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| | |-+  approved for SSI, denied for DAC - hearing in 1 mo.
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Topic: approved for SSI, denied for DAC - hearing in 1 mo.  (Read 2954 times)
Onthemove
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« on: February 09, 2013, 12:15:35 PM »

I am new and have a few questions as I prepare for my son's ALJ hearing.

We applied for DAC on his deceased father's work record.  He had received survivor's benefits when he was in high school, but no one told us he could extend those due to disability.

He was denied for DAC - they said he did not meet the SSA criteria for disabled due to his work and education.  They said he did not have enough work credit for SSDI.  But he was awarded SSI on mental disability.

He is 30 and has never made more than 1800.00 in a full year.  He attempted 2 semesters of college, but failed both semesters.  He may have had SGA for 1 -2 months, but was fired for emotional outbursts and inability to get along with other employees.  He has never had successful employment.

He was evaluated by a SSA doctor, who must have deemed him disabled, because he got the SSI right away.

His disability began as a child, with serious mental issues and hospitalization at age 15.  He has had continuous ongoing psychological treatment.  Including special schools for high school.

Does an appeal of the DAC mean a review of the SSI?  Is he at risk for losing that if the judge rules unfavorably?

He got the SSI on the first application.  He applied in Dec. 2011 and approved in May 2012.  He was denied for the DAC at the same time of SSI approval. 

I appealed and was denied again a few weeks later.  Now we have ALJ hearing scheduled.

Any ideas?
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Name: This is for my son
Location: Arkansas
Age at Application: 29
Disability: GAD, Depression, PTSD, panic attacks, ADD, chronic back pain
Date Applied: 11/11
First Approval/Denial Date: 5/12 denied DAC, approved SSI
Reconsideration Approval/Denial Date: 7/12 denied DAC
Date OTR requested: none
Date Hearing Notice Received: Feb 2013
Hearing Date: March 20, 2013
ALJ Approval/Denial Date: 11/14/13
Date Award Letter Received: 11/26/13
LostArk
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« Reply #1 on: February 09, 2013, 02:01:27 PM »

How could someone be denied SSD but approved for SSI? I thought the requirements were the same?  Main13
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jsm
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« Reply #2 on: February 09, 2013, 04:12:24 PM »

Since this was a concurrent claim, the ALJ can reopen the SSI claim to a denial if the evidence warrants it. However, the date of onset issues are not the same for the CDB (DAC) claim as they are for the SSI claim.  You say he is age 30 today, so to get the CDB (DAC) benefit you have to prove that his condition was serious enough at age 22, which is 8 years ago. The evidence has to be dated in 2005 or earlier. Has this old evidence been obtained and submitted?  SSA will ask for it, but if the source doesn't respond or indicates the evidence is lost, they won't ask again.

Mental illness can be progressive; the condition may get worse over time so having problems dating back to age 15 is not necessarily the same as being severely disabled back to age 15 or before age 22. That is probably why the CDB (DAC) claim was denied. That is the argument you have to make with evidence.

For SSI, the date of onset has to be established as of the application date and no earlier. So my guess is that it is unlikely that the SSI decision would be set aside. But that is not a guarantee.

When his survivor benefits stopped at age 18, there was probably a short paragraph or maybe one or two sentences that told him about the possibility of CDB benefits. Also, the reporting instructions in the application would have said to report if he became disabled.  But applicants and recipients don't always read the entire notices or applications.  Now that he is on SSI, has anyone read all the reporting instructions for SSI?  There are many.
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Onthemove
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« Reply #3 on: February 09, 2013, 04:54:48 PM »

I have two letters from treating physicians when he was 17.  One was a proposed treatment which lined out his issues and treatment plan.

The other was the very expensive evaluation that explained all the testing and each result.  It listed all his Axis diagnosis and a low GFA.  In it the doctor gave great detail as to what each test result meant how that particular issue affected his ability to function in the world and school.  His GFA was 43.

He was deemed incompetent when he reach 18 in 2 states.  He was in residential treatment until he was almost nineteen.

That is about all I have, besides lots of receipts for bills and meds.  No one ever gave me copies of his evaluations after he turned 18, even though I was appointed guardian.

I am his rep payee, so I keep up with his bills and mail.  I hope I am doing everything right.  So far, they have made me nuts in the process.
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Name: This is for my son
Location: Arkansas
Age at Application: 29
Disability: GAD, Depression, PTSD, panic attacks, ADD, chronic back pain
Date Applied: 11/11
First Approval/Denial Date: 5/12 denied DAC, approved SSI
Reconsideration Approval/Denial Date: 7/12 denied DAC
Date OTR requested: none
Date Hearing Notice Received: Feb 2013
Hearing Date: March 20, 2013
ALJ Approval/Denial Date: 11/14/13
Date Award Letter Received: 11/26/13
Floating
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« Reply #4 on: February 09, 2013, 07:12:15 PM »

I hope I am doing everything right.  So far, they have made me nuts in the process.

