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View Poll Results: has your profile category changed L TO M while your profile score has dropped?
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Old 08-27-2016, 11:48 AM #1
nospammer nospammer is offline
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Confused profile score of 083 showing as M not L ?

the 2nd scanline on my latest (2016) short form letter shows profile category M for medium despite score showing as 083 . the previous (2013) short form showed L for low with score of 129.

how can the score drop from 129 to 083 but profile category go from L to M?
I followed the instrux for M when completing the short form but
what does this mean when your score drops while your profile category changes from L to M ?


here's some info i compiled from somewhere else (can't remember where) for folks wondering about profile scores:
q: What is ssa's profile sheet for the short form & what do they mean?
a: profile category (Low, Medium or High), Low profiles are those with the least potential for medical improvement. Your SSA-455-OCR-SM form should have 3 scanlines. On the 2nd scanline there is a determination of either high, medium, or low. Depending upon which one you are, the SSA will review your responses differently.
Example: If you are a HIGH or MEDIUM, and you answer the question that your condition is the same, you will be scheduled for a full CDR Review (CDR = Complete Disability Review. If you are a low, the reviewer will go to the next question. Same goes for the next question of whether you talked to your doctor about returning to work. If you didn't, and you are a HIGH/MEDIUM, you will be reviewed and have to undergo a full CDR.
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Old 08-27-2016, 06:14 PM #2
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i have no idea why your numeric score would go down 33% but your category would go up from low to medium.
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Old 02-12-2017, 12:35 AM #3
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FWIW, I had this happen to me just today.

Went to the mailbox, darned CDR was there! They were even a month early this time. They send it out every three years like clockwork, but usually in March.

I was originally approved in 2007 on Bipolar Disorder. Benefits started in 2008. Got my first CDR (short form) in the mail and filled it out in 2011.

I don't remember what I said on it, but I know that I probably did everything the worst way possible. I didn't read anything like "Don't put remarks on the short form." or Social Security's flow chart for processing the form that shows you what they do at each question. Anyway, they send me the long form UGH.

The long form is basically 11 pages long. You have to tell them at least as much stuff as on the initial application. It was horrible. I decided that while I was attaching more information anyway, that I'd go ahead and tell them about my high cholesterol, high blood pressure, and so on. I explained that I was having trouble affording treatment for anything while waiting for Medicare to kick in the first two years, and that I was going to a local free clinic at a church. Then they asked if they could speak to anyone who knew me, like friends and family members. They sent out a bunch of forms to my mom.

Anyway, they sent me a letter back that said my benefits would continue and they would review my case from time to time.

2014. Another short form I don't remember what my profile score was, but the form indicated that I was a Low. I filled it out according to the instructions and made no remarks. Everything in the boxes. Original diagnosis only... All that good stuff. Two months later, they sent me a letter that said that my benefits would continue and they would review my case from time to time.

2017. Today. I get a short form. I'm a Medium with a profile score of 0101! How does that happen? Like I said, I think the profile score was higher last time, but still....The profile scores start at 0000 and go as high as 9999. How is a 0101 a Medium?

Whatever. I filled out the form with no remarks and everything in the boxes, original diagnosis, dates of recent doctor visits, etc.

I was trying to figure out how to answer "Are you better, the same, or worse?". I looked at the flow chart for the Social Security people again and the darned thing says if you're a Medium (which I am, somehow) and you say "same", they do a CDR right there, no question about it, so I did some more thinking and decided to answer "worse", because it's hard to measure these things, because I do feel worse, and because I am measurably worse.

If they send me a long form (Oh god, please, no....), I will qualify that with remarks. First off, my boyfriend lives with me and can tell them everything about how I am tranquilized by my meds, which have changed, gone up, and the doctor added more since February 2015 (which is when the form said it was interested in). I was filling out other paperwork trying to get on the Medicare Savings Program the other day in Illinois. They completely screwed up my case. It's been seven months and someone flagged that Indiana was still paying (it's not), so I filed an appeal and set some extra pages that I didn't need on top of a burning candle and almost set our apartment on fire. (That's definitely worse.). I can't remember things sometimes. I go to tell a story and my bf is like "You've already told me this 100 times!", and I can't remember things like where I put something that I just had. I was in a research study for people with bipolar disorder at the University of Chicago last summer and I felt totally embarrassed, because they would say a string of words and I wouldn't remember any of them, or maybe just one, or I'd tell them a word that wasn't there. I felt stupid.

So, we'll see what happens. Now, from what I understand, the question of whether you've seen the doctor recently (which I have and I put the original diagnosis and last three dates), if you say YES, and you're a Medium or High, it says "Take a CDR action if there is anything in the narrative or DIRCON (telephone call with you) to indicate a possible medical improvement.".

So, I *think* I'm in the clear, but I don't want to jinx it.

It's hard to reach a conclusion that there's a medical improvement when there's no recent work or school activity, you say you're worse, you've been to the doctor, haven't been to the hospital, and there's no remarks.

