When you decide your medical condition has become severe enough that it has affected your ability to be able to work for at least 12 months, it might be time to consider filing for Social Security Disability Insurance. Social Security is a federal program in the United States and each state makes their disability decisions following the same regulations. While it is not uncommon for disability claims to be denied at the initial level, each application is thoroughly reviewed and processed. Social Security disability decisions are based on a combination of factors, including: all medical impairments, age, functioning at daily activities, and the ability to work at your current job or at a different job. Therefore, it is very important to be thorough in providing detailed and concise information about your illnesses and how it affects your ability to work.
INITIAL DOCUMENTATION
Be sure to read the entire disability application completely. Make sure you enter your current address and phone number. You will need to include your medical history from at least a year prior to the time that you have considered yourself medically disabled to present. Be as complete as possible with your doctor’s names and addresses. You do not need to include appointments for routine exams such as mammograms or dental appointments if it is not related to your disability. You can submit medical records, but the most important thing to do is include your history of medical visits. You must also sign and submit form 827, which is the authorization for request for medical records. These are the legal forms required by the disability examiner to request medical records. Without these, the disability office will not be able to obtain your medical records, which could cause delays, unneeded consultative exams, or denials. Contact the disability office if you need more forms for more doctors.
LIST YOUR SYMPTOMS
In regards to your vestibular disorders, do not merely state that you have dizziness or vertigo. Does your dizziness include feeling lightheaded and therefore impact your concentration? Do you have a spinning sensation (vertigo) that impacts your gait and therefore you walk with a cane? Is your cane or a walker prescribed by your doctor? Include any impact on your vision. Does it impact your driving or the ability to work in an office with fluorescent lights? You want to be sure to be specific when you list your symptoms and their impact. Include any mental as well as physical symptoms.
LIST ALL MEDICAL IMPAIRMENTS
List all your medical impairments, not just those related to your vestibular disorder. There can be times when disability may be granted for something other than your primary complaint, or it may be a combination of impairments. Also, include all testing you have had done related to your medical impairments. Disability examiners have to investigate everything that comes up in your medical records or is mentioned by you, the claimant. If your doctor noted you have back problems but there are no X-rays, the examiner might contact you to see if you have back pain, and if so order an X-ray. This also includes medication. If no mental illness is listed on your application but your medical records show that you are taking an antidepressant, which is often prescribed for a vestibular disorder, an examiner may order a psychiatric evaluation. If you are not taking medication for a mental illness, make sure to note the reason you take the medication.
WORK HISTORY
List the main responsibilities of your job and the cognitive skills involved with each one. Include your work history for at least the last five years. If your cognitive and physical skills are impacted by your job duties, give an explanation. Some typical cognitive impairments include:
- Poor concentration
- Memory and word recall
- Impaired ability to track printed words
- Impaired mental stamina
- Reduced ability to learn & problem-solve
- Impaired ability to work well with a team
- Difficulty keeping pace and communicating
- Impaired ability to learn new information
PHYSICAL IMPAIRMENTS
List the physical impairments preventing you from performing your job duties.
- Can you drive to work in heavy traffic and in the dark with oncoming traffic lights?
- Are you able to take public transportation safely if you cannot drive?
- If required, can you travel for your job?
- Do you have extreme fatigue that impacts your ability to work?
- Do you take medication that causes fatigue?
- Can you work without taking significant breaks during the day?
- How would this impact meeting in groups, interacting with your manager?
- Do you have dizziness/imbalance without standing or walking?
- Do you have symptoms while sitting down at your desk?
- You can have symptoms of dizziness/vertigo without provoking it by physical movements. If this is true for you, it is crucial that you emphasize it. Be sure to explain if you are not able to stand or walk for any length of time.
- Do you have bouncing vision with only slight head movements? How does this impact your ability to enter information into a computer or complete other office tasks?
- Does the movement of other people trigger symptoms? For example constant walking in the office or hand movements in meetings.
- Does your workplace have lighting, sounds or too much movement that affect your vestibular disorders and are unable for you to avoid?
