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» LymeNet Flash » Questions and Discussion » Medical Questions » Disability letter, anyone?

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Author Topic: Disability letter, anyone?
Ann-OH
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I am not sure where to post this so I will put it here and on Support.

My friend has requested that I see if I can find a letter that someone used in their disability appeal.

I told her that her letter needs to be very specific about her and I think that she understands that there is no form letter to be used.

I think she just wants to look at the format and see how people go about it.

I know this is a very personal matter, so maybe if people could just say what they did - what they covered first, next etc. and what went into the conclusion, that would help greatly.

Thanks,
Ann - OH

--------------------
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bettyg
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Ann, I'm going to copy/paste MY personal experience and things that are in "Betty's newbie links" I send to all newbies joining us here. Putting it here to help ANYONE ELSE needing help too.

In my 5 yrs. of personal experience, a letter does NOT cut it!

Thanks to another online friend, Julie, who has MS/Lyme and the DISINISSUES web site, which the link is below; I was able to put together my DOCUMENENTED PROOF showing from the medical experts HOW I was disabled and could NO LONGER WORK.

It was a TABLE of info explained below.
Our example was previously on the DISINISSUES SITE but the "MD's format sample" was removed!

If you have more questions, email me ok; would be happy to help your friend get what is coming to them! Bettyg [Big Grin]

*****************************
SSDI, SSI, LTD procedures:
Here is what I post for all on SSDI/SSI/LTD... I tried the link of the female MD ``template''; you are right; it's no longer good!

2 alternatives: use what I provide below as guidance since you have LYME disease and not filing for chronic fatigue.

OR go to the bad web site, click on REFRESH, and go to that site! Ask Mary, web owner, the question since she posted this on disinissues; SHE started that site! It was her close friend who okd to post her info for others. Betty Gordon

***********************************
TRYING TO GET SSDI, SS DISABILITY INSURANCE BENEFITS OR LTD:

Hi! I know what you mean about memory & typing, etc....it's the pits!

I do suggest you join the FREE DISINISSUES and read thoroughly or just print it all off of the FEMALE MD with chronic fatigue, etc. she gives wonderful, detailed examples that DDS, disability reps, want to approve/deny you.

Also have you looked thru the ADULT APPROVED LIST OF IMPAIRMENTS? That's critical also!

http://www.ssa.gov/disability/professionals/bluebook/1.00-Musculoskeletal-Adult.htm

note 1.04; look at the rest of the 14 other specific areas too....

I printed off 1-14 sections showing what brief guidelines were for each section. I used that against ALL my medical records, 3" thick!! Then I went to their DETAILED specifics for the sections that applied to my illnesses!

TIMECONSUMING....TOOK ALL 7 WEEKS from my notice of my ALJ hearing date!

So you have NOT submitted your INITIAL APP TO SS OFFICE, correct? Good, you want this to be as complete as possible so they can NOT turn you down on the 1st step as they do us all!!
=============================================

What I did with an online friend was this:

prepared a chart noting the specific section of 1 - 14 that my diagnosed illnesses showed the wording, dr. seen & date.

Example, 14.09 LYME disease is mentioned in but doesn't give any examples. So I showed 14.09 with my drs. name & date plus specific details about each visit where lyme symptoms were stated..

I hope you have a copy of ALL MEDICAL REPORTS...drs., xrays, all blood labs, etc.
It's critical that you KEEP A COPY FOR YOURSELF!
========================================

On mine, I showed the date mailed to ALJ & LAWYER PLUS I kept a copy. Then I went to copy center nearby & copied and mailed promptly to lawyer per his request.

WHY THIS IS IMPORTANT:
********************
if you have an ALJ hearing, request thru your local SS office to REVIEW your complete SSDI app at THEIR local office!

When you see things you submitted with your writing on, don't look at them!


