SS will not ever request you undergo a FCE. They will also not request your docs fill out RFC forms. (RFC forms WERE part of the application in the past.) You can submit this information nevertheless. I don't remember SS having a "function report". They do request information about your "Activities of Daily Living" though. http://www.disabilitysecrets.com/res...ily-living.htm

I was confused, btw! I thought your denial letter was after an ALJ hearing. Sorry about that. Some of my earlier posts don't apply now! The Grid Rules will likely come into play if you end up at an ALJ hearing.

It was unlikely for you to be approved at the first stage because you don't meet an Impairment Listing. In theory, the adjudicator can rule in your favor if your impairment/s "equal" a listing.

Have you read the Blue Book? If not, THIS SHOULD BE THE PLACE YOU START: http://www.ssa.gov/disability/profes...ltListings.htm

Okay, what is an RFC? And how do I go about that? How do I get my doc to fill out an FCE? Is that form available online to download?

From my understanding of my denial letter (from initial app), I do meet one of the impairment diagnoses. Just was not evaluated to prevent me from SGA (most likely due to not enough information regarding my functional limits). I never got anything specific to ADL's, only what was on the initial app. And now I have 2 more diagnoses to add.

As for the Function Report, I found it online when looking into the reconsideration/appeal procedure. I downloaded it and have been working on filling it out/re-filling it out/going over every little thing I can/cannot do. I think I read where ssa used to send it out regularly with work history report. Perhaps they still do but did not feel it warranted in my case due to the omission of functional capacity in the documents they received.

There is a big difference between a Medically Determinable Impairment and meeting the requirements of an Impaired Listing. The language of these ruling are very precise. It is confusing.

If you meet the requirements for a Listed Impairment there is no further requirements for approval. The issues of former work or any work are not addressed. The Listed Impairments are found in the Blue Book, which I linked to in my last post #17. RSD/CRPS is not a Listed Impairment. SS's ruling about how to evaluate RSD/CRPS (which I linked to in post #7) states, under "Evaluation of the Claim", that the sequential process is used (what I referred to earlier as the 5 Step Process.) It is still worthwhile to read the ENTIRE Blue Book, so that you can get a good idea of what SS needs you to document.

There are 3 ways to be approved. 1) Meet a Listed Impairment 2)Via the Grid Rules 3)The 5 Step Process. Right now, you're trying to prove you qualify through the 5 Step Process. Should you choose to amend you Alleged Onset Date to when you turn 50, than your claim would be evaluated via the Grid Rules.

Section C of The Adult Function Report is where you list your Daily Activities. I have no idea why you weren't sent these. Perhaps it was determined you didn't have enough medical evidence proving the severity of your disability to get that far in the process. There is also a 3rd party Adult Function Report which you'd have your daughter fill out. I don't know if it's appropriate to send those in before requested? (I'm rereading the long thread at SSDfacts. In post #54 you stated "Not sure why a Function Report would NOT have been requested given that was pretty much the reason for denial." I disagree that your subjective reporting would have made the difference between you being approved or not. The medical documentation needed to prove the severity of your disability prevents even sedentary work is substantial.)

There are 2 versions of RFC forms--physical and mental. You simply ask your doctor to fill it out. Some will charge a small fee, some will require a Functional Capacity Evaluation before filling out the forms. Some may perform the FCE themselves, some might send you to another doc or physical therapist. It is MUCH better to undergo a FCE, the results of which will be put into a report, and then have the RFC forms filled out IMO, but ESPECIALLY in your scenario with new docs and a new diagnosis. Docs can over or under estimate your Functional Capacity--some are little better than guesswork. SS only gives weight to your docs opinion when you have an established history--which you don't have.

Not to make this more confusing, but SS will perform a RFC assessment with an internal medical consultant, and an ALJ is the final authority on setting the RFC rating. By undergoing FCE testing, which your doc/s will then use to fill out a RFC form, will help the SS medical consultant give you an accurate RFC assessment, and potentially give an ALJ the evidence to set your RFC rating for less than sedentary work (which would give you a Fully Favorable decision back to your AOD.)

http://www.disabilitysecrets.com/rfc-win.html

Sorry if this info overload, but all of the above is very important.

After reading your post #63 on SSDfacts, I would hold off sending an Adult Function Report until requested. Why? Because without meds or treatment, your current function is not an accurate reflection of your potential function, so I just don't think it will help you at this point.

The Listing Impairment that you might be able to qualify with is the Musculoskeletal System, if there are structural issues that can't be repaired with surgery and you would require the use of a walker, crutches or wheelchair long term. SS does factor the potential effects of treatment though. So, when your doc claims you're refusing ankle surgery that should resolve your difficulty walking unassisted, SS will likely use that to deny you.

http://www.ssa.gov/disability/profes...etal-Adult.htm

"I. Effects of treatment.

1. General. Treatments for musculoskeletal disorders may have beneficial effects or adverse side effects. Therefore, medical treatment (including surgical treatment) must be considered in terms of its effectiveness in ameliorating the signs, symptoms, and laboratory abnormalities of the disorder, and in terms of any side effects that may further limit the individual.

2. Response to treatment. Response to treatment and adverse consequences of treatment may vary widely. For example, a pain medication may relieve an individual's pain completely, partially, or not at all. It may also result in adverse effects, e.g., drowsiness, dizziness, or disorientation, that compromise the individual's ability to function. Therefore, each case must be considered on an individual basis, and include consideration of the effects of treatment on the individual's ability to function.