EMPHASIZE THE UNPREDICTABLE NATURE OF VESTIBULAR DISORDERS
For example, you may feel fine one day and completely wiped out the next. A good day may not be dependent on going home and resting up. A good night’s sleep may be followed by a day with symptoms at their worst. You may not know all of your triggers. Emphasize how you can no longer carry out certain responsibilities, or how you would need to take frequent breaks to complete these tasks. This would make it impossible to meet deadlines and be an effective and efficient employee. It’s important to include how you cannot think of any reasonable accommodations that your employer can make to allow your return to your position.
NON-WORK RELATED TASKS
Describe in detail how long it takes, and the difficulties you have, in completing basic tasks that are not necessarily work-related, although they require the use of your cognitive skills. Examples:
- List how many breaks it took to complete the disability form and materials. Emphasize any help needed to complete the paperwork.
- Does it take you longer to pay your bills because writing out checks or paying bills online requires more concentration?
- Are you able to balance your accounts?
- Do you have difficulties sorting your medications or remembering to take them?
- Are you able to follow a recipe and cook safely?
- Is keeping a calendar, remembering important dates, making appointments and getting to them on time ever an issue?
OTHER TIPS
Do not feel constrained by the disability form, whether it’s the first application or an appeal. Include any information that would give a caseworker an accurate depiction of your disability. Emphasize the reasons why you cannot work, but do not be afraid to discuss what you can do, as long as you give it context. For example, you can say “although I used to go hiking several times a month, I do not have the balance for such an activity now; my doctor has limited me to simple outdoor activities like walking, where I am close to home in case I need to stop or if I need to ask for help.” Or you can say “while I used to go on dates with my spouse to restaurants, movies, or walks, now if I am having a good day we may just pick up a meal and watch a movie at home so we can turn it off and I can rest if I don’t feel well.”
Be honest, both about your limitations and about how low-key activities can be a challenge for you now. It is always good to keep communicating with your doctor who is advocating for you and is also completing disability paperwork on your behalf. If your doctor does not have a good understanding of your job, then have a discussion to explain your duties and expectations so the doctor can be aware of the cognitive and physical impairments at your job and it can be included in the paperwork. Often the disability forms that the doctor is asked to complete focus on a physical impairment that prevents a worker from performing physical tasks (e.g. lifting objects, etc.). If the doctor has already completed the initial disability paperwork, consider asking him/ her to write a letter for your appeal. Request a copy of this letter and send it with your appeal package.
INCLUDE INFORMATION FROM AN AUTHORITATIVE SOURCE, SUCH AS VEDA
Visit vestibular.org and download our free short publications. Choose short articles rather than entire books. An overview on the vestibular system and the impact on cognitive skills are crucial. Also, if your doctor has a website with information on vestibular disorders, consider referencing the doctor’s website or provide some information from the site.
FINAL THOUGHTS
This is a long, difficult process. It was not set up to deter people from filing, but to ensure benefits are being approved appropriately.
You can get representation to help you through the process. However, you can also complete the application and forms and provide all the information on your own, because you know what you are going through. The disability examiner will request all of your medical records. Representation can be helpful at the hearings level. Getting representation is a personal decision. If you decide on representation, there is a set fee and you do not pay anything unless you are approved. Take time to complete the documents and have someone help if needed. More is not always better. Just be sure to include all relevant medical issues, limitations, and why you cannot work. However, it is very important to remember that while the functional information is important, it must also be supported by the medical information.
Always respond timely to phone calls or follow up paperwork, and if denied, appeal the decision immediately. If you see a new doctor related to your disabling condition or have new testing while your case is being reviewed, let your examiner know so they can obtain that information. And remember, you can not compare one person’s disability case to another’s. Each person is always different and unique.
Finally, send all communication to the Social Security office or insurance company by registered mail, priority mail with tracking, or by express mail with a signature required.
By Claire Haddad, Cassie Springer Ayeni – disability attorney, and Darcy Bonjour – retired Social Security Claims Representative