Appealing Disability Benefits

[01ajp2012]

I reside in Pennsylvania. I was told by a state worker to apply for SSDI benefits for my son. His differences are as follows:

-Syndactyly of the first digit bilaterally
-Ectrodactyly of the second digit bilaterally on upper and lower extremities.
-Missing joint(s) in fifth digit on right hand.

I applied, listed these differences, and the fact he will need therapy and surgery, plus will be affected due to having significantly less than the amount of normal digits. I received the denial notice in the mail the other day, stating: "Medical findings reveal that he has a deformity of his feet and hands; however, he maintains adequate function and mobility. The evidence does not show any other condition that does not impact his daily functioning." This is FALSE. He is impacted, and is behind in development as far as his hands go for a 3 month old child.

 

[TheGeekess]

I reside in Pennsylvania. I was told by a state worker to apply for SSDI benefits for my son. His differences are as follows:

-Syndactyly of the first digit bilaterally
-Ectrodactyly of the second digit bilaterally on upper and lower extremities.
-Missing joint(s) in fifth digit on right hand.

I applied, listed these differences, and the fact he will need therapy and surgery, plus will be affected due to having significantly less than the amount of normal digits. I received the denial notice in the mail the other day, stating: "Medical findings reveal that he has a deformity of his feet and hands; however, he maintains adequate function and mobility. The evidence does not show any other condition that does not impact his daily functioning." This is FALSE. He is impacted, and is behind in development as far as his hands go for a 3 month old child.

What ADL*s do you think a 3 MONTH OLD performs?

*Activities of Daily Life

 

[01ajp2012]

First of all, the condescending manner is not appreciated. Second, just because he is a 3 month old child, does not mean he doesn't have ADL; they are just in different means. As a 3 month old, he should not be keeping his hands in fists at all times, he should be beginning to grip things, even if he doesn't hold on to them long, and should be showing signs of rolling over, or at least attempting to. None of which he does. He is greater than or equal to 25% delayed in his development for his age group.

 

[Zigner]

http://arabiaenglish.babycenter.com/baby/development/03month/

Better arm, leg, and hand co-ordination
Your baby can now wave his arms and kick his legs. As his hip and knee joints become more flexible, his kicks are getting stronger. And if you hold him up with his feet on the floor he should push down on his legs now. He can bring both hands together and open his fingers, though he'll probably use a closed fist to bat at dangling objects. (Of course, swatting at a toy or other object is developmental progress in itself!) Encourage his hand development by holding out a toy to see if he'll grasp it.


I think each child is different...it's a bit early to assume that his ADL is affected enough to qualify for disability.

 

[BL]

I reside in Pennsylvania. I was told by a state worker to apply for SSDI benefits for my son. His differences are as follows:

-Syndactyly of the first digit bilaterally
-Ectrodactyly of the second digit bilaterally on upper and lower extremities.
-Missing joint(s) in fifth digit on right hand.

I applied, listed these differences, and the fact he will need therapy and surgery, plus will be affected due to having significantly less than the amount of normal digits. I received the denial notice in the mail the other day, stating: "Medical findings reveal that he has a deformity of his feet and hands; however, he maintains adequate function and mobility. The evidence does not show any other condition that does not impact his daily functioning." This is FALSE. He is impacted, and is behind in development as far as his hands go for a 3 month old child.

If you were told by a State Welfare worker ,applying for SSI benefits may have been a requirement.

You have to read the decision on how to appeal and the time line to do so.

You file for a reconsideration.

Understanding Supplemental Security Income (SSI)-- Appeals Process

If you can not print the form , call SSA and ask to be sent a form ,or you can go to your SSA office and ask for help filling the form out to submit.

No attorney necessary at this point.

If the reconsideration is denied ,you may want to consult an SSI attorney .

If they believe you have a chance at winning they should take the case on a contingency bases.Meaning if you lose they receive no money.if they win ,they receive about 25% of back payment amounts.