3. Documentation. A specific description of the drugs or treatment given (including surgery), dosage, frequency of administration, and a description of the complications or response to treatment should be obtained. The effects of treatment may be temporary or long-term. As such, the finding regarding the impact of treatment must be based on a sufficient period of treatment to permit proper consideration or judgment about future functioning."

Definitely confusing!! I am still trying to figure this all out! I guess my thought was with the "The medical evidence in file shows that your condition does cause some restrictions..." statement on my denial letter, I have a MDI that just per documentation does not meet the severity SSA is looking for.

The diagnosis on my initial app did not include RSD/CRPS, only patella fracture, meniscus tear & peroneal nerve damage. I will be adding the depression and RSD to my reconsideration request.

But if I amend AOD to when I turn 50, first of all: I don't even turn 50 for another year and a half; secondly: how is that even possible???


So my doctor's office has access to the RFC forms? Or do I download/print them and take them to the doctor? If I download/print them, are they found on the SSA site?
I can certainly make an appointment with my TN ortho for a follow-up/re-check visit if that helps the longevity of care. Sadly, I could no longer afford $2300/mo for COBRA or travel 500+ miles for continued care. I, too, hate the lapse in care.

It was knee surgery and considering I subsequently underwent surgery (performed by a different ortho) for that same diagnosis (given by the ortho that erroneously documented I 'refused'), does that factor at all? Would that be something I can discuss with ALJ? I actually told the first ortho I would "do whatever it takes to get my life back", a sentence I continue to repeat today. I would much rather be doing what I have loved and wanted to do since I was 5 years old than have my daughter on stand-by when I shower & help me get my pants on.

Currently, there has been no surgical recommendation for my nerve damage. PT has been recommended/ordered and performed. I actually purchased a recumbent bike to work on my quad strength at home, but without a current MRI to determine if there is new injury or not, I am reluctant to potentially cause more damage.

Finally getting a PCP and an ortho referral, I am hopeful I will be able to obtain updated records within the 60 day time frame for reconsideration. Failing that (since you are so knowledgeable & helpful ), would I submit a new application with AOD reflecting the peroneal nerve damage diagnosis (4/2014) or the RSD diagnosis (2/2015) (which would definitely take more time to determine 12 months or more) or both/all?

My apologies for such a lengthy post and the ongoing continued questions. And many many thanks for your assistance!

No problem!

I am feeling so alone on so many fronts here and I appreciate your help so much! I almost feel like understanding the SSDI stuff is going to require way more work than my care (we have already come up with some solutions, but I am terribly worried my daughter-who has been my biggest help-will run off with her boyfriend who is of the mindset that I "can do stuff when I want to.

"This confuses me a bit but what I believe you are saying is the lapse in seeing an MD is my downfall. So the fact that I could not afford an MD until such time as I did see one (and received the diagnosis at that visit) will not really come into play with my appeal...???"

It's MOST LIKELY your downfall for a fast approval IMO. There are certain illnesses where this is not the case--pretty much those that qualify as Impairment Listings found in the Blue Book, and this is why it can get confusing. You have a different set of requirements. Assuming your biggest current health issue is RSD/CRPS, you're newly diagnosed with no history of how you'll respond to meds or treatment. If you do a good job of documenting your case between now and your ALJ hearing, it's totally conceivable that you could receive a Fully Favorable decision and receive backpay to your Alleged Onset Date.

If you are still on crutches and can not walk without them, that MIGHT be a game changer for a faster approval.

"With a new app after I turn 50, would I have the same AOD as it relates to my original app?"

No. You have to have an AOD on your 50th bday or later (or 6 months prior IF an ALJ allows it). So if you stick with your current application, and current AOD, the standard for approval will not decrease. (An ALJ doesn't actually need your permission to change your AOD btw, but then it becomes a Partially Favorable Decision. So, most often the applicant agrees to the change, a Fully Favorable decision is made, and you are unable to appeal the older AOD.)

"Found the RFC forms (). Still confused about the FCE. Whom do I request that from? Is there a form I missed for that?"

You ask your doc if he or she feels a Functional Capacity Evaluation would be appropriate. If you undergo a FCE, the doc or pt will generate a report showing the results.

It is an incredibly difficult process. I don't mind contributing if I can help. If you choose to hire representation you still need to be involved, but to a lesser degree. Some attorneys are very good and you might want to check out local non attorney reps as well. Some attorneys will only look at your file half an hour before walking into an ALJ hearing--way too late to help you in many cases. Allsup has non attorney reps and they have a good rep for being hands on, which I think might make your life easier.

I received a Partially Favorable Decision for a closed period award where I had attorney representation, and then won a Fully Favorable Decision pro se several years ago. It's a good idea to have a rep in most cases...

Your daughter is probably just as likely to kick her bf out. How would he react if she has to face a devastating illness at some point? (I'm not sure I'd bring this up to her, but you get the point.) It is intrusive to be dependent financially and physically on anyone...

Be active about your treatment--both physical and mental. Go to a pain psych doc to help learn some strategies in coping with a permanent disability. Get food stamps if you're able (or food banks) and research any other financial programs you might qualify for. Do things to help around the house when you're feeling at your best. If it means getting up for 5 minute intervals to make dinner to help out, or fold laundry in bed, or make cookies as a surprise--great. You might want to check to see if there are any local housing options you might qualify for--even with long wait lists, it might be a good idea long term.