I don't really engage in many discussions on here, but have kept up with a lot of advice and discussion that takes place and feel confident that you can assist me in a few matters.
I was recently denied benefits, and the main reason the Administrative Law Judge stated was that my diagnosis of Lyme Disease was not supported by lab results/diagnostics. First off, while my Igenex did not support this diagnosis, my CD-57 and SPECT DID and as far as I know, these are tests that both the CDC and Insurance Companies acknowledge as legit in diagnosing Lyme (correct me if I am wrong).
To make matters even more frustrating, the ALJ did not even have a medical expert present at the hearing (only a vocational expert; whom he directed not a single question the entire hearing), yet he is still overruling my doctor's diagnosis and notes dating back 3 1/2 years.
Are the judges allowed to do that, given this is a Lyme Literate Medical Doctor, and he is a judge with no qualifications or knowledge in this field?
Also, any advice on how I could proceed in this matter would be greatly helpful -- we are of course appealing the decision, but I'm trying to figure out if there is anything else that can be done?
Thanks in advance, many blessings.
Posts: 85 | From Texas | Registered: Dec 2007
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bettyg
Unregistered
posted
hd,
so your had your 1 on 1 w/ALJUDGE, and he gave you his judgement ... NOT approved.
yes, judge can overrule your supportive llmd. he goes by what is in your MEDICAL records provided to them to make their decision.
medical expert won't be there unless YOU provide them and pay their wages...
other person is always there telling them what positions are open for other jobs in your state.
member connie mc would have the BEST advise for you since she is a NON-LAWYER represents patients in this!!
if you didn't get good enough info to alj BEFORE his decision, i'm sorry, but i personally feel you are screwed. it will go to appeals council PROVIDING your lawyer writes a BRIEF summarying why the judge is wrong.
appeals council takes 2.5 years plus before they even get your file there to review IF lawyer sent a brief!!
mine did NOT waiting on a tape from alj which never came; he then quit me 4 yrs. into my 5 yrs. of hell.
so this is my 1`st hand experience on my 1st claim; vs. 2nd claim. .... sorry, i don't sugar coat anything. **********************************************************
did you have SUPPORTIVE info like RFC? i'm going to copy/paste here to save me time ok.
did you SUPPORTIVE DR. complete a RESIDUAL FUNCTION CAPACITY, RFC, form ??
all, please go to top of SUPPORT and click on MINOUCAT'S DISABILITY info.
print it all out; huge volume of good info there especially CONNIE MC'S Q/As to be completed by your SUPPORTIVE drs.
here's the key on winning SSDI, disability insurance benefits:
now your drs. need to complete each of the questions based upon on how your HEALTH TODAY; not last day you worked:
RESIDUAL FUNCTION CAPACITY, RFC, form
how long you can do the below examples daily!' *******************************************************
0-2 hrs., 2-4, 4-6 , and 6-8 hours
sitting, standing lifting crawling bending climbing using your hands cognitive skills
it's these things your being approved for will win your case! NEVER THE ILLNESSES when it is NOT on the list of approved list of impairments!!
so for those denied or just submitted, go immediately to minoucat's info and print it off; read over and over to comprehend it all.
then get those needed documents to build your case of winning 1st time, 1st step. otherwise it takes 2.5 years to get your admin law judge hearing face-to-face or a LIVE CONFERENCE video one.
we're all speaking from personal experiences.
in my case, my hired lawyer of almost 4 entire years quit me when 1st was at appeals council where he did NOT SUBMIT A BRIEF; so after 2.5 yrs. of being there and NOT opened; AC did NOT have to look at my 3-4" file. they only had to look over my denial from aljudge's notes!!
i went thru both of my 2 claims and started noting things taking 8 wks. to do this. typed up my report and used their list of APPROVED IMPAIRMENTS showing their chapters that matched my medical conditions documented by drs.
had connie's special Q/A forms completed, and i feel the things I DID were what won it for me, and i had a video live w/judge. he said it would be several months before i heard from him and NOT TO CALL HIM.
he approved me in 2 wks!! went back 3 yrs. but NOT back to 1st claim!
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posted
Betty, Thanks for your response -- all of the documents were there, however this ALJ seemed to have it out for me from the get-go.
The ALJ spoke negatively of my LLMD right away and shot down the Lyme DX despite my low CD-57, SPECT scan, and years worth of clinical observations.
My law group has submitted the appeal, but I am anxious to hear others thoughts that have more experience than I.
I will reference Connie's documents, and hopefully she will be willing to chime in a bit. Anyone else, feel free to PM me if that is easier, I would greatly appreciate it! Thanks again for your time, Betty!