Anyway, I'll check back in when I hear back. I dropped it in the mail right away to get it over with. The thought of being reviewed makes me sick to my stomach. You have no idea how stressful the process is (or maybe you do....if you don't, then pray you never find out!).
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Old 02-12-2017, 12:25 PM #4
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Quote:
Originally Posted by nospammer View Post
the 2nd scanline on my latest (2016) short form letter shows profile category M for medium despite score showing as 083 . the previous (2013) short form showed L for low with score of 129.

how can the score drop from 129 to 083 but profile category go from L to M?
I followed the instrux for M when completing the short form but
what does this mean when your score drops while your profile category changes from L to M ?


here's some info i compiled from somewhere else (can't remember where) for folks wondering about profile scores:
q: What is ssa's profile sheet for the short form & what do they mean?
a: profile category (Low, Medium or High), Low profiles are those with the least potential for medical improvement. Your SSA-455-OCR-SM form should have 3 scanlines. On the 2nd scanline there is a determination of either high, medium, or low. Depending upon which one you are, the SSA will review your responses differently.
Example: If you are a HIGH or MEDIUM, and you answer the question that your condition is the same, you will be scheduled for a full CDR Review (CDR = Complete Disability Review. If you are a low, the reviewer will go to the next question. Same goes for the next question of whether you talked to your doctor about returning to work. If you didn't, and you are a HIGH/MEDIUM, you will be reviewed and have to undergo a full CDR.
the last sentance of your post is incorrect. SSA's guidelines on processing disability review mailer forms state that for the talked to your doctor about returning to work question, if you answer have not discussed or cannot work, the reviewer should go to the next question which is about whether your health is the same, better or worse. only if you answer can work does it trigger a full cdr.

the instructions for processing the mailer are toward the bottom of the page in the link below.

SSA - POMS: DI 40502.001 - Processing Center Instructions for the Continuing Disability Review Mailer Forms SSA-455 and SSA-455-OCR-SM - 09/22/2016
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Old 02-12-2017, 04:11 PM #5
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Just throwing this out here for others to read.

For the question as to whether your doctor said that they think you can work or not, you should tell the truth[1], *but* to avoid having to tell them that your doctor said that you can work, which WILL trigger a CDR no matter what your profile score is, you should avoid discussing the matter with your doctor. Most doctors don't particularly care what you do, and I haven't met one yet that just blurted out their opinion on whether I could work or not. As you noted, the "Haven't discussed it." and "Doctor told me that I can't work." responses both lead to the next question, and won't lead to a CDR at this step in the process.

[1] (Especially when it's something that is easy to discover or quantify. You should occasionally ask for a printed copy of your medical records and read everything, even if there's a small fee to have them printed out. I know it's boring, but you'll know exactly what an Examiner would be reading if they got their hands on it. Many psychiatrists don't keep highly detailed notes. Some barely keep any at all. Some appointments just note that they refilled your medication and "Patient expressed that he was feeling bad because his aunt passed away.")

By the time you've been a patient somewhere for a while, your medical records start telling a story about you. This is part of the "narrative" that Social Security is talking about.

It's another reason why I just take my pills and avoid "talk therapy". It's exactly those kinds of detailed notes that throw a curveball into the CDR process. The more you talk, the more likely something damaging to your case will end up in there. I'm not saying that that would happen to me or any particular person, but I don't find talk therapy very helpful anyway and it is quite expensive, especially when your state keeps messing up your Medicaid stuff and you're left paying Medicare premiums, copays, and deductibles on a Social Security check that really isn't that much money.

The CDR process puts the burden of proof on the SSA to prove you've gotten better, and better as it relates to your ability to work, and so the less information they have to work with, the harder it is for them to reach an unfavorable finding. Especially on the Short Form, where the best thing any "remarks" will do is cause a CDR and the worst thing it could do is sink your case. If you get a long form, again, cooperate and keep your answers short, truthful, to the point, and carefully moderated. Regardless, you want 90% of what they hear to be from you, which gives you more control over where the process ends up.

That's my opinion, at least.
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Old 02-12-2017, 05:52 PM #6
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is there anyone else reading this thread who has gotten the same or a lower profiling score and had their profile type changed from L (low) to M (Medium) on their most recent cdr mailer (short form cdr)?
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Old 02-12-2017, 10:27 PM #7
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Personally, it wouldn't surprise me if they're up to something. With the number of people on disability growing ** it wouldn't surprise me one bit if Social Security has changed a regulation somewhere to bump people up from Low to Medium or from Medium to High without a corresponding profile score increase.

It would hike up the number of full CDRs being done. Of course, without more money to process them, the agencies doing them will get severely backlogged, which means that while they are pestering a few people who really don't need a full review, others could go extra months or even years without getting one.

Of course, the CR for government funding runs out in April and Congress could send more money for these. It was probably only a matter of time. They've been making it harder to get an initial award to begin with for several years, and the number of fully favorable decisions has been falling since around 2010.

Again, it's only a hypothesis. Time will tell.

Last edited by Chemar; 02-13-2017 at 08:09 AM. Reason: Per guidelines on limiting direct political comments
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Old 02-13-2017, 11:17 AM #8
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i'm also wondering whether they are classifying a medium profile for a low profile score for everyone or for certain illnesses.
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