Look & read only the secretative ``RFC & MFC''
done by the the in-staff DDS DRS & PSYCHOOGISTS!
**********************************************

You want to make copies of ALL the stuff they have & other stuff you don't have so you can use that info against them !


NOTE: I'D DO THIS DIFFERENTLY NOW!
**********************************

SEND 1 COPY TO ALJ and 1 to your lawyer!

Lawyer did NOT SEND MY REPORTS TO DDS STAFF PROMPTLY;

they didn't see many things when they denied me although I had good medical info !

Examples, 2 RFC, residual function capacity done by PCP dr. of 26 yrs. & rheumatologist;

plus 2 MFC, mental function capacity, done by psychiatrist & psychologist....the 1st person was the one judge used in APPROVING my 2nd claim for severe depression/effective disorder & anxiety .

ALJ's don't like working with LYME, FIBRO, CHRONIC FATIGUE. MENTAL is on approved list of adult approved impairment list! So don't fight it, go with it!
============================================

This message is sent upon subscription, and again monthly.

There are links to helpful websites found by clicking on 'Links'
on the Disinissues website or by going directly to
http://groups.yahoo.com/group/Disinissues/links

There are many more links, as well as advice and "useful" messages
in the Files area of the website. Go to
http://groups.yahoo.com/group/Disinissues
and click on Files.

The website provides compilations of several areas of interest which
are commonly requested and mentioned. They reflect the collected wisdom
of this group. Check them out - you just might find the information
you were looking for! Take a look at Files that are not specific to
your situation, because they might be helpful anyway - what works for
Social Security may work for LTD claims, what applies to CFS, chronic fatigue syndrome, may apply to your medical condition.

The Welcome Message and Group Guidelines are in the Files section, if
you need a refresher on how this group works.

You must register with Yahoo to use the website, but note:
Be careful not to permit your address to be put into the directory
when you register. Put as little as possible into your public profile.
You do not need a Yahoo address to use the website. Your email address
is what Yahoo calls your "alternate address."

Please let the moderators know if any links have changed.

Contact the moderators at
[email protected]
or for AOL subscribers:
Click here

BETTY NOTE: Look at the female MD''s DETAILED BACKGROUND right below this paragraph. Print off her detailed responses as to why she could NOT do her job, and then apply that to YOUR own job as to why you no longer can do any type of sustainable work now nor in the foreseeable future! NO LONGER GOOD 5-17-06:
http://www.cfids-me.org/socsec.html

*************************************
An online friend of mine from disinissues web site posted this info today, so I have copied it over here.

Subject: fibro/CFS disability info [Disinissues] what does an Functional Capacity Exam entail ?

Lyme, fibro, & CFS support group members who are/will be filing for SS Disability insurance benefits, please go to the web page shown below.

There were 9 pages of info I printed below area where you can order from fibro network a 70 page packet.

I too plan on including this info when I send my FINAL packet of info to chief ALJ before my June 16, 2005 hearing...my last chance!
=======================================

Please read the site mentioned on: WHY DISABILITY TESTING FOR FMS IS OFTEN MISLEADING ADVICE FOR FM/CFS PATIENTS AND THEIR DISABILITY TEAM.....

Also after this article are the following articles:

WHAT COULD BE CAUSING DELAYED-PHASE FLARES?

BENNETT'S METHOD FOR ASSESSING FUNCTION IN FMS..

TECTONIC CHANGES IN DISABILITY LAW by lawyer Joshua Potter, CALIF.

MEDICALLY DETERMINABLE IMPAIRMENT REQUIREMENTS FOR CFS & FMS

DOCUMENTIONATION...VIEW IT AS AN INSURANCE POLICY

I printed this out in larger print for my eyes....9 pages! Will read it thoroughly and mark up 2nd copy to go to ALJudge for my 2nd hearing as medical evidence also....

by windy Bettyg [Big Grin]

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lymednva
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The key to my winning my SSDI was the neuropsych testing that my attorney sent me for almost as soon as I hired him.

