Mark in Idaho- Pace and Persistence? That's good information to have. We had one day where we were out as a family and he was seemingly doing well... and then he got too warm. Total meltdown. Tears. We had to leave. Go home. Not a big deal... but even something like a change in body temperature can throw him off.

He is applying through social security. The company that he was working for was bought out two months before the accident. Being as such, the new company did nothing for me. I got letters saying he wouldn't qualify for FMLA or any other benefits through them, because he had not been with the company for a full year. They replaced him- which I understand- he was their food and beverage director, they needed a chef. I get that. But when he asked to come back, even on a part time basis, he was denied. The new chef started telling everyone that my husband was on anti-psychotic meds to treat schizophrenia because of the accident. (Which isn't true I might add)

The first application was done at the hospital in October through a company in the hospital called Chamberlain Edmonds. It took until May before he got the first denial.... just as you said, because they expect he could recover before October... Chamberlain Edmonds referred me to the lawyer and filed my appeal. The second denial came through before we even had the first consultation with the lawyer. The lawyer told us to document, document, document!!

MakNeil- I'm sure she does. I thank you, from the bottom of my heart, for the warm welcome. It's nice to have people to talk to about this... who understand what our family has been through.

i'll leave mark in Idaho to answer the hard questions and let you know if I was 10 years younger and healthy I would beat the @#$$ out of the chef that lied about your husband having schizophrenia

Did Chamberlain Edmonds apply for SSDI or for SSI. Their web site suggests they would apply for SSI and Medicaid in hopes of receiving payments for the hospital. Any SSDI application starts after a SSI application.

Document, document, document is true but the attorney should be meeting with you before submitting an application. Does not sound right to me.

Go to the SS website and look for the Disability Blue Book. Find the part about brain injuries and also the part about mental illness. They both apply. You will see the terms they look for. I cut and pasted the relevant issues into my own document for later reference.

btw, What happened to the pedestrian he hit ?

They applied for disability. I asked the lady at the state's disability board, and she said that both applications for SSI and SSDI are lumped together. When we got denials, we got two separate letters saying he had been denied for both.

When we got the first denial, the lady I talked to at Chamberlain Edmonds said it was clear we needed a lawyer, she said she would set up the referral for the law firm they use (which she highly regarded... but I guess the proof will be in the pudding) and she filed the appeal, since appeals are time sensitive. So technically, she filed the original and the appeal... and it was denied before we even got to talk to the lawyer. I got a big packet from the lawyer at the end of May and an appointment date of July 18th. Bothered me that the appointment was so far into the future. We are living with my parents, and I have to tell you- we'd be drowning, if not.

Sadly, the pedestrian didn't make it. This is a source of anxiety for my husband. He does not remember anything about the accident, and was basically lifeless on the scene. My father-in-law was hit by a car crossing the street about 12 years ago, fell into a coma and died a week later. At this point, you'd think comas were a family curse. This all hit very close to home for my husband. He is upset he doesn't remember anything. A man died, and my husband is focused on whether he could have done something to prevent it. The witnesses at the scene say that the elderly gentleman stepped into the street. My husband honked his horn, and tried to swerve. The elderly man, heard the horn, turned to look at my husband and didn't move. He didn't budge. Just looked at him. I don't get it. The police found the pedestrian 100% at fault. The witnesses say there was nothing my husband could do. I wasn't there. But my husband has it locked in his brain that he should remember the accident, and is upset he never will.

MarkNeil- We called corporate.... who basically did nothing. It's hearsay... My husband was their food and beverage director/executive chef before the accident. He asked to come back in any capacity they had available (they had a part time baking position open that my husband, a man with a pastry degree would have been perfect for... it would have been in a familiar environment, with familiar people around him, and only part time hours so that he could rest and still pursue disability) and they dragged their feet on it. One of my husband's former employees called us one night and told us that the new chef was telling everyone that corporate didn't want my husband back, because he was on meds for schizophrenia and that he was liability to the company. So... we called corporate. And all that came of that was that my husband was told he was not welcome back because he was too close to his former staff. What a crock!

The fact your husband does not remember the accident should be considered a blessing. He does not have that trauma playing over and over in his head.

I have a very brief memory of my fall on a bike that changed my life. It is nothing but terror.

It may be better that he can not work at his old place. The memories of his past abilities and others comments about that would be counter to his good health. Getting a fresh start somewhere else would be best. Have you checked with your State Vocational Rehab Dept ? They may have a way for him to get back to work.

