Denied for SSI Appeal in Georgia

"Will not take much time here. My daughter, Brooke, a 19yr old 9th grader (low grades). To my complete surprize denied SSI benefits. My wife and I both medically inclined. Our daughter has volumes of medical history born without a functioning pituitary suffered seizures and numererous complications from childbirth causing brain damage and obvious endocrine system problems, she is very slow, speech & hearing impared, and has many other issues like, she doesn't understand or comprehend well. She requires medicine to just keep her alive. A fever can kill her without special treatment.

Brooke was denied benefits here in Georgia and denied on appeal. It is absolutely heartbreaking. There is NO WAY she can care for herself if anything happened to me and my wife.

What hurts so bad is that we know many doctors (friends) and they know Brooke well. One is even the State of NC psych doctor. They are completely blown away how exactly SSI came to the WRONG conclusions. One of the docs said that we have a spanish last name, expect to fight it all the way to court. This is so unfair. Not sure what we can do? Our lawyer is mistified - he says there are cases with far less being approved and it is not understandable.

Is there anything else that can be done?"

Your daughter is experiencing what so many disability applicants experience; in that she has multiple medical problems that may be severe, but individually none are able to qualify for SSI disability.

Social Security Disability processing guidelines are, to put it one way, more harsh at the initial disability claim and reconsideration appeals in Georgia (and all states for that matter), because the disability decision are made by disability examiners who are strictly bound by the individual state agencies in which they work (SSA uses disability determination services agencies, a.k.a. DDS, in each state to render determinations on claims) as well as to the criteria listed in the Social Security Disability guide book, when making their disability determinations.

Even though your daughter may be slow, it appears that her psychological testing does not indicate that her IQ is low enough to meet or equal the criteria of impairment listing 12.05 (mental retardation).While she may have learning disabilities, there may not be enough evidence to support that her learning problems would prevent her from working according to Social Security Disability guidelines.

I am guessing that your daughter's endocrine problem does not fall into any of the endocrine impairment listings addressed in the disability guidebook, which makes it a condition which, while severe, is very difficult to determine a finding of "disabled", using the normal disability criteria.

Disability examiners have very little flexibility in their disability Decisions. So, it is not difficult for me to believe that your daughter was denied on her initial disability application and her reconsideration appeal. Most individuals are denied at the reconsideration appeal; in fact only ten to fifteen percent are approved for disability benefits.

This is, I hate to say, logical, considering that reconsideration appeals are sent to the same disability agency for a decision. If the first disability examiner made the 'correct decision' according to Social Security Disability guidelines then it would be natural to assume a second disability examiner using the same guidelines would have to deny the reconsideration appeal unless there was new evidence to clearly suggest a finding of disability.

I would suggest that you have her treating physician (endocrine) complete a comprehensive physician's statement that would include your daughter's diagnosis, symptoms, prognosis, and treatment, response to treatment, her limitations, and their opinion as to how this condition would affect her ability to sustain substantial self-supporting work activity. Also, I would have her evaluated by a psychologist to get a true picture of her learning problems and how those problems might affect her ability to work.

Social Security Disability is based on two things (for adults, and at 19 she is considered to be an adult by SSA). Having a severe impairment and possessing an inability to perform substantial gainful work activity. It really does not matter what the condition is. These two criteria must be met. The severe impairment or impairments must be documented by objective medical evidence to support a finding of disability.

You stated that one of your friends is a North Carolina psych doctor, who is "blown away" as to how they came to these conclusions. Unfortunately, the Social Security Disability process is somewhat subjective and if your daughter does not exactly fit the criteria needed to meet Social Security Disability severity requirements she will be found not disabled.

If you daughter's initial disability claim was denied her best chance of being approved for disability is at a disability hearing with an administrative law judge; unfortunately the only way to do that is file the reconsideration appeal. If your appeal period of sixty five days from the date of the reconsideration appeal denial notice has passed, she needs to file a new disability claim and follow it all the way to a disability hearing.

I hope your lawyer has filed a Request for Hearing, so your daughter can get to her hearing. The disability hearing level of the Social Security Disability process offers the highest chance of being approved for disability benefits. Nearly, sixty percent of the disability hearings held in North Carolina result in an approval for disability benefits.

One last thing, the fact that you have a Spanish last name has absolutely no bearing on whether or not she will be approved for disability. Disability examiners, medical professionals, and administrative law judges have dealt with individuals whose names are from all over the world. Preparation and medical evidence to substantiate your daughter's disabling conditions will go a long way toward winning her disability case.

Good Luck

Tim Moore

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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