This psychologist was very thorough and picked up on small things, unlike the ones I was sent to by my LTD company.

I also had a letter from a CFIDS researcher (that was my dx at the time) and tons of info from my doctor, as well as his forms filled out with all the necessary info. He is quite experienced with disability, so that didn't hurt. He knew what they would be looking for.

You need as much documentation from professionals as you can get. That way it's not just your word against theirs. That is why just a letter won't cut it.

--------------------
Lymednva

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hopeful4
LymeNet Contributor
Member # 8486

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Hi Ann,
I'm making an assumption that you are talking about Social Security Disability. Is that correct?

I'm not sure what "letter" she is referring to. When I applied, I had tons of paperwork forms to fill out, and some for members of my family to complete.

My first application was denied. That's common. So I went to an attorney specializing in SSD. She filed an appeal, for which I won a "partial" award. It took a long time.

At the time, I didn't know I had lyme. I was diagnosed w/CFIDS. However, I didn't win the award on that, I won it on a psych evaluation with a diagnosis of depression.

I strongly suggest that your friend contact an attorney who specializes in SSD. That gives her the best chance of winning. My attorney is also helping me appeal my case to try to get the remainder of the award.

Also, check out Scott Davis's website and articles on how to win SSD:

http://tinyurl.com/j3mov

He has the following articles:


Articles on Social Security Disability and Various Other Disabilities

1. NEW! Five Reasons Judges Approve Social Security Disability Claims

2. How to Prepare for Your Social Security Disability Hearing before an Administrative Law Judge

3. Winning Your Social Security Disability Claim: 15 Mistakes You Can't Afford to Make!

4. How Does Social Security Define ``Disability'' Anyway?

5. Does having an attorney determine whether you win or lose your Social Security Disability case?

6. Obtaining Social Security Disability: How to Begin the Process

7. Seven Important Steps to Winning Your Disability Case

8. Why it is Important to Persevere in Your Disability Claim

9. How To Talk with your Physician about Supporting your Disability Claim

10. Winning Your Disability Case in Three Words...Frequency, Severity and Duration

11. Five Critical Tips to keep in Mind when Completing Disability Forms

12. Here's a ``Golden Nugget''...win your disability case by obtaining your personnel file from work

13. Winning Your Disability Case with the Help of Co-Workers, Family Members and Friends

14. Obtaining Disability Benefits . . . David vs. Goliath

15. Why it is Important to Address Psychological Issues in your Chronic Pain Disability Case

16. How to Win Your Hepatitis Disability Case

17. Not Filing a Disability Claim is a Financial Disaster Waiting to Happen

Wishing her good luck, and perserverance.
Hopeful4

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Ann-OH
Frequent Contributor (5K+ posts)
Member # 2020

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Thanks so much for all the good info!

I sent it on to her and will let you know how she does.

Ann - OH

--------------------
www.ldbullseye.com

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ConnieMc
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Member # 191

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I wrote the following for my LLMD:

Guidelines for Use in Writing Letters/Reports in Support of Social Security Benefits for Patients With Tick-borne Diseases

By: Connie MS, CRC, CVE, CCM
Disability Advocate

General principles of focus to consider when preparing this report:

1. The report/letter must have a longitudinal perspective that allows Disability Determination Services (DDS) to see the frequency, duration.,
and recurrence of major symptoms of tick-borne diseases. Medical records will generally show this, but a letter needs to state the general course of disability thus far, as well as the projected length of the disabling condition.

2. The report/letter must include descriptions of all treatment regimens and responses to therapy must be given. For example, oral antibiotics, and general response. Did this result in limited improvement, which necessitated the initiation of intravenous therapy?