Try to get a copy of the application and appeal that was denied. Then, you can know what you need to add to reinforce his qualifications. Has he had a Neuro Psychological Assessment yet ? That will define his functional capacity. SSDI may order one in an abbreviated form. They did with me.

Have you accessed the SSDI Blue Book yet ? Here is a copy of part of the Traumatic Brain Injury section. I've made a few lines BOLD for your attention.

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

F. Traumatic brain injury (TBI). The guidelines for evaluating impairments caused by cerebral trauma are contained in 11.18. Listing 11.18 states that cerebral trauma is to be evaluated under 11.02, 11.03, 11.04, and 12.02, as applicable.

TBI may result in neurological and mental impairments with a wide variety of posttraumatic symptoms and signs. The rate and extent of recovery can be highly variable and the long-term outcome may be difficult to predict in the first few months post-injury. Generally, the neurological impairment (s) will stabilize more rapidly than any mental impairment (s). Sometimes a mental impairment may appear to improve immediately following TBI and then worsen, or, conversely, it may appear much worse initially but improve after a few months. Therefore, the mental findings immediately following TBI may not reflect the actual severity of your mental impairment (s). The actual severity of a mental impairment may not become apparent until 6 months post-injury.

In some cases, evidence of a profound neurological impairment is sufficient to permit a finding of disability within 3 months post-injury. If a finding of disability within 3 months post-injury is not possible based on any neurological impairment (s), we will defer adjudication of the claim until we obtain evidence of your neurological or mental impairments at least 3 months post-injury. If a finding of disability still is not possible at that time, we will again defer adjudication of the claim until we obtain evidence at least 6 months post-injury. At that time, we will fully evaluate any neurological and mental impairments and adjudicate the claim.

http://www.ssa.gov/disability/profes...dult.htm#12_01

12.02 Organic mental disorders: Psychological or behavioral abnormalities associated with a dysfunction of the brain. History and physical examination or laboratory tests demonstrate the presence of a specific organic factor judged to be etiologically related to the abnormal mental state and loss of previously acquired functional abilities.

The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied.

A. Demonstration of a loss of specific cognitive abilities or affective changes and the medically documented persistence of at least one of the following:

1. Disorientation to time and place; or

2. Memory impairment, either short-term (inability to learn new information), intermediate, or long-term (inability to remember information that was known sometime in the past); or

3. Perceptual or thinking disturbances (e.g., hallucinations, delusions); or

4. Change in personality; or

5. Disturbance in mood; or

6. Emotional lability (e.g., explosive temper outbursts, sudden crying, etc.) and impairment in impulse control; or

7. Loss of measured intellectual ability of at least 15 I.Q. points from premorbid levels or overall impairment index clearly within the severely impaired range on neuropsychological testing, e.g., Luria-Nebraska, Halstead-Reitan, etc;

AND

B. Resulting in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marked difficulties in maintaining social functioning; or

3. Marked difficulties in maintaining concentration, persistence, or pace; or

4. Repeated episodes of decompensation, each of extended duration;

OR

C. Medically documented history of a chronic organic mental disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following:

1. Repeated episodes of decompensation, each of extended duration; or

2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or

3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.

BTW, I don't think the hospital records from last October and such will mean much. They will be more interested in how he is functioning now. They expect some level of recovery and improvement. You need to show what he can and can not do now. If you notice in the first section of the Blue Book above :
In some cases, evidence of a profound neurological impairment is sufficient to permit a finding of disability within 3 months post-injury. If a finding of disability within 3 months post-injury is not possible based on any neurological impairment (s), we will defer adjudication of the claim until we obtain evidence of your neurological or mental impairments at least 3 months post-injury. If a finding of disability still is not possible at that time, we will again defer adjudication of the claim until we obtain evidence at least 6 months post-injury. At that time, we will fully evaluate any neurological and mental impairments and adjudicate the claim.

Try to put together evidence that his recovery has plateaued.

Wow! So much information.

They did the neuro assessment in April and the results of that were submitted with the initial disability claim. He scored in the average range on most of the test. However, his doctor said that he is sure with my husband's educational background that he is certain that my husband was not in the average range prior to the accident. Which is correct. I always said my husband is the smartest person I know. (Which is still true... the information is all still there, most of the past knowledge is... his short-term memory suffers) There was nothing "average" about him pre-injury.

