Social Security Disability and Back Problems, Arthritis and, other Musculoskeletal-Orthopedic Impairments

Medical Image of Rheumatoid Arthritis
Medical Image of Rheumatoid Arthritis

The Social Security Disability program can be complex, confusing and, frustrating. This article will help to simplify the program for those with musculoskeletal/orthopedic conditions.

In regards to ortho. related problems, the more common allegations deal with back problems, arthritis, amputations and, fractures. The program covers everything however.

You can't be working at the time you apply. Ok, technically you can work up to a certain dollar amount but your ability to work, even part time, will weigh against you...unless you are obviously disabled...like wheelchair bound for life. Your condition has to be expected to last for 12 months or longer and/or to result in death.

If eligible, your claim will be forwarded to a Disability Determination Office in the state in which you live. Sometimes there is one office in the state and sometimes multiple. Once the adjudicator gets your claim, they will contact your treating sources for medical records. If they cannot obtain enough current-recent medical records a consultative exam will be scheduled at no cost to you. They can arrange transportation (taxi service, bus tickets, etc.) if you have no way to get to your exam.You must cooperate with the process or you will likely be found not disabled due to failure to cooperate or insufficient evidence.

X rays and other imaging studies are important as are testing for range of motion, strength, reflexes, and gait. A need for an assistive device is in your favor but don't fake it cause experienced Ortho. doctors can tell. If you fake it then you can be sent to fraud, subject to surveillance and, prosecuted.

Two amputations are generally an automatic allowance. People who are permanently wheelchair or bed bound are allowed. A leg amputation with inability to effectively use a prosthesis is generally allowing. A leg fracture which does not heal within 12 months and which results in an inability to effectively ambulate can allow. Major problems with both upper extremities resulting in inability to perform fine and gross movements is generally allowing.

If not allowing by itself your impairment can still factor into a finding of disabled based upon other medical and vocational factors. For example, you may also have diabetes and a heart condition which restricts your ability to function. These impairments combined with your orthopedic problems can result in your claim being approved.

Your age is VERY important. Ages 50, 55 and 60 are especially important. The program is weighted to favor older folks which makes sense. A 42 year old can be denied but a 55 year old with the same condition can be allowed. Other non medical issues such as educational level, work history and, ability to speak English can come into play.

Once enough evidence is received your claim will be forwarded to a medical consultant. The consultant will determine your residual functional capacity in accordance with Social Security guidelines. The claim will then go back to the adjudicator who will perform additional analysis. It is the adjudicator who will ultimately make and input the decision.

To save money, a few corrupt states mostly bypass the medical consultant and have the adjudicator with a Bachelors Degree assume most of the role of medical consultant. Be very scared! This is called Single Decision Maker and is a twisted perversion of the program. In these states the medical consultant use to be a bonafide, legitimate doctor. Now it is primarily a person who never went to medical school, who has never prescribed medication and, who has never treated a patient. During the claims process you should ask your adjudicator if the state is a single decision maker state. If it is (hopefully they will tell you the truth) you should have little to no confidence in the program and if denied should definitely appeal. The "Single Decision Maker" crime happens mostly in the NW part of the nation i.e. Washington, Oregon, Idaho, Alaska...

Due to this scandal some of these states eliminated the phrase "Single Decision Maker" but still maintain the practice. So, if you ask them if they are a Single Decision Maker state they can say no when really they still are.

If you are denied you have x number of days to file an appeal. Your claim will then be reconsidered. The reversal rate is low. If you are denied again and if you appeal you then go to the third level before a judge.

The program is interpreted differently at this level in a way which is VERY favorable to you. The judges take note of all the objective findings of course but focuses more on the subjective at this level than at the prior two levels. Examples of subjective variables are pain, fatigue, etc.

The judges often get lost in historical court case precedents and lots of other legal mumbo jumbo. The judges like to pontificate to prove to everybody how smart they are. Aside from possibly annoying or boring you this does you no harm--be quiet and let them pontificate!

The bad news is it takes well over a year to get before the judge...often much more than a year. Sixty to seventy percent of all claims are reversed to an allowance at the third level. Don't try to make sense out of some of these things or you will lose your mind. You do not need an attorney or an attorney representative (like Allsup) at the first and second level but definitely do at the third level.

There are many other nuances and complexities but I've covered quite a bit of the basics herein.

Best Wishes!

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Comments 6 comments

Missing Link profile image

Missing Link 3 years ago from Oregon Author

Denied,

Most people at Allsup are good people. Most of them are just normal citizens doing a job cause they need the job to make money to pay their bills. The idea behind Allsup is a clever one.

Being a former insider with Social Security however, I can say something that orgs. like Allsup would never want to be made public----a non attorney rep (like Allsup) or an attorney rep. makes very little difference whatsoever at the initial or Recon level. It is at the 3rd level, where one goes before an ALJ (a judge) that you need a rep.

A rep. at the first or 2nd level can sometimes help with paperwork but the claimant, a friend or family member could have easily done this had they not been too lazy. With or without a rep., the decision is almost always the same at the initial or recon level.....so why give Allsup a big cut when the decision would have gone in your favor anyway?

I saw many people who were dying and the approval of their claim was a slam dunk but the claimant thought they needed Allsup. What easy money for Allsup this was---poor claimant gave part of their disability money away when they would have been easily approved without any help whatsoever. Oh well!

And then there is the issue of infiltrating private sector insurance companies to get access to their disability files...oh never mind---I don't feel like explaining it.

Organizations like Allsup are a clever business idea....like a tattoo or massage parlor on the outskirts of a military base. They are a hanger on, a remora if you will, somewhat parasitic in nature.....but clever nevertheless. Many other businesses are the same.

Allsup does help many people but mostly at the third level. Most people at Allsup are good people. Most of the line staff are outstanding. It is in the upper levels that you get the cut-throat, two faced, unscrupulous types but again this is very common in the private sector, as well as in government.

If you are going before a judge at the third level it is there I think that Allsup can help a lot. At that level you pretty much have to have a rep.---there it is a must so why not contact Allsup to see if they want to represent you----they can decline if they think you have a weak case.

I was an insider for many years and a student of the program, blah, blah, blah to anyone else who tries to throw you or anyone else off the scent.

Social Security is rife with horrendous corruption and there are way too many monstrous and dim witted people in positions of influence. I was such a fool to stay involved with it for as long as I did.


Missing Link profile image

Missing Link 3 years ago from Oregon Author

denied from 25 hours ago said:

Do NOT hire Allsup. The rep (Joe Schmoe-Missing Link changed name) at the hearing said no more than 10 words and 2 were Good morning


Missing Link profile image

Missing Link 4 years ago from Oregon Author

kikio,

It sounds like this worked out in your favor---good for you! Thanks for stopping by and for your comments--best wishes!

VE is vocational expert in case other readers were wondering.


kikio 4 years ago

I had my hearing a few weeks ago. After answering questions about hallucinations, the VE stated I could probably be a security guard. Thankfully I had a lawyer who repeated my list of symptoms to the judge and the VE had to retract her answer and admit there were no jobs I could work. Yes you will lose your mind if you try to understand some of the things that go along with the process.


Missing Link profile image

Missing Link 5 years ago from Oregon Author

stayingalivemoma,

Thanks much! I hope you were approved!!


stayingalivemoma profile image

stayingalivemoma 5 years ago from Tempe, Arizona

very good information. I am waiting on my ssdi decision now. They told me a decision has been made and I'll get a letter in the mail in 7 - 10 days. Wish me luck!

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