3. The report/letter must include any significant restrictions the patient has experienced in his/her normal activities since the onset of the diseases. Here, we are asking the physician to describe changes in lifestyle, such as household, personal care, and social activities, as may be determined through history. Also, the physician can report any
observed limitations such as walking, climbing, etc. as the patient functions in the exam room. A ``Incapacity Checklist'' can be helpful, and
the physician can have the patient complete this for reference before the support letter is written. (A copy is at the end of this document). The patient needs to provide specific examples of limitations in function,
which the doctor can document in the letter. The advocate can then obtain supporting statements from others (friends, family) to confirm what the
patient has reported to the doctor.

4. The report/letter must report on any objective testing which has been done to determine the appropriate diagnosis. For example, any positive lab studies, and other supporting evidence such as positive SPECT scan
results, positive findings of joint inflammation on x-rays, etc. Any testing which supports the presence of illness is acceptable. Includes
the clinical examination, not just lab studies.

Once the above is established, the physician must then identify and describe the most significant and disabling symptoms frequently associated
with TBD. For example:

1. Fatigue - the existence of chronic and/or recurrent debilitating tiredness, which is demonstrated by an inability to perform basic minimal tasks of daily living (ADLs).

2. Neuropsychological - the existence of forgetfulness and distractability, inability to concentrate, memory impairments, confusion,
difficulty thinking, photophobia

3. Neurological - numbness and tingling, sensory impairment.

4. Pain - recurrent and chronic pain which significantly impedes the performance of ADLs and unrelieved by prescribed treatment. Location of
such pain and any objective findings utilized to diagnose the origin of such pain. This includes chronic headaches and myalgia.

5. Sleep disorder - Any disruption of normal sleep patterns that is recurrent and does not respond to treatment.

6. Depression - Is depression primary or secondary? Is it related to the patient's reaction to the daily physical symptoms? Are there other psychiatric symptoms present which are apparent to the physician?

7. Cardiac - heart block, hypertension, other cardiac complications.

Sample Letter

Re:
DOB:

Please be advised that I have provided medical care for Ms. Blank since 5/7/2003. Ms. Blank carries a diagnosis of persistent Lyme Disease made on the basis of a number of clinical features, including marked fatigue,
chronic relapsing pain, CNS irritability, nonrestorative sleep and severe
cognitive dysfunction. This patient is disabled by incapacitating fatigue and myalgias aggravated by repetitive or sustained physical activities.
Her symptoms are consistent with her discase, which has been confirmed by positive IgM Western Blot in May of 2003. There is also evidence on
examination of persistent disorganization of motor function as evidenced by peripheral nerve dysfunction. She frequently becomes confused during discussion of treatment recommendations, and must rely on others to insure she has information she needs to proceed with recommended treatment.

Ms. Blank has had marked impairment of her daily activities and finds it difficult to get out of bed on most days. She routinely requires
assistance with showering and dressing. She uses a cane for ambulation. She cannot stand for more than 5 minutes to prepare meals, and must obtain
assistance from others. She cannot lift or carry dishes or a gallon of milk. She cannot vacuum or mop or garden. She is unable to do laundry.
She has difficulty managing her medication and must receive assistance
from others to make sure she takes the recommended medications at the recommended times. She has difficulty getting in and out of a car and is unable to drive due to cognitive dysfunction.

Ms. Blank has been treated vigorously with oral antibiotics as well as supplements and other supportive care. There has been limited improvement thus far, and therapy with intravenous antibiotics is recommended for the
near future.

By reason of the unpredictability of the frequency of her multiple physical symptoms, Ms. Blank has been totally and permanently disabled
from engaging in, and more importantly, in sustaining any gainful employment activity, even light part-time sedentary work at home. Ms.
Blank's status has been consistent since I first began seeing her in May of 2003.

It is my opinion that she is likely to remain disabled for the foreseeable future, but, in any event, for not less than 12 consecutive months.
Prognosis remains guarded and uncertain.

