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Old 10-25-2017, 03:42 AM #1
LIT LOVE LIT LOVE is offline
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You want to read all of 3.00 and then the appropriate Listing, I'm guessing 3.02 Chronic Respiratory Disorders: 3.-Respiratory-Adult

SS is very specific about the requirements for test type, as well as how it's performed and documented. Since you were denied at the initial level, in all likelihood you either didn't have the test documented as needed, you don't meet the Listing requirements or SS didn't receive the medical documentation.

Those that are approved at the initial stage usually meet a Listing. Those that are 50 or older and meet other requirements are sometimes approved quickly as well, but 2/3 of applicants are denied at the first stage. Reconsideration approval rates are a little over 10% and approvals mostly occur when new medical documentation is submitted that helps a claimant meet a Listing or helps with the GRID.

There is also a full 5 Step Sequential Evaluation Process that is used to approve or deny SSI/SSDI benefits, but it usually will require an ALJ hearing which takes a couple of years. https://www.ssa.gov/oidap/Documents/...Evaluation.pdf

So, if you might possibly meet a Listing, but require new testing be performed, I would suggest you request your case worker allow you time to schedule it and get the results back. Since you're already scheduled for more testing, verify if it will be what SS requires and if not, see if it can be.
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Old 10-25-2017, 04:48 PM #2
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Quote:
Originally Posted by LIT LOVE View Post
You want to read all of 3.00 and then the appropriate Listing, I'm guessing 3.02 Chronic Respiratory Disorders: 3.-Respiratory-Adult

SS is very specific about the requirements for test type, as well as how it's performed and documented. Since you were denied at the initial level, in all likelihood you either didn't have the test documented as needed, you don't meet the Listing requirements or SS didn't receive the medical documentation.

Those that are approved at the initial stage usually meet a Listing. Those that are 50 or older and meet other requirements are sometimes approved quickly as well, but 2/3 of applicants are denied at the first stage. Reconsideration approval rates are a little over 10% and approvals mostly occur when new medical documentation is submitted that helps a claimant meet a Listing or helps with the GRID.

There is also a full 5 Step Sequential Evaluation Process that is used to approve or deny SSI/SSDI benefits, but it usually will require an ALJ hearing which takes a couple of years. https://www.ssa.gov/oidap/Documents/...Evaluation.pdf

So, if you might possibly meet a Listing, but require new testing be performed, I would suggest you request your case worker allow you time to schedule it and get the results back. Since you're already scheduled for more testing, verify if it will be what SS requires and if not, see if it can be.

Yes, I looked at the Listing/bluebook BEFORE I filed my claim. I was denied at the initial level because they said " Your condition results in some limitations in your ability to perform work related actives , however these limitations do not prevent you from performing work you have done in the past" They never said anything about me not meeting the Listing requirements.

I had a CT scan, a Spirometry test and the six minute walk test done ,there are NO other tests that can be done for COPD, these tests were done at a a major hospital and the person that did them has been trained do preform them. SS has ALL of my test results and documents ( including ER visits, new meds etc ). I have been vigilant about making sure that SS has any new information about my health. I will be having a CT scan, a Spirometry test and the six minute walk test done next month and YES these tests meet SS requirements because there are NO OTHER tests that came be done for COPD.

*admin edit*

Last edited by Chemar; 11-17-2017 at 09:41 AM. Reason: **admin edit per NeuroTalk guidelines
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Old 10-25-2017, 10:08 PM #3
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You were denied at Step 4. If you had met a Listing, you would have been approved at Step 3, and then the process stops. See link for the 5 Step Sequential Evaluation Process above.

It's not that your test wasn't performed properly, it just might not have been performed the way SS requires. As one example, it could be something as simple as you had a change of medication within two weeks of spirometry testing, so the test was invalidated. See 3.00 E from link for Listings.

Your case worker would not be asking about upcoming breathing tests if you had enough medical documentation to prove you meet a Listing today. You can ask why you don't already meet a Listing--I'm not sure why they don't volunteer this, but there must be a policy against it. Or, if denied at Reconsideration, you can request a copy of your file to see why they determined that you didn't meet a Listing.
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Old 10-26-2017, 11:09 AM #4
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did they also do a lung diffusion and lung volume testing after the spirometry?
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Old 10-26-2017, 12:43 PM #5
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Quote:
Originally Posted by echoes long ago View Post
did they also do a lung diffusion and lung volume testing after the spirometry?
Yes, all of the breathing/walk tests (CT was done at the same hospital on a different day) where done on the same day. It took a little over 90 mins to do all of the tests.

Last edited by Alice P; 10-26-2017 at 01:55 PM.
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Old 10-26-2017, 12:39 PM #6
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Quote:
Originally Posted by LIT LOVE View Post
You were denied at Step 4. If you had met a Listing, you would have been approved at Step 3, and then the process stops. See link for the 5 Step Sequential Evaluation Process above.

It's not that your test wasn't performed properly, it just might not have been performed the way SS requires. As one example, it could be something as simple as you had a change of medication within two weeks of spirometry testing, so the test was invalidated. See 3.00 E from link for Listings.