I think that is a sign. The more careful we are, trying to do it right, the more nuts we go. If you aren't doing this, you aren't doing it right? Angry14 Angry17  Main19
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Age at Application: 35
Disability: Multiple
Date Applied: Dec 2012
First Approval/Denial Date: March 2013
Reconsideration Approval/Denial Date: Approved July 2013
jsm
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« Reply #5 on: February 09, 2013, 10:41:10 PM »

It sounds like you are representing him without an attorney or representative. That is a choice and it is possible that the evidence will be strong enough for you to convince the ALJ that your son was severely disabled before age 22 even though it wasn't strong enough to convince a DDS analyst (and you are sure this evidence was in the electronic file?). I think the guardianship orders are also evidence that should be considered. Have you also submitted documentation of the dates of all the jobs he had (start and stop dates, dollars earned) and why they should be considered unsuccessful work attempts? Do you know the definition of an UWA for SSA?  Do you understand the legal argument you need to make?

What will you do if the ALJ denies the case? You can request an Appeals Council review. Statistically, chances are low with the AC, and most of hit hinges on whether or not the ALJ applied an error of the law, not whether you disagree with the conclusion. Do you know enough about the law to be able to make that argument?

If this CDB (DAC) claim is denied by the ALJ for your 30 year old son, any subsequent CDB claims will be denied at the initial level, res judicata - which really means that the outcome of this ALJ hearing is supremely important.  Does your son have an attorney or not?  Yes, the attorney will charge a fee for his expertise that will be paid out of any retroactive benefits and with the SSI claim already paid will also reduce any retroactive benefits.  But for the long haul, the rest of your son's life, I think that qualifying for the CDB benefits in addition to or instead of only  SSI has so many other benefits that it would be worth the peace of mind that would come from have a representative.

SSI is a good program for the neediest of the needy, but it has alot of restrictions and generally being on Medicare (after two years on CDB) as well as Medicaid gives more treatment options. Don't know the amount of the survivor benefit, but often it is much higher than the SSI.
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Onthemove
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« Reply #6 on: February 09, 2013, 11:39:33 PM »

Thanks so much, I really appreciate your input.

He does have a lawyer, but his lawyer has never handled an adult case that attempted to get child's benefits. 

We have met a few times already, and I have been trying to pull together whatever records I can find or get.  We have a meeting next week to see what else we might need to do before the March hearing.

I am a professional, but not a lawyer, so I have been reading everything I can find on the subject.  That is how I discovered the concept of UWA.  I think I understand what it means, I am not certain it applies to DAC cases.  I was planning to bring it up to the lawyer.  I am trying to learn everything I can, to make sure I feel we did all we could do.

Much of the evidence is not in my son's file.  I am not sure that any of the old stuff is in there.  I took some of it down a couple of months ago to the attorney, and I am getting copies of the guardianship orders, but they are not in the file.

In reading the denial, I think the work and school issues may be the biggest stumbling blocks, but he never held a job for more than 3 months except his part-time job in our family business, and even that may not have been 6 mos. 

I will have to get the old office records out to know for sure.  I think these are issues, because in his initial interview he said he had 2 years of college, and that he had held several good jobs.  Most of the few jobs he got only lasted for days.  He overstates his abilities and his achievements - that is part of his disease.  That is documented in his older evaluation.

I don't know what we will do if he is denied.  I do understand the significance of getting the CDB vs. the SSI.  I hate to risk the SSI in the process, but it would be a greater benefit all the way around. 

I appreciate any and all input.
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Name: This is for my son
Location: Arkansas
Age at Application: 29
Disability: GAD, Depression, PTSD, panic attacks, ADD, chronic back pain
Date Applied: 11/11
First Approval/Denial Date: 5/12 denied DAC, approved SSI
Reconsideration Approval/Denial Date: 7/12 denied DAC
Date OTR requested: none
Date Hearing Notice Received: Feb 2013
Hearing Date: March 20, 2013
ALJ Approval/Denial Date: 11/14/13
Date Award Letter Received: 11/26/13
whyhellothere123
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« Reply #7 on: February 10, 2013, 01:08:40 AM »

