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SSI Appeal

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Pinkie39

Member
What is the name of your state? Ohio

Hello all,

My 47 year old brother was recently denied for SSI and I have a question about the appeals process. My sister and I are his authorized representatives with the SSA.

He has a long history of severe mental illness, for which he had received treatment/been involuntarily hospitalized for, in the past. He suffered a stroke in March, due to undiagnosed high blood pressure and diabetes. The stroke left him paralyzed on his right (dominant side).

Prior to the stroke, he had not worked in over 10 years, due to his mental illness. He lived with our elderly mother and was her caretaker. He has no high school diploma, and his prior work experience was in low paying, unskilled jobs.

He's been in several rehab facilities continuously since March, and is essentially homeless, as our mother died a week after his stroke.

He's made a lot of progress since the stroke, but is still disabled. He can only walk very short distances with a cane or walker. He can only stand for a few minutes at a time. He can lift his right arm a bit, and can grasp things with his right hand, but he can't release them. He solely uses his left arm/hand now. He has cognitive issues as a result of the stroke, like long term memory loss, and I believe some vision damage as well. He was put back on psychiatric medications at the rehab facility where he is currently.

I'm very surprised his SSI application was denied, although I've heard most are denied initially.

I know there are attorneys who will take Social Security appeals cases on contingency. However, he would only be SSI eligible, due to no work credits in the past 10 years. I know SSI normally gets reduced to $30 a month when someone is hospitalized or in a facility over 30 days.

My question is then, is the likelihood of an attorney taking his case on contingency slim to none, since there would presumably be little back pay for the attorney to collect from? I suspect that's the case, but I'd like to be sure.
 
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adjusterjack

Senior Member
My question is then, is the likelihood of an attorney taking his case on contingency slim to none, since there would presumably be little back pay for the attorney to collect from? I suspect that's the case, but I'd like to be sure.
Ask a social security attorney instead of strangers on the internet.
 

doucar

Junior Member
Attorneys take these cases on contingency all the time. You can also try your local legal aid society who, if he is eligible, take the case for no fee at all.
 

Janke

Member
What is the name of your state? Ohio

Hello all,

My 47 year old brother was recently denied for SSI and I have a question about the appeals process. My sister and I are his authorized representatives with the SSA.

He has a long history of severe mental illness, for which he had received treatment/been involuntarily hospitalized for, in the past. He suffered a stroke in March, due to undiagnosed high blood pressure and diabetes. The stroke left him paralyzed on his right (dominant side).

Prior to the stroke, he had not worked in over 10 years, due to his mental illness. He lived with our elderly mother and was her caretaker. He has no high school diploma, and his prior work experience was in low paying, unskilled jobs.

He's been in several rehab facilities continuously since March, and is essentially homeless, as our mother died a week spree his stroke.

He's made a lot of progress since the stroke, but is still disabled. He can only walk very short distances with a cane or walker. He can only stand for a few minutes at a time. He can lift his right arm a bit, and can grasp things with his right hand, but he can't release them. He solely uses his left arm/hand now. He has cognitive issues as a result of the stroke, like long term memory loss, and I believe some vision damage as well. He was put back on psychiatric medications at the rehab facility where he is currently.

I'm very surprised his SSI application was denied, although I've heard most are denied initially.

I know there are attorneys who will take Social Security appeals cases on contingency. However, he would only be SSI eligible, due to no work credits in the past 10 years. I know SSI normally gets reduced to $30 a month when someone is hospitalized or in a facility over 30 days.

My question is then, is the likelihood of an attorney taking his case on contingency slim to none, since there would presumably be little back pay for the attorney to collect from? I suspect that's the case, but I'd like to be sure.

If your brother's case is still at the first appeal level, the reconsideration, I would encourage you to become much more proactive in the appeal. First thing you need to do is get a CD copy of the file and read the whole thing. I am quite surprised that your brother would be denied, based on how you describe his condition. Quite surprised. So it makes me wonder what information is missing? What didn't get to the DDS analyst?

My suggestion, only if this is still at the first appeal level reconsideration, is for you to do it yourself by reading the file and try to follow the logic of the decisionmaker, the DDS analyst.

My own father's initial claim was denied but then approved on recon after we discovered a critical piece of information was missing.