Sincerely,


Name: _________________________________Date: _________________


Incapacity Checklist

How does your condition affect:

1. Your daily activities


2. Your ability to stand, sit or walk for a long period


3. Your ability to lift or carry weight


4. Your ability to understand, carry out, and remember instructions


5. Your ability to respond appropriately to your supervisor and coworkers


6. Other physical or psychological functional restrictions


7. Your ability to adjust to the stress of a work environment

Anyone who wants to provide this to their LLMD for use is more than welcome to do this. I have used this same format many times and DDS and ALJs seem to be receptive to it. It includes all the information SSA is looking for to help them allow claims.

Connie

[ 14. August 2006, 12:00 AM: Message edited by: ConnieMc ]

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bettyg
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Connie, WOW; great info you wrote and very detailed! Outstanding job. Thanks for adding it here.

May I add it to my NEWBIE'S LIST I send to newbie's when I greet them with my other disability info I showed above?

Connie, would you make sure you copy this and send to MINOUCAT who has detailed disability, etc. links galore that Treepatrol has in his newbie links? Your info would really help so many folks Connie! [group hug] [Big Grin]
Bettyg

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Ann-OH
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Thank you Connie. Every doc should have this to work from!

I sent it on to my friend and I know she will be very grateful.

Thanks again,
Ann - OH

--------------------
www.ldbullseye.com

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ConnieMc
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Member # 191

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The info I wrote can be used in any way you all want. If individuals want to print out for their LLMD, please do. I researched this thoroughly and have used this successfully in my work.

My LLMD's office uses it for all types of disability letters, not just SS.

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bettyg
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Thank you Connie for giving us all permission to use what you wrote to help others going thru the SSDI process and other situations!

I'll pass it along to others on my lyme/fibro/CFS lists members.

EDITED: I just copied it to Minoucat's disability links and Treepatrol's newbie links.

I copied it to my word, and left your words as is but formatted using bullet for your important points so the MDs would not overlook the critical data needed you explained so well Connie.
Bettyg [group hug] [kiss]

[ 14. August 2006, 02:00 AM: Message edited by: bettyg ]

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bettyg
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Betty's reformatted version of Connie Mc's info above with bullets for critical/important info!


8-12-2006 from Connie Mc, lymenet.org
I wrote the following for my LLMD:


Guidelines for Use in Writing Letters/Reports in Support of Social Security Benefits for Patients With Tick-borne Diseases

By: Connie MS, CRC, CVE, CCM,
from www.lymenet.org
Disability Advocate


General principles of focus to consider when preparing this report:

1. The report/letter must have a longitudinal perspective that allows Disability Determination Services (DDS) to see the frequency, duration, and recurrence of major symptoms of tick-borne diseases.
 Medical records will generally show this, but a letter needs to state the general course of disability thus far, as well as the projected length of the disabling condition.

2. The report/letter must include descriptions of all treatment regimens and responses to therapy must be given; example:

 oral antibiotics, and general response.
 Did this result in limited improvement, which necessitated the initiation of intravenous therapy?

3. The report/letter must include any significant restrictions the patient has experienced in his/her normal activities since the onset of the diseases.

 Here, we are asking the physician to describe changes in lifestyle, such as:
 household, personal care, and social activities, as may be determined through history.
 Also, the physician can report any observed limitations; such as,
 walking, climbing, etc. as the patient functions in the exam room.
 A ``Incapacity Checklist'' can be helpful, and the physician can have the patient complete this for reference before the support letter is written. (A copy is at the end of this document).
 The patient needs to provide specific examples of limitations in function, which the doctor can document in the letter.
 The advocate can then obtain supporting statements from others (friends, family) to confirm what the patient has reported to the doctor.

4. The report/letter must report on any objective testing which has been done to determine the appropriate diagnosis. For example,
 any positive lab studies,
 and other supporting evidence such as positive SPECT scan
results,
 positive findings of joint inflammation on x-rays, etc.
 Any testing which supports the presence of illness is acceptable.
 Includes the clinical examination, not just lab studies.