Your case worker would not be asking about upcoming breathing tests if you had enough medical documentation to prove you meet a Listing today. You can ask why you don't already meet a Listing--I'm not sure why they don't volunteer this, but there must be a policy against it. Or, if denied at Reconsideration, you can request a copy of your file to see why they determined that you didn't meet a Listing.

Sigh, I'm not talking about the denial. The denial was in June and its water under the bridge. I spend zero time thinking about the denial because that part of the process is over.

I'm under reconsideration and that's where my focus is.

The reason that my case worker ask me the question remains to be seen. I'm not sure how you can say unequivocally that you know what is happening with my case. My own lawyer is cautious when making assessments about my case and yet you seem to have all of the answers.....

Last edited by Alice P; 10-26-2017 at 03:26 PM.
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Old 10-26-2017, 06:00 PM #7
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Quote:
Originally Posted by Alice P View Post
Sigh, I'm not talking about the denial. The denial was in June and its water under the bridge. I spend zero time thinking about the denial because that part of the process is over.

I'm under reconsideration and that's where my focus is.

The reason that my case worker ask me the question remains to be seen. I'm not sure how you can say unequivocally that you know what is happening with my case. My own lawyer is cautious when making assessments about my case and yet you seem to have all of the answers.....
At the initial stage and Reconsideration, the process is based upon rules and procedures. SS has worked very hard to make sure that their decisions are uniform in every state via the QC process.

Reconsideration is exactly the same as the initial stage, with the only difference being another case worker reviews it. The odds of a case worker making an error and it not being caught by a supervisor or by QC, is very, very low. The small percentage of claimants that are approved during Recon, almost without exception have discovered that not all their medical records were submitted, which they rectify, or the addition of new medical documentation makes the difference.

Your attorney should be able to look at your medical records and determine why you were denied at the initial stage. (Many attorneys won't even sign clients until they've been denied Recon and most won't do much to expedite an approval since their compensation comes from their clients backpay, but let's assume yours will review your file for you.)

There are only a few Listings that are based upon objective tests, which are very predictive: Chronic Respiratory Disorders, statutory blindness and hearing loss are the most notable.

When a case worker has enough medical documentation to award an approval, they stop the process. If you currently had enough medical documentation, your case worker wouldn't be asking if you're going to have more breathing tests performed soon. But, if the case worker didn't believe that an additional test might provide the documentation, they would just deny you and close the case.

It would be a shame for you to narrowly miss an approval and have to wait for an ALJ hearing, or even deal with the long delay of an OTR request.
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Old 10-26-2017, 09:01 PM #8
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Quote:
Originally Posted by LIT LOVE View Post
At the initial stage and Reconsideration, the process is based upon rules and procedures. SS has worked very hard to make sure that their decisions are uniform in every state via the QC process.

Reconsideration is exactly the same as the initial stage, with the only difference being another case worker reviews it. The odds of a case worker making an error and it not being caught by a supervisor or by QC, is very, very low. The small percentage of claimants that are approved during Recon, almost without exception have discovered that not all their medical records were submitted, which they rectify, or the addition of new medical documentation makes the difference.

Your attorney should be able to look at your medical records and determine why you were denied at the initial stage. (Many attorneys won't even sign clients until they've been denied Recon and most won't do much to expedite an approval since their compensation comes from their clients backpay, but let's assume yours will review your file for you.)

There are only a few Listings that are based upon objective tests, which are very predictive: Chronic Respiratory Disorders, statutory blindness and hearing loss are the most notable.

When a case worker has enough medical documentation to award an approval, they stop the process. If you currently had enough medical documentation, your case worker wouldn't be asking if you're going to have more breathing tests performed soon. But, if the case worker didn't believe that an additional test might provide the documentation, they would just deny you and close the case.

It would be a shame for you to narrowly miss an approval and have to wait for an ALJ hearing, or even deal with the long delay of an OTR request.
What are your qualifications ? Are you a former claims examiner ? A disability lawyer/ paralegal ? A patient advocate ?

How is it that you know so much about the inner working of the SSD system ?
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Old 10-26-2017, 11:46 PM #9
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I am disabled myself. I successfully represented myself at the ALJ level, after receiving a partially favorable decision with an inexperienced attorney that was substituted at my first hearing. --I was aware I probably needed to hire a new attorney and don't recommend the pro se process even though it worked well for me. It's generally best to utilize your representative, as well as self advocate.

I continued to learn about the process so that I could potentially help others by reading other websites and attorney's books, the posts of a SS staffer here at NT, and then eventually digging in to the SS source material directly at SSA.gov. After the SS forum at this site slowed down, I began volunteering at SSDFacts and have been a moderator there for a few years. I've been less active here for a year or so, but came back to participate in my impairment related forum after a traumatic health issue arose and stopped back in to this forum as well.

If I was well enough to be dependable physically, I would study and apply to be a non attorney rep myself. I've been actively learning about the process for 15+ years, and active here 7+ years. If I don't know something, I know where to look or who to ask. And while this site isn't as busy, there are a hand full of very knowledgeable posters that would call me out if I was posting nonsense.

I can link to reputable sources for everything I've stated, and the patterns and anecdotal evidence I've noted is not unique. (I have linked to some of those sources in the stickies above.) My daily interactions with other claimants have simply confirmed that there are predictable patterns in many scenarios.
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