It could be a duration issue; the DDS analyst may have not been able to approve it so soon after the date of onset, so you should also focus on the long term recovery and loss of function time. How long will he be unable to work and why. What evidence points to that.

I think a well written recon appeal, referencing evidence in the file, might get him approved without an attorney.

Now, if this is at the OHO hearing level, well, you will just have to shop around for an attorney. You don't need to volunteer that you think the back pay will be low. You might be wrong anyway. Just what is his Date Last Insured for SSDI and has an SSDI claim been filed and had medical determination that he was not disabled before DLI? How many times did he file SSDI claims in his life and how far were those appealed? You said he has a lifelong history of mental illness. Date of onset of disability can be difficult to pin down, and is generally based on specific medical evidence. How much medical evidence is there before DLI? Has it been evaluated by SSA/DDS?
 

Pinkie39

Member
Hi janke,

Thank you so much for replying!

I had initially applied online for my brother about a week after his stroke in March. He was denied for SSDI for not having enough work credits in the past 10 years, which I assumed would happen. But I thought they would then review his eligibility for SSI.

I called the SSA to inquire, and was told SSI requires a separate application. They scheduled a phone appointment to apply for mid August.

My/our sister then completed the SSI application over the phone, with my brother and a social worker for the facility where he's staying. She said it took about 2 hours.

My sister is a licensed professional counselor, with her own practice and two decades of work experience in the mental health field, so I assume she was able to provide them with very detailed information about our brother's mental health history.

He was diagnosed with schizophrenia at about age 24. He's been involuntarily institutionalized once, and held at a hospital psych ward for several days the second time. The first facility where he was placed closed probably 15 years ago, and I don't know where their records went. It was a city psychiatric hospital. He was also arrested once, in 2010, for assaulting a family member, after a psychotic episode, but was not charged with a crime, and was released from jail after a few days.

He was stabilized on medication after the first hospitalization, and held down the same full time job for 10 years, although he continued to live with our mother. He lost his medical insurance when his employer closed, and he went off his medication, causing his schizophrenia to relapse.

The 3 day hold at a hospital psych ward occurred after that. He never went back to work after losing his job in 2008, and once he relapsed, he refused to leave the house for the next decade, except to run errands for our mother. He would not willingly see a doctor, as he was afraid of being institutionalized again. Hence the undiagnosed high blood pressure and diabetes. He ended up back on psych medication after his stroke, when he had a psychotic episode at the nursing facility.

I saw my brother yesterday, and he gave me the denial letter from the SSA.

This what it says:

"We have determined your condition was not disabling on any dare through 3/31/2013, when you were last insured for disability benefits. In deciding this, we considered the medical records, your statements and how your condition affected your ability to work.

You said you were disabled due to schizophrenia, stroke, depression, high blood pressure, diabetes, sleep apnea and chest pain. In order to be entitled to benefits, your condition must be found to be severe prior to 03/31/2013. The evidence in file is not sufficient to fully evaluate your claim and the evidence needed cannot be obtained".

So, it looks to me like he was denied a second time for SSDI, rather than being evaluated for SSI, because they're looking back to 2013, rather than 2019, when he had the stroke. Am I reading it correctly?
 
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Pinkie39

Member
Oh, I forgot to mention that my brother had also applied for SSDI back in 2009 I believe it was. He was denied because he refused to go to an evaluation appointment with a doctor appointed by the SSA. He said he went to an appointment with a SSA doctor and a SSA psychiatrist this time.
 

Janke

Member
Hi janke,

Thank you so much for replying!

I had initially applied online for my brother about a week after his stroke in March. He was denied for SSDI for not having enough work credits in the past 10 years, which I assumed would happen. But I thought they would then review his eligibility for SSI.

I called the SSA to inquire, and was told SSI requires a separate application. They scheduled a phone appointment to apply for mid August.

My/our sister then completed the SSI application over the phone, with my brother and a social worker for the facility where he's staying. She said it took about 2 hours.

My sister is a licensed professional counselor, with her own practice and two decades of work experience in the mental health field, so I assume she was able to provide them with very detailed information about our brother's mental health history.

He was diagnosed with schizophrenia at about age 24. He's been involuntarily institutionalized once, and held at a hospital psych ward for several days the second time. The first facility where he was placed closed probably 15 years ago, and I don't know where their records went. It was a city psychiatric hospital. He was also arrested once, in 2010, for assaulting a family member, after a psychotic episode, but was not charged with a crime, and was released from jail after a few days.