They had to do the assessment in three different sessions. They started it in January, and his mental state deteriorated. He was having really bad anxiety, so his Speech therapist and Occupational Therapist begged his neuropsychologist to postpone the testing. The last two sessions were done in early April. In the assessment report that was sent to the disability board, the therapist noted that my husband had varying bouts of insomnia and hypersomnia and required naps roughly 4-6 days in every week that would possibly impede him from holding any 9-5 job. As well as inability to cope with stress and juggling more than one task at a time that would probably make it difficult for him to hold down a job in his career field of choice. Being a chef is a very "think on your feet" type of job. If a recipe fails, or there is a problem in the kitchen, you need a cool, calm head to be able to handle the stresses. I honestly worry that going back to work full-time will not only prove to be challenging and frustrating for him, but a detriment to his recovery.

I agree 100% about it being a blessing. I asked early on if he'd remember the accident, and was relieved when they told me no. I didn't realize how hard it would be for him to not have those memories (or really ANY memories of the first few weeks after waking up from the coma) I have this gross, morbid image of him flying through the air and hitting the ground in my mind's eye. It's horrifying. I can't imagine having ACTUAL memories.

Breaking up and postponing the NeuroPsych Assessment was to his detriment. His OT and ST should not have butted in. Breaking up the NPA can enable him to perform much better than doing it all at once. The fatigue factor is reduced. Fatigue is a major factor in his disability.

Reduced function from high to normal does not qualify for disability. Being able to hold a full time minimum wage job means one does not qualify for disability. His career field of choice does not matter with SSDI. If he had private disability insurance, it sometimes does. SSDI is for when the disability prevents any substantial gainful employment (Wages over $1070 per month)

It sounds like he has a good claim for 'pace and persistence' as his main issue. Plus, does he have a difficult time with confrontation ? It is a common symptom. It can make employment difficult.

A report from an occupational psychologist may help.

Right now he can barely tolerate a part-time minimum wage job. Today, he mowed the lawn... then came inside, showered and took a 2 hour nap... got up, ate dinner... and then took another 2 hour nap.

I wish they hadn't broken up that assessment or postponed it. Had they done it one straight shot and in January like they were supposed to, I don't believe we'd be in this mess. His performance would have been much different in January, as opposed to April... and a lot different had they done it all at once. I feel so defeated knowing they should have done it at once. Feels like he was sabotaged out of the gate. They did it in 3- 4 hour sessions.

Pace and persistence is definitely an issue. He does have issues with confrontation. Although, I admit, he always has.... he's quick to anger, and of course as with the exacerbated personality issues that can come with brain injury, now he's even more so. He's actually been let go from jobs in the past for not getting along with others. Now, working with my dad, he has been there for 3 weeks and already has people he doesn't like... people he wants to pick fights with. It doesn't help that he's extremely paranoid, all the time, that someone is out to get him.

And exhibits, the best way I can put it... bad judgement. We have issues with alcohol abuse. He had a hard day one day and picked up two tall boys on his way home... then he went to his part-time job with my dad... and on the way home, he picked up a four pack of tall boys... and drank all four... that's 6 big beers in one day. Every time we were out together, if I ran into walgreens, next thing I would know, he'd have a pint of gin, rum or vodka... I can't seem to stress enough to him how bad alcohol is for his recovery. I honestly don't know what to do there. This is the one area that I feel I am at my wits end. When he first came home from the hospital, it was easier to keep him away from it. He couldn't drive, and I would just tell him no... although we had some epic fights about it that he can't even remember. I don't know what to do to get him to understand. Also, when he was in out-patient rehab, it was easier to defer those issues to the therapists. I'd tell him to talk to his therapists and they gave the green light, then he'd have my blessing.

It was the same way about driving. Lots of fights and confrontation. And paranoia. We sold our car last summer, because we had outgrown it, as a family. (We have 4 kids) My mom's car is big enough for us when we want to go anywhere, so he bought the motorcycle so that we could save on gas and insurance... and look into getting a bigger car for our family. The motorcycle is gone (thank god) ... so in order to drive again, he'd have to borrow my mom's car. She was having none of that (and rightfully so) and he was so angry over it. I kept telling him that he wasn't ready yet. That there was no way of knowing how his driving would be impaired, because a brain injury can throw off your reaction times, etc... and he was so insistent that it had nothing to do with that, that it was because my mom wanted to punish him (being punished is a huge post-injury theme that we deal with... everything feels to him like he's being punished. He was going to work when the accident happened, so he feels he is being punished for going out and providing for his family) that she just wanted to hold it over his head that he couldn't drive her "precious car." He was certain that the only way he was going to be able to drive again was to buy a car (or another motorcycle of his own) And once he is locked onto an idea, you can't get him off of it.