Posts: 85 | From Texas | Registered: Dec 2007
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bettyg
Unregistered
posted
hd,
also my 1st alj was somewhat like yours.
he wouldn't let me finish sentences; i had my heating pad going on me full power too due to my extreme pain, and REFUSED to let me go to the bathroom when i needed to.
lawyer finally convinced him to let me go while voc rehab man gave his summary.
when i got back i heard tail end of his summary... after the IF this were to occur, what positions could i do.
1st time he gave 3 jobs; 2nd time using my drs. medical report stating i could not work at all, etc. voc rehab said NO JOBS would there be since i took so much sick leave months due to my many illnesses and going to bathroom all day long.
still alj DENIED me!
go also to ss.gov site...you've got to spell it out, and minoutcat's site probably has it there.
read about SSDI; they put alot of stuff in their files ... open to public.
but study minoucat's info 1st ok.
did your dr. do a RFC that i mentioned above showing how many hours you could do the PHYSICAL THINGS.
on my 2 claims, LABS/ETC. were NOT considered or at least did not appear in my written denial or approval on 2nd one!
Then get a copy of the Johns Hopkins blood test study showing 75% of people are missed with blood tests for Lyme.
Then get the IDiots studies on the trials they always quote.
In them they have categories stating XX number of people in their study had Lyme but negative tests... and XX number had symptoms remaining after being treated with IDSA protocols.
Use the IDiots stuff to prove your point. It is out there... just takes some searching.
Trying to use ONLY a LLMD's opinion usually won't get it... even if Superman is your LLMD.
I would also.. if you have symptoms.. see a chiropractor.
Number one.. they usually can help you feel and be better.
Number two... they usually take insurance.
Number three.... they can document ongoing symptoms and problems you are having on a regular basis and the need for help from various fields of medicine for various things.
Number 4... that vocational "expert" ... they often suck... can't carry a chiropractors socks when it comes to their one time assessment... and the chiro's ongoing documentation.
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You said... "my CD-57 and SPECT DID and as far as I know, these are tests that both the CDC and Insurance Companies acknowledge as legit in diagnosing Lyme (correct me if I am wrong)."
Personally I've never heard of these tests being used to diagnose Lyme... not by themselves.
They can indicate problems but they can not say if a person has Lyme or not ... in the true sense of the word.
Try NOT to focus on Lyme but the problems you have as a result.
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
KNEW I'd forget something...
Print out a copy of the Connecticut Attorney General's Press Release from May 2008.
Your attorneys should read and be familiar with it so they can use it to counter the corruption the other side is using as their foundation for your denial.
Thank you both for your time and willingness to offer me some guidance. I loved the IDiots mention, by the way.
I am working on all of those documents you referenced and will be submitting everything to my lawyers and such. I'm guessing I have at least a year in the interim...
Posts: 85 | From Texas | Registered: Dec 2007
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bettyg
Unregistered
posted
remember to make copies of everything!
i noted dates on everything i sent to who..lawyer/dds with my name as they're going to ask who wrote on these.
later you will want to review your entire SS file in your local office before having admin law judge hearing so you can use THEIR info against them! and prove them wrong.
that's why it's important to make comments on YOUR info; saves you time reading them in SS office where everyone notes everythign you do!!
how you are dressed; if you're organized, how you walk, behave, EVERYTHING.
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Bugg
Frequent Contributor (1K+ posts)
Member # 8095
posted
HamDune-
I assume that your attorneys are working on submitting a brief (letter) to the Appeals Council. As you may know, it can take the Appeals Council anywhere from 3 months to 24 months to render a decision depending upon the "backlog" in your area. Your attorneys should be familiar with the typical turnaround...
As you may know, the Appeals Council will either 1) deny a review (which in essence is the same as a denial or 2) the ALJ will reverse the ALJ's decision or 3) return it to an ALJ for another review. In their brief, your attorneys are going to argue that the ALJ made reversible mistakes and so the case should be reversed or remanded. A common argument is that the ALJ's decision was not supported by substantial evidence (meaning the medical evidence in the record).
This is where you should assist your attorneys (when they write the brief) by showing that the evidence the ALJ relied upon to make his decision does not support his determination. I think the best strategy is to be very brief and precise about the ALJ's error. For example, if the ALJ said lab reports submitted do not support a lyme disease diagnosis, you might want to focus on substantiating how SPECT scans, for ex., are repeteadly used as diagnostic indicators for lyme...submit medical abstracts/studies to substantiate this claim.....The focus is on what the ALJ had in the record at the time of his decision and how he neglected (erred) in his review of the medical evidence before him (mainly by ignoring critical evidence that's ROUTINELY AND SIGNIFICANTLY relied upon to diagnose lyme)....Also, make sure he didn't ignore critical pieces of evidence (for example you may have submitted mental health records which he didn't even examine)...
You've got to remember, though, that you're working with what the ALJ had to review at the time of his decision (ie what was in the record)...
Hope this helps...
Posts: 1155 | From Southeast | Registered: Oct 2005
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