He was stabilized on medication after the first hospitalization, and held down the same full time job for 10 years, although he continued to live with our mother. He lost his medical insurance when his employer closed, and he went off his medication, causing his schizophrenia to relapse.

The 3 day hold at a hospital psych ward occurred after that. He never went back to work after losing his job in 2008, and once he relapsed, he refused to leave the house for the next decade, except to run errands for our mother. He would not willingly see a doctor, as he was afraid of being institutionalized again. Hence the undiagnosed high blood pressure and diabetes. He ended up back on psych medication after his stroke, when he had a psychotic episode at the nursing facility.

I saw my brother yesterday, and he gave me the denial letter from the SSA.

This what it says:

"We have determined your condition was not disabling on any dare through 3/31/2013, when you were last insured for disability benefits. In deciding this, we considered the medical records, your statements and how your condition affected your ability to work.

You said you were disabled due to schizophrenia, stroke, depression, high blood pressure, diabetes, sleep apnea and chest pain. In order to be entitled to benefits, your condition must be found to be severe prior to 03/31/2013. The evidence in file is not sufficient to fully evaluate your claim and the evidence needed cannot be obtained".

So, it looks to me like he was denied a second time for SSDI, rather than being evaluated for SSI, because they're looking back to 2013, rather than 2019, when he had the stroke. Am I reading it correctly?

It is highly possible that both and SSI and an SSDI claim were being evaluated. Separate letters are sent. If there is no notice with the title Supplemental Security Income on the letterhead, then it is not an SSI denial letter.

I am actually happy to know that SSA took a second look at the prior claim and the onset before 3/31/13. It means that they did attempt to locate sufficient medical evidence dated before 2013 in order to make a substantive decision about SSDI. Unfortunately it is unfavorable, and from your description, there isn't any evidence that can be found for that period. But at least there was a formal attempt, not just ignored. Sometimes a case can turn on just one document. But he doesn't have any medical records dated before 3/31/2013 so that permanently closes the door on SSDI; which you suspected.

I think it is possible that the SSI claim is still pending at DDS or has been referred to the field office for recontact after approval. Unless you have an official SSI denial letter, that is my best guess about the status of your brother's claim. Based on what you have said. I find it very difficult to believe he was found not disabled for SSI.

But remember my opinion makes zero difference. Curious about the outcome of this.
 

Pinkie39

Member
Than
It is highly possible that both and SSI and an SSDI claim were being evaluated. Separate letters are sent. If there is no notice with the title Supplemental Security Income on the letterhead, then it is not an SSI denial letter.

I am actually happy to know that SSA took a second look at the prior claim and the onset before 3/31/13. It means that they did attempt to locate sufficient medical evidence dated before 2013 in order to make a substantive decision about SSDI. Unfortunately it is unfavorable, and from your description, there isn't any evidence that can be found for that period. But at least there was a formal attempt, not just ignored. Sometimes a case can turn on just one document. But he doesn't have any medical records dated before 3/31/2013 so that permanently closes the door on SSDI; which you suspected.

I think it is possible that the SSI claim is still pending at DDS or has been referred to the field office for recontact after approval. Unless you have an official SSI denial letter, that is my best guess about the status of your brother's claim. Based on what you have said. I find it very difficult to believe he was found not disabled for SSI.

But remember my opinion makes zero difference. Curious about the outcome of this.
Thank you so much, Janke. The heading of the letter just says "Social Security Notice" followed by "Disability Insurance Benefits". No mention of SSI.

I will appeal in the meantime, and hopefully we get a second, favorable decision on SSI.
 

Janke

Member
Than


Thank you so much, Janke. The heading of the letter just says "Social Security Notice" followed by "Disability Insurance Benefits". No mention of SSI.

I will appeal in the meantime, and hopefully we get a second, favorable decision on SSI.

You should be able to call and get an answer on the status of the SSI claim. This week will be bare bones staff but employees will be there tomorrow.

The point of appealing the SSDI claim is to prove he was disabled before 3/31/2013 so no medical evidence dated after that date will be at all helpful, useful or worth submitting. The serious issues that happened in 2019, like the stroke and the hospitalization, is not at all helpful.