I was looking at the blue book terms- and here's what I am dealing with-

1. Disorientation to time and place
(this was the issue that first brought me to this board. This episode scared me so bad, that I seriously worried that he had some bleeding on the brain. He was so very disoriented. He tells me all the time that when he wakes up, he's disoriented- doesn't know what time it is, if it's day or night, or sometimes who he is... I thought he was exaggerating, until I saw it for myself.)

3. Perceptual or thinking disturbances (e.g., hallucinations, delusions);
(Continually, he will ask me to go to the bathroom with him, because he is afraid of the mirror. He says sometimes he doesn't recognize the person looking back at him)

6. Emotional lability (e.g., explosive temper outbursts, sudden crying, etc.) and impairment in impulse control
(Nevermind the alcohol issues. There are times when he doesn't want me to leave the room, and will burst into tears if I do. This was actually documented with his speech and OT therapists and was the reason that they asked his psychologist to postpone testing. In fact it was in the written report sent to the disability board... that sometimes he would burst into tears and have episodes of depression and was discharged from speech therapy only because he became insistent that it wasn't helping and wasn't challenging him, even when he was performing poorly on tests given and was resistant and incapable of dealing with change. I believe I spoke of an incident where we were out with the kids and even a change in body temperature and fatigue caused him to cry in a very public place and need to go home.)

3. Marked difficulties in maintaining concentration, persistence, or pace;
(Yeah... half hour in the sun.... napped for four hours and was in bed early tonight. Need I say more? He requires naps almost daily. Sometimes he suffers from insomnia.... and sometimes he sleeps 14 hours straight.)

1. Repeated episodes of decompensation, each of extended duration;
(We have had WEEKS were he has only left our bedroom to shower and use the bathroom. No exaggeration there, I am dead serious) Then I get him out of the room to go to the store... we go, we come back... and back up to our room he goes. In fact, he hasn't spent a day downstairs in months. When we were at home- he's in our bedroom. May come down for 15 minutes, sweep the floors, wipe the counters... and then back to the room. The only way to get him out of our bedroom is to completely remove him from the house.)

3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.
(We aren't at a year yet, but we are marching towards it.)

I'm not entirely sure what "2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate" means.... but if it means that a small change in brain function or demands can cause him to have episodes of depression- then check that off the list, too.

I am his security blanket... he keeps telling me that, over and over. Even in doing his part-time job, he spends 90% of the time on the phone with me. I don't mind it... I love hearing his voice, and honestly I worry more when I don't hear from him. He's working with my dad, and although my dad would never tell me this, he tells my mom that he can tell from observing my husband at work that he's in no shape to go back to work full time. His processing time is slower... he completes tasks slower... his body betrays him and he has a hard time making those connections to his hands or his feet from the brain... drops things, trips a lot. Even tests are very subjective... it's great that my husband can still tell you who wrote Sherlock Holmes, but how does that translate to the real world? Unless he is working at a library?

Plateau would be nice. When the lady at Chamberlain and Edmonds was doing the referral and appeal paperwork, she asked me if I thought he was better or worse. I said worse. When he first got home from the hospital, he was up by 9 or 10.. went downstairs and watched tv. Made an effort to help around the house... now he's retreated into his own little world. I hadn't noticed how bad it was until she asked. He was never social anyway... it's not like he had poker night with the guys and now doesn't. But he always made a marked effort to be downstairs with the kids... he was a very hands-on father... now, he sees our 4 year old once a day, and that's when she comes in to get kisses at bedtime.

I'll look into an occupational psychologist. I have to return the new client forms to the lawyer, now seeing what disability looks for, I know what terms to use with the lawyer and what information I should be discussing with him. I can highlight the issues that I mentioned above and give the lawyer a brief description on how these impairments affect my Prince Charming. Maybe the lawyer can provide me with specific direction as to what doctors to see to help prove the claim. I understand that documentation is key. But without an idea of where to start, it makes it difficult.

His initial claim was filed in mid-October, when he was still in a coma. You would have thought it would have been approved easily then. But there was a slight snafu.... the last time my husband went to get a new social security card, the person who filed the paperwork hit 6 instead of 9 in the computer and they had his birthday wrong by 3 days. We didn't find out until January. Had to get his birth certificate and sit at the social security office and have it corrected before they could even process the claim. How did we find out? I got tired of waiting for news of how his claim was going and called social security and they told me they had no record of a claim!! I about had a stroke!! As you can imagine. So sadly, we were already past the three month mark when the paperwork finally got straightened out.

