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A few things from my denial letter.

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Old 01-20-2018, 09:14 PM   #1
Alice P
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Default A few things from my denial letter.

A few things from my denial letter

“We have determined that your condition is not severe enough to keep you from working. We considered the medical and other information, your age, education, training and work experience in determining how your condition affects ability to work.”

Doe’s this mean that they used the GRID or the five step Social Security sequential evaluation? Or are those two things the same ?

“Your condition results in some limitations in your ability to preform work related activities. However, these limitations do not prevent you from preforming work you have done in the past as a restaurant manager, as you described. We have determined that your condition is not severe enough to keep you from working. “

This is the EXACT same reason for denial at initial *sigh* what a waste of time.

“Your statements about your ability to preform work related activities are not fully supported by other evidence in file.”

This one sentence bothers me the MOST! What does this mean?

Does this mean that my doctors are saying that my conditions are not bad enough to keep me from working?

Does it mean that I’m not as sick as I think I am?

What is other evidence?

This one sentence makes me want to drop the whole thing. I feel like they are saying that I’m lying .

Last edited by Alice P; 01-21-2018 at 12:07 AM. Reason: spelling
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Old 01-22-2018, 02:27 PM   #2
LIT LOVE
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The process at the first two stages are the same. When you go before an ALJ it is evaluated differently. You can't/shouldn't take this process personally. The language in the denial is typical. They're not saying you're lying. You need to continue if you're unable to work.

The 5 Step Sequential Evaluation Process is always used. The Grid is at the end of Step 4.

I'm not sure why they would evaluate the Grid when they found you could perform your previous work? https://www.ssa.gov/oidap/Documents/...Evaluation.pdf

Get a copy of your CD and discuss with your attorney why you didn't meet a Listing.
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Alice P (01-23-2018)
Old 01-22-2018, 04:20 PM   #3
Alice P
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Thank you Lit Love.

I’ve calmed down quite a bit since writing this post. Thanks for reminding me not to take this personally

You are right about the initial and recon stages being the same.

I thought that the GRID rules were automatically applied once that someone turned 50 (I was 55 when I applied and 56 now). But I’ve always been confused about the prosses. Lol

I talked to my lawyer and Iam feeling more confident about the hearing.

I told my lawyer to request an OTR and told her that I wanted done ASAP, you told me and I’ve read that some lawyers wait until the last minute to request the OTR. I don’t think that there’s anything to lose in asking for it. I did read this last night :

“One group of claimants that are good candidates for OTR requests are those who are 55 years old or older, are clearly unable to perform their past relevant work, and are limited to unskilled work. Social Security's Medical-Vocational Guidelines direct a finding of "disabled" for such claimants, so an OTR decision is a strong possibility. “

On the Record Decisions - Maine Social Security Disability Lawyer

but other than age, I don’t know if any of this applies to me.

I will be requesting a CD, I'm kinda afraid to see what's on it, but we need to know so we can move forward .

Thank you so much for responding. I greatly appreciate it .
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Old 01-23-2018, 04:21 AM   #4
LIT LOVE
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I was going with the assumption you'd request the OTR by meeting a Listing. Has she addressed why you didn't meet a Listing? She should be able to look at your test results and identify the issue.

If they're claiming you can do your previous work, then an OTR likely won't be successful unless your medical records address your functional restrictions and limitation if you're trying to qualify via the GRID.

As of right now, my assumption is they're claiming you have a RFC rating of at least Light. Your age at application isn't the issue, it's your age at your Alleged Onset Date. With a Light rating, if your 54 at your AOD you will be denied via the Grid.

Here's the DOT title the VE would probably use which has a strength rating of Light: 187.167-106 - MANAGER, FOOD SERVICE (hotel & rest.; personal ser.) - DOT Dictionary of Occupational Titles Job Description and the Light Grid: Light Work Grid Rules | Medical Vocational Guidelines | Light

Don't insist on the OTR prematurely. The attorney should be able to explain to you clearly what her strategy for approval is, if you should amend your AOD to your 55th birthday, etc.

Last edited by LIT LOVE; 01-23-2018 at 04:49 AM.
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Old 01-23-2018, 05:40 PM   #5
Alice P
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I'm going to have a sit down meeting with my lawyer next week. I've been writing down things that need to be addressed. Thank you for bringing up the listing and the fact that she should have a strategy, it helps me sharpen the focus of the meeting.

Yes, they're claiming that I can do your previous work so maybe OTR isn't viable. Maybe the med records will show something different ?

I stopped working July/12/2016 and was admitted to the hospital on Aug/1/2016 (DX COPD). I turned 56 in Oct of 2016 so I was 55 at the AOD.

Thanks for the links. I've saved all of the links that you've posted so I can reference them, its been a HUGE help !!
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Old 01-23-2018, 09:10 PM   #6
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I'm not discouraging an OTR request, you just need to be prepared and understand why the application hasn't been successful before moving forward. Don't let the attorney delay just to increase backpay but don't request prematurely either.

If you were hospitalized, you were likely medically unstable at the time, so if you had a spirometry test then it would have been invalid for meeting a Listing within 30 days. Hopefully the adjustor's notes in the CD will help make it clear.

Good to know you were 55 at the time of your AOD.
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Old 01-24-2018, 01:09 AM   #7
Alice P
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I had my first spirometry test done in Sept of 2016 and was officially DX in Oct of 2016. I started my SSD claim in Nov of 2016.

What does " meeting a Listing within 30 days '' mean ?

On Aug 1st I had gone to Urgent Care and had an x-ray of my lungs, the results where ‘unremarkable’. I was told by the UC doctor that I should go to the ER because my oxygen was low 82/85. The doctors in the ER did an EKG, blood work (they took a lot of blood), a CT and a few other tests. They (for some reason I had quite a few doctors lol) came in and told me that I was having a COPD exacerbation, that I had pneumonia and sepsis. I’m not sure how the doctors in the hospital where able to DX COPD without a spirometry. CT ?

In 2017 I was DX with colitis and degenerative disc disease ...getting old sucks lol

Thanks for the advice on the OTR.
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Old 01-24-2018, 11:53 AM   #8
LIT LOVE
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"You must be medically stable at the time of the test."

Example of when you would not be considered stable.

3.00 E2ii
"Experiencing, or within 30 days of completion of treatment for, a lower respiratory tract infection."


Your attorney should be able to tell you which spirometry tests are valid or invalid.

Getting older isn't fun, but at least you were healthy while you were younger. I try to be optimistic...
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Old 01-24-2018, 01:09 PM   #9
Alice P
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Quote:
Originally Posted by LIT LOVE View Post
"You must be medically stable at the time of the test."

Example of when you would not be considered stable.

3.00 E2ii
"Experiencing, or within 30 days of completion of treatment for, a lower respiratory tract infection."


Your attorney should be able to tell you which spirometry tests are valid or invalid.

Getting older isn't fun, but at least you were healthy while you were younger. I try to be optimistic...
OK, That make sense.

Thanks for the words of encouragement
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Old 01-24-2018, 04:23 PM   #10
LIT LOVE
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While I know many/most attorneys don't closely examine medical records when they sign a client, they darn well should, especially in a scenario like yours.

Have your spirometry results improved with any subsequent tests or stayed the same?
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