A Letter in the Mail.

In the words of the great Chuck D: “I got a letter from the government the other day. I opened and read it…” . Unfortunately, it didn’t say they were suckers. After almost a year of sending in medical information, speaking with my attorney and going to see State Appointed doctors and psychiatrists, the letter I received from the government said their decision.

I was denied.

“Based on the review of your health problems you do not qualify…This is because you are not disabled under our rules.”

So, according to their rules:

The evaluation of disability on the basis of mental disorders requires documentation of a medically determinable impairment(s), consideration of the degree of limitation such impairment(s) may impose on your ability to work, and consideration of whether these limitations have lasted or are expected to last for a continuous period of at least 12 months… (12.05); anxiety-related disorders

I was diagnosed with bipolar disorder and anxiety back in 2007, so I definitely meet the 12 months mark and I have been in both inpatient and outpatient facilities throughout those 9 years, plus been through multiple shrinks and therapists.

Here’s the funny part. In the year that they have been examining my case. The evidence that they used to determine this decision was based on:

  1. My primary care physician
  2. My therapist’s notes
  3. Their psychiatrist
  4. Their doctor.

Despite the fact that I submitted all of my hospitalizations, my past psychiatrists, my past therapists, and that they have had a year to call or fax these people, they only use their shit and two sources that I submitted to make their decision?

 

To me this does not satisfy Paragraph B of these rules:

B. Need for medical evidence: We must establish the existence of a medically determinable impairment(s) of the required duration by medical evidence consisting of symptoms, signs, and laboratory findings (including psychological test findings).

They did not weigh all of the evidence submitted that shows the existence of my impairments and symptoms by their own admission. So the next section is not even completely measured correctly.

C. Assessment of severity: We measure severity according to the functional limitations imposed by your medically determinable mental impairment(s). We assess functional limitations using the four criteria in paragraph B

You didn’t use all of the evidence submitted in paragraph B; however lets’ look at this anyway.

1. Activities of daily living include adaptive activities such as cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, caring appropriately for your grooming and hygiene, using telephones and directories, and using a post office.

OK, some of these I can do. I clean like a beast because I am manic/hypomanic and I have OCD and I obsess about things “looking right”.  Shopping? Only if its during off peak hours, I have popped a clonazepam and chased it with a red bull.  the wife pays the bills but I could if needed, I can shower and wipe my own ass; however I admittedly do not shower every day and my hygiene is a bit laxed. Yeah, I can use a phone and look-up a number. Going to a post-office would actually be a challenge because it involves people as well as public transportation.

2. Social functioning refers to your capacity to interact independently, appropriately, effectively, and on a sustained basis with other individuals. Social functioning includes the ability to get along with others, such as family members, friends, neighbors, grocery clerks, landlords, or bus drivers. You may demonstrate impaired social functioning by, for example, a history of altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships, or social isolation.

Yeah, see here is the one that I would fail at. I don’t get along with people. Right now I am supposed to be going over to my friends house, which I am late for because all of my friends went to a “music in the park” thing and I said a big nope to that because of the crowd. I can stand family members to an extent; however my wife has a large family and when we have large family gatherings I get anxious. I have been fired a few times, and laid off a few times. So, this is a big thing. I fail at social functioning.

3. Concentration, persistence or pace refers to the ability to sustain focused attention and concentration sufficiently long to permit the timely and appropriate completion of tasks commonly found in work settings. Limitations in concentration, persistence, or pace are best observed in work settings, but may also be reflected by limitations in other settings.

This is another place where I noticed that my anxiety and my depression were taking a toll. I was getting to a point where I was not able to concentrate on my work and not able to close as many cases as I used to. I was having to take more frequent breaks to deal with my anxiety or because I just didn’t have the energy to do the job due to my depression. I was also getting more and more frustrated with my co-workers and leads and lashing out.

4. Episodes of decompensation are exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning, as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace. Episodes of decompensation may be demonstrated by an exacerbation in symptoms or signs that would ordinarily require increased treatment or a less stressful situation (or a combination of the two). Episodes of decompensation may be inferred from medical records showing significant alteration in medication; or documentation of the need for a more structured psychological support system (e.g., hospitalizations, placement in a halfway house, or a highly structured and directing household); or other relevant information in the record about the existence, severity, and duration of the episode.

The term repeated episodes of decompensation, each of extended duration in these listings means three episodes within 1 year, or an average of once every 4 months, each lasting for at least 2 weeks. If you have experienced more frequent episodes of shorter duration or less frequent episodes of longer duration, we must use judgment to determine if the duration and functional effects of the episodes are of equal severity and may be used to substitute for the listed finding in a determination of equivalence.

Basically, this to me just means have you gone into the hospital a lot? Have your meds changed a lot? Well, they apparently didn’t review mine enough.

So, this list of what is covered and how it is covered goes on and on and by these rules and criteria, I meet the demands; however these geniuses just didn’t weigh the evidence. Now I have to call my attorney on Tuesday and we start the appeal process. It looks like this is probably going to go to a hearing and my nightmare is going to come true.

Now, I have to go get in the shower and go see my friends.

I think that is what I need right now.

 

 

 

 

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s