doctorÔÇÖs recommendation.
SSA make their decisions based on multiple YEARS of medical records with repeated complaints mentioned to your doctor EACH TIME.
2. STROKES- Does he have any PHYSICAL side effects from strokes? Any documented muscle weakness? Make sure you have current medical documentation and physical exams (with the last 3 months). What is the actual strength of his hands? Legs? 5/5? 3/5? Can he walk without assistance?
You mentioned that he has problems with MEMORY. ÔÇö->Has he had any full psychological evaluations to test his memory? His memory and executive functioning can also prove and support that heÔÇÖs not able to work.
They are not going to seriously consider any complaints that have not been FULLY evaluated.
It Sounds like his heart has been fully evaluated, but the other complaints have not.
Regardless, continue to apply but also heed my advice and make sure he is talking to his doctor about every single health issue, repeatedly, over the next 1-2 years so that his medical records will not contradict his allegations of disability.
I used to work for the disability office every doctor PCP visit, or cardiologist visit where you say your are fine with no complaints, your medication is working fine, no concerns with side effects.Thats not going to help your claim of being disabled.
DonÔÇÖt bring the documentation to the appointment. The Doctor he is seeing is not making the decision on his claim. You need to send it to the examiner who has his CDR claim.