Once the above is established, the physician must then identify and describe the most significant and disabling symptoms frequently associated with TBD, tick-borne disease. For example:

1. Fatigue - the existence of chronic and/or recurrent debilitating tiredness, which is demonstrated by an inability to perform basic minimal tasks of daily living (ADLs).

2. Neuropsychological - the existence of forgetfulness and distractability, inability to concentrate, memory impairments, confusion, difficulty thinking, photophobia

3. Neurological - numbness and tingling, sensory impairment.

4. Pain - recurrent and chronic pain which significantly impedes the performance of ADLs and unrelieved by prescribed treatment.

Location of such pain and any objective findings utilized to diagnose the origin of such pain. This includes: chronic headaches and myalgia.

5. Sleep disorder - Any disruption of normal sleep patterns that is recurrent and does not respond to treatment.

6. Depression -
 Is depression primary or secondary?
 Is it related to the patient's reaction to the daily physical symptoms?
 Are there other psychiatric symptoms present which are apparent to the physician?

7. Cardiac - heart block, hypertension, and other cardiac complications.

Sample Letter

Re:
DOB:

Please be advised that I have provided medical care for Ms. Blank since 5/7/2003. Ms. Blank carries a diagnosis of persistent Lyme Disease made on the basis of a number of clinical features, including: marked fatigue, chronic relapsing pain, CNS irritability, nonrestorative sleep and severe cognitive dysfunction.

This patient is disabled by incapacitating fatigue and myalgias aggravated by repetitive or sustained physical activities.

Her symptoms are consistent with her disease, which has been confirmed by positive IgM Western Blot in May of 2003.
There is also evidence on examination of persistent disorganization of motor function as evidenced by peripheral nerve dysfunction.

 She frequently becomes confused during discussion of treatment recommendations, and must rely on others to insure she has information she needs to proceed with recommended treatment.
 Ms. Blank has had marked impairment of her daily activities and finds it difficult to get out of bed on most days.
 She routinely requires assistance with showering and dressing.
 She uses a cane for ambulation.
 She cannot stand for more than 5 minutes to prepare meals, and must obtain assistance from others.
 She cannot lift or carry dishes or a gallon of milk.
 She cannot vacuum or mop or garden.
 She is unable to do laundry.
 She has difficulty managing her medication and must receive assistance from others to make sure she takes the recommended medications at the recommended times.
 She has difficulty getting in and out of a car and is unable to drive due to cognitive dysfunction.

Ms. Blank has been treated vigorously with oral antibiotics as well as supplements and other supportive care. There has been limited improvement thus far, and therapy with intravenous antibiotics is recommended for the near future.

By reason of the unpredictability of the frequency of her multiple physical symptoms, Ms. Blank has been totally and permanently disabled from engaging in, and more importantly, in sustaining any gainful employment activity, even light part-time sedentary work at home.

 Ms. Blank's status has been consistent since I first began seeing her in May of 2003.


 It is my opinion that she is likely to remain disabled for the foreseeable future, but, in any event, for not less than 12 consecutive months. Prognosis remains guarded and uncertain.

Sincerely,


Name: ____________________________Date: _________


Incapacity Checklist

How does your condition affect:

1. Your daily activities


2. Your ability to stand, sit or walk for a long period


3. Your ability to lift or carry weight


4. Your ability to understand, carry out, and remember instructions


5. Your ability to respond appropriately to your supervisor and coworkers


6. Other physical or psychological functional restrictions


7. Your ability to adjust to the stress of a work environment

Anyone who wants to provide this to their LLMD for use is more than welcome to do this.

I have used this same format many times and DDS and ALJs seem to be receptive to it. It includes all the information SSA is looking for to help them allow claims. Connie
[14. August 2006]

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bettyg
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up; knowing of 2-3 people in this SSDI process right now; hoping they will see Connie Mc's excellent info.

If you do, go to my post where I reformatted it with bullets for important/critical stuff where a MD could check off making sure they send DDS or the admin law judge everything they should be ending. Bettyg

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