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Wow I am so surprised you were denied. In November of 2008 Scleroderma was listed as a disease that is to be fast-tracked for approval under the compassionate allowance. This means that due to your having the disease it is almost always approved if your medical documentation is good in showing that you suffer from everything that sclero does to you. I was lucky in that I applied in October, had my telephone interview in November, approved in December, and received my first check in January. Mine was fast-tracked for approval under the compassionate allowance. The social security rep that did my telephone interview was a huge help and went over my application thoroughly and made necessary changes. I guess I was lucky that where I doctor at did a very good job in the medical records in what I have and the problems that I have. You need to talk to your doctor and get him to help you in getting this disability. If he were to write a letter indicating everything medically and to really document what you have; how it affects you; what you're not able to do; and what you will probably continue to have in the future and what you are up against.........I think would be a huge help.

 

With regard to Medicare they are right. I didn't have to do a thing and it's 2 years this January and I already received my Medicare card. Now I will find a supplement that will pick up the 20% that Medicare doesn't pay and a prescription plan to cover my meds. These 2 policies will still be a huge savings to us monthly and I am so grateful that I got disability and now Medicare. I honestly don't know how I could go to work..........I couldn't. I have such terrible fatigue that it seems when the clock strikes Noon my day is done and my body has had it. I can't fight the yawns and the eyes go shut and my body has had it. Granted it may due to the terrible muscle pain that I deal with that by then my body says enough is enough but how in the world does a person hold down a job with this disease?!

 

I wish you good luck and if you get the medical documentation done to the degree that it needs to be to show you can't work you should be able to get it. It would be so nice if you could do this without an attorney as this usually ends up being easy money for them and they take a portion of your settlement that you get as your disability approval will go back to the day you first applied so if this takes a long time that can add up to quite a bit and the attorneys love this.

 

Again, good luck and keep at it.

 

Warm hugs,

Peggy

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There are three levels of appeal in a Social Security claim- a reconsideration, where the case is returned to the same agency that made the original decision but to a different employee. Then there is a hearing in from of an Administrative Law Judge, who is an attorney and is held face to face. The last is an Appeals Council review.

Disability determinations are made from criteria listed in the DISM- a manual that lists all medical conditions and the thing that are needed to approve the claim. Sometimes people miss mentioning some key phrase that is needed and a lot of time, doctors only copy their medical records and send them in and those medical records do not have complete information- this should be listed in the denial letter.

There have even been cases of the wrong records being in file. Or the agency not waiting till all records are in file.

 

If you can provide extra information that includes the items the lletter said was not proven, maybe a letter from your doctor covering this, it may be enough for a reconsideration. Make sure all records are in file.

Usually lawyers will charge on a contingency basis- no money unless approved. Law judges certainly do like to listen to lawyers.

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I had an interesting discussion with my rheumatologist concerning disability eligibility. It was encouraging when she told me that she had never known a patient more deserving of benefits!

 

When I originally submitted the information, I did a detailed summary of my medical history, but this was not made use of, as they went about "filling in the fields on the computer screen", which excluded an extensive explanation (including the entire cancer history).

 

Needless to say, I will use the summary in the appeals process, with great detail of all symptoms (I had assumed that the mention of a serious disease made the effects/symptoms obvious, but apparently not. Also, I have a tendency to play down medical symptoms, as I find such things tiresome when there isn't anything that can be done). Guess I will have to work on becoming a bit more of a drama queen!

 

Craig

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Since there are symptoms that have to be sort of "checked-off" to be awarded benefits at the first level of appeal, making sure that a good history is in file is not being a drama queen but makes sure that you have the best shot of getting those "magic" words in the file. Especially if your doctor can say them too.

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  • 3 weeks later...

I met with a lawyer - who started by pulling at his hair over how absurd the denial was.

 

He pulled out the actual law code and said that I more than qualified for scleroderma, but also met the qualifications for Sjogren's syndrome. So that is the first appeal level.

 

Craig

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Hi Craig,

Hopefully your appeal will go quickly and smoothly!! I had to appeal twice, then get a lawyer and was waiting for a court date when the paperwork came from the judge who automatically approved me.

 

Fingers crossed for you!! Keep us posted.

 

Hugs,

Lisa

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I think you have a good chance but if you don't want to go through the hearings process the best way is to have a lawyer apply for you. They will get 25% of your back pay with a maximum of $6300. It is worth it. I was approved after 2 years and after the hearing.

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