 

[01ajp2012]

I agree completely that each child is different. I work in the healthcare industry, so I have seen various stages of development in infants. At birth, the pediatricians determined that he will have issues, need surgery and therapy. It's not a possibility, it's a fact, and just a matter of how delayed he will be. And let it be clear that I am not out to be a welfare seeker, or to label my child as "disabled" because that's not the case. If I get denied, I get denied. It's the principle of the matter that my child has differences that are and will affect him, yet someone who's child is diagnosed with ADD or ADHD, they will get SSDI no problem.

 

[BL]

I agree completely that each child is different. I work in the healthcare industry, so I have seen various stages of development in infants. At birth, the pediatricians determined that he will have issues, need surgery and therapy. It's not a possibility, it's a fact, and just a matter of how delayed he will be. And let it be clear that I am not out to be a welfare seeker, or to label my child as "disabled" because that's not the case. If I get denied, I get denied. It's the principle of the matter that my child has differences that are and will affect him, yet someone who's child is diagnosed with ADD or ADHD, they will get SSDI no problem.

Your child is not of an age to compare that scenario ,and most likely denied because there is movement and being 3 months old .

In a nut shell , IMO ,it's to early.

 

[FlyingRon]

First of all, the condescending manner is not appreciated. Second, just because he is a 3 month old child, does not mean he doesn't have ADL; they are just in different means. As a 3 month old, he should not be keeping his hands in fists at all times, he should be beginning to grip things, even if he doesn't hold on to them long, and should be showing signs of rolling over, or at least attempting to. None of which he does. He is greater than or equal to 25% delayed in his development for his age group.

Unfortunately, being affected is not the criteria. Being delayed in development is not a criteria. At three months it would be really hard to show in a hand deformity case that there is sufficient disability as Zigner (perhaps sarcastically put it) in the criteria. He may qualify later when it can be showed that he is unable to care for himself in ADDITION to limitations in mobility and manipulating objects, but just being delayed in such things isn't a criteria for SSI/SSDI disability. You need to be three standards of deviations out in 2 or more of the functional categories. This will be near impossible to justify at this point. The only real way around this is if his condition matches something they already have guidance for (like down's syndrome, FAS, etc...) but in this case it sounds like they've not got such a match.

Of course, at least trying, is often required by some state agencies. You can still go back and argue with the state/local services that he deserves developmental assistance even if not officially disabled.

 

[01ajp2012]

Movement, yet not proper movement. This isn't my opinion. This has been stated by medical professionals, i.e. his pediatrician, chiropractor, and orthopedic surgeon. This coming week he will be evaluated by a therapist who will determine exactly how delayed he is.

 

[BL]

Movement, yet not proper movement. This isn't my opinion. This has been stated by medical professionals, i.e. his pediatrician, chiropractor, and orthopedic surgeon. This coming week he will be evaluated by a therapist who will determine exactly how delayed he is.

Then wait till the child is re-evaluated and file a reconsideration providing any new evidence,as I described in my other post.

It doesn't cost a thing, and arguing it on this board will get nowhere.

 

[01ajp2012]

FlyingRon,

I'm not sure where you obtained your knowledge on the criteria.

Health problems must:

result in marked and severe functional limitations (which they do), and last, or be expected to last, for at least 12 months in a row, or result in death (which they will last). I also read, and forgive me because I don't have the source (I believe it was off of ssa.gov) under the Musculoskeletal section, and he qualifies under their specifications for that as well.

 

[01ajp2012]

I am going to appeal it, however, that brings me to my next question. I have read everything online about having to do a recon, then requesting a hearing, and whatnot. However, in the letter that was sent to me, it says that I have the right to request a hearing, and gives me no other options. It tells me to fill out the Appeal form and the request for appeal form. I'm just curious why mine says that, rather than giving me the option to recon and then request a hearing?

 

[Zigner]

For the record, I was not being sarcastic.

And, I have heard (and witnessed) that just about everyone gets denied 3 times before they're approved. Of course, my observations represented a very very very tiny portion of the whole


OP - don't give up, but please do be aware of all aspects of the situation.

 

[FlyingRon]

This site may be of use to you http://www.ultimatedisabilityguide.com/

 

[Ozark_Sophist]

Generally, 15% who apply qualify on initial application. Some of these people have terminal conditions. Of those who continue through each appeals process step, about 85% generally are approved.