I am so sorry abuot your situation. there was a while in the beginning when I would wake up and not know where I was or what day it was. that has completely gone away. I did not leave the couch in the living room for anything except to wash for weeks at a time and that is better. I see a psychiatrist and a psychologist and if there were someone else to see I would see that person too. get all the help you can for your husband. as for the drinking it is brutal on a heard injury, old or new. just a few beers and I am dizzy and sick all over again. I wish you and your husband the best.

Thank you, MarkNeil. I find it hard to talk him (or anyone, for that matter) into getting help when the person has a hard time seeing that there is something to get help for. I adore my husband... if he had died, his would not have been the only heart to stop beating that day. That being said, he's stubborn as the day is long. I've dealt with a lot of "I know I almost died, but I didn't and now I'm ok" And that behavior persists to this day. I sort of thought that as he gained a better awareness of the impairments and limitations that he has, that that would soften with time. (And I am sure it will... someday) So far, it hasn't. Because with an awareness of how his body is revolting against him (the other night he said he kept dropping things because his fingers wouldn't work) also comes a determination to be who he was before. Well to a point, anyway... to physically be who he was before. Mentally, he has become very introspective about the person he once was, and past mistakes that he has made. Looking at this as a second chance on life... That is the positive change, he does try to self-analyze why things are the way they are. Perhaps, however, he should be doing so on a therapists couch. He doesn't have to go alone... I'm happy to attend, if he feels he needs me there. I have always felt therapy is an intensely private thing and that if there are things he wants to say that he doesn't want me to hear, I can wait outside in the waiting room... but if he wants me there, I am happy to be there, too. The choice is his.

In almost 15 years of marriage, I have seen him willingly see a doctor 3 times. Once because of a car accident we were in (we were sitting still in traffic when another car rear-ended us going 40 miles an hour- she wasn't looking) and twice for chest pains. All three times the doctors told him he needed to stay the night, all three times he refused help and checked himself out. The only reason he stayed in in-patient rehab is because he had no legal authority to leave. The hardest thing I had to do was leave him there, with him not of sound mind, and ranting and raving that he had the right to leave when he wanted to and that I needed to take him home. Every day he was there, I dealt with this. Broke my heart over and over again to see him that way. My brilliant husband... like a caged animal.

It is helpful, though... being here. Sharing his story... and having people like you tell me it does get better. It's not so much me that I worry about. If it weren't for the kids, I'd happily sit up in the bedroom with him all day. He's my best friend in the world.... him and our 14 year-old daughter. I enjoy his company... I enjoy the talks we have. I'd sit with him all day, if I could... but someone has to watch the kids. Feed them. Teach them. (homeschooled) Take care of them. I do find myself torn, because they all need me and he gets very upset when I spend too much time away from him, even when I'm with the kids. My concern here is for my husband... his quality of life. I understand he'll never be 100% the same. But I have seen flashes of that person... He can't be getting much out of life sitting on our bed watching TV... He will lose track of his days, too. He can tell you, in the aftermath, that he had a bout of depression where he stayed in our bedroom for days... but he can't tell how many days he was like that. Or he can have a flash where he realizes what he's doing- and say "I haven't been downstairs in x number of days" but he can't seem to correct it. He will feel bad about it. Tell me that he realizes I've been the one downstairs doing all the cleaning and say "I need to help you more" or realize he hasn't spent much time with the kids and say "I need to help you with their education more"... but does nothing about it. I just don't want him to feel like he missed out on years of our kids growing up... whether he returns to work or gets disability, that is an issue, sure... but right now, he's hardly an active participant in the household. And I know he feels bad about that... but I'm not sure how to help him with it. Like I said, if I make plans to take the kids out, he will drag his feet but go along (and need the entire next day to sleep) but he doesn't take the initiative, he can't stay out as long as he used to, he complains while we are out, can't tolerate heat, has trouble helping me with the kids... I know someday he's going to look back and wish that he was more of an active participant in their lives through this. I don't mind the naps... in fact, I encourage all the rest he can get... but just by the simple act of coming downstairs once in a while and sitting with the kids, would make me happy... and would thrill our kids. Sit and watch a movie with them. If you can sit on the bed and watch tv... no reason you can't sit on the couch next to our four year old and do it. At least I think... I don't push him to do it... I let him go at his own pace... should I push him more?