Was your brother disabled in 2013? You believe the answer is yes. It is possible that the answer is yes. Do you know of any medical evidence that was dated before 3/31/2013 that has not yet been found? That is what you need. It may not exist, but without it, your brother doesn't have a chance of being approved for SSDI. Any appeal will be quickly denied since there is no new medical evidence to look at. You said he had a long history including involuntary hospitalizations. That is the evidence you need to find. All of it. SSA will make an attempt to find it and will then quit. Burden is on you.

What have they found so far? What is missing? You need a copy of the CD of the claim file.

And you need to know for sure that the SSI is still pending and focus on that claim. Doesn't mean he shouldn't appeal the SSDI denial, but the priority now is the SSI claim.
 

Pinkie39

Member
You should be able to call and get an answer on the status of the SSI claim. This week will be bare bones staff but employees will be there tomorrow.

The point of appealing the SSDI claim is to prove he was disabled before 3/31/2013 so no medical evidence dated after that date will be at all helpful, useful or worth submitting. The serious issues that happened in 2019, like the stroke and the hospitalization, is not at all helpful.

Was your brother disabled in 2013? You believe the answer is yes. It is possible that the answer is yes. Do you know of any medical evidence that was dated before 3/31/2013 that has not yet been found? That is what you need. It may not exist, but without it, your brother doesn't have a chance of being approved for SSDI. Any appeal will be quickly denied since there is no new medical evidence to look at. You said he had a long history including involuntary hospitalizations. That is the evidence you need to find. All of it. SSA will make an attempt to find it and will then quit. Burden is on you.

What have they found so far? What is missing? You need a copy of the CD of the claim file.

And you need to know for sure that the SSI is still pending and focus on that claim. Doesn't mean he shouldn't appeal the SSDI denial, but the priority now is the SSI claim.
Thank you Janke, that is very helpful. I will try to give the SSA a call this week.

I'm not so worried about the SSDI claim as much as the SSI one. My brother only worked at low paying jobs when he was employed, so I doubt SSDI would pay him much more than SSI. I believe the most he ever earned was $9 or $10 an hour, back in 2008.

I will ask about getting a copy of his file when I call as well.
 

Janke

Member
Thank you Janke, that is very helpful. I will try to give the SSA a call this week.

I'm not so worried about the SSDI claim as much as the SSI one. My brother only worked at low paying jobs when he was employed, so I doubt SSDI would pay him much more than SSI. I believe the most he ever earned was $9 or $10 an hour, back in 2008.

I will ask about getting a copy of his file when I call as well.

The SSDI may not be higher than SSI, but it is not a welfare, means-tested benefit. If he gets any other income, like inheritances, some insurance settlements, gifts, free food or shelter, gambling winnings, etc. it affects SSI dollar for dollar. Not true with SSDI. Also he can only have $2000 in savings and no non-home real estate. He would be very limited on what he could own if he was only on SSI. That may not matter ever in his life, but things can happen. Also, he would be on Medicare earlier than age 65 and that often makes a difference than straight Medicaid.

But the SSDI is a long shot anyway since there is so little old evidence. And he did file and SSA took a look at it and made a decision.
 

Pinkie39

Member
The SSDI may not be higher than SSI, but it is not a welfare, means-tested benefit. If he gets any other income, like inheritances, some insurance settlements, gifts, free food or shelter, gambling winnings, etc. it affects SSI dollar for dollar. Not true with SSDI. Also he can only have $2000 in savings and no non-home real estate. He would be very limited on what he could own if he was only on SSI. That may not matter ever in his life, but things can happen. Also, he would be on Medicare earlier than age 65 and that often makes a difference than straight Medicaid.

But the SSDI is a long shot anyway since there is so little old evidence. And he did file and SSA took a look at it and made a decision.
Good points, thank you. It does sound like it would be helpful if we could get him approved for SSDI eventually. I'll post back once I'm able to speak to someone at the SSA.
 

Pinkie39

Member
Well, I tried calling the SSA twice this morning. I surprisingly didn't have to wait to speak to someone. They would not give me any information because they said I'm not on file as a rep payee.

My brother had signed the authorized rep form when we filed the initial application in March, and I had sent it in. I had spoken to the SSA at one point and they had it.

Why would I need to be listed as a rep payee vs an authorized rep, if he is not yet receiving benefits?
 

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