I am on DAC benefits as well as SSDI. They said as long as I wasnt married, under the age of 22 when it started, and have a parent on SSDI, I qualified. So Im not sure why your son wouldnt. I do know that it depends on when the alleged onset date was. They listed mine as March of 2010. I was 20 then, and even though my illness started at 18, they told me it was when I was found truly disabled.
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DX: Dysautonomia (autonomic dysfunction), Postural Orthostatic Tachycardia Syndrome, Orthostatic Intolerance, Multiple Sclerosis, Chronic Migraines, Gastroparesis, IBS, legally blind in right eye from optic neuritis.
Panic disorder, agoraphobia, depression.
Age at Application: 21
Date Applied: 01/03/11
First Approval/Denial Date: 05/11
Reconsideration Approval/Denial Date: 12/11
Date OTR requested: 01/12
Date Hearing Notice Received: 12/05/12
Hearing Date: 01/10/13
ALJ Approval/Denial Date: approved 1/18/13
Date Award Letter Received: SSDI award letter 2/4/2013. DAC award letter 2/13/13
Date Back Pay Received: SSDI-2/4/13. Still waiting on DAC back pay
Date Dependent Benefits Received: Daughters-2/11/13
Additional Info: I recieve SSDI, DAC benefits and dependent benefits for my daughter.
Different Perspective
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« Reply #8 on: February 10, 2013, 07:57:38 AM »


To be eligible for DAC (Disabled Adult Child) benefits the applicant must prove his/her condition(s) met the adult standards for disability prior to age 22 (http://www.ssa.gov/dibplan/dqualify10.htm). 

Current records, including those from a Consultative Examination paid for by SSA  will not, cannot, prove disability in the past.  Only historical records can prove disability in the past.  See jsm's  responses. 

A diagnosis does not equal disability.  Just because an applicant has an Axis I, II, III, IV, or V diagnosis means nothing without description of long term loss of function.  Likewise receiving the benefit of Special Education services does not mean the student meets the SSA definition of disability.  (Students may receive the benefit of SE services if they are exceptional in that they have high IQ's.)  SSA is not bound by, rulings of incompetency of any state.  Likewise a onetime GIF  score does not equal disability.  People in traumatic situations often have a low GIF score but these scores can be acute and not chronic. 

Having laid out the bad news, it appears you have a lot of historical evidence that could prove disability prior to age 22.  The ALJ will certainly be impressed with the information you list.  The records of long term inpatient treatment at age 19 should be especially impressive, IF they are available.  If they are not available they may as well not exist. 

As both you and jsm point out this Hearing is critical and pivotal.  If benefits are lost at this Hearing, they are probably lost forever.  If you are not completely comfortable with the experience and ability of your lawyer, now is the time to seek other representation.  Suggest you have a frank discussion with your lawyer and determine his/her case theory and how s/he plans to prove the disability.  If s/he and you are not comfortable that the available medical and non-medical evidence available for the ALJ will not support an allowance you may want to ask for a continuance to have more time to get the critical evidence.  This may require extraordinary effort on your part to get the treating sources to dig through dusty warehouse files or read reels of microfilm, but those old records may be critical.

 Again, talk to your lawyer about what is/is not critical.  The fact that s/he has not presented a  DAC case to the ALJ does not mean s/he is incapable of doing so.  The information you and s/he are reading is probably accurate.  The basic difference between a regular adult claim and a DAC claim is that the claimant must prove s/he met the SSA definition of disability between the ages of 16 and 22.   

It is unlikely that your son's work history is being held against him.  Your attorney should be able to look at the earnings record (provided with the pre-Hearing disk) and persuade the ALJ that the work record does not support Significant Gainful Employment.   

Yes, no - approval for DAC benefits will not mean a MEDICAL review of the SSI (medical and non-medical standards are the same) but receipt of DAC benefits will be considered income and will reduce SSI payments.  How much?  Depends upon the amount of DAC benefits.  Back payment of DAC benefits may cause an overpayment of SSI benefits and may trigger efforts to recover the overpayment of SSI. 
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Additional Info: My Different Perspective comes from a lifetime of being near, working with and for those with disabilities, working for the Easter Seal Society, working for the Disability Determination Services (20+ years) and working as a case assistant to an attorney who, until he retired, worked on SSA disability cases exclusively and have attended approximately 185 Hearings. I have great empathy for the truly disabled and greater antipathy for those who try to game or scam the system. With my background, I quickly make distinctions between the two. I am ready to admit my error as soon as the evidence proves me wrong. Any posts I make are based on my experience, memory and current research. Anything, particularly opinions, I post should be verified by someone who has access to the entire case record and not just selected shorts offered by those seeking information, preferably by a competent attorney or non-attorney representative who thoroughly understands SSA law.
Onthemove
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« Reply #9 on: February 10, 2013, 10:57:58 AM »

Thanks for your input.  I feel like I am on a roller coaster.  One day I think he has a good chance, the next day I feel like it looks rather hopeless.

I feel like he would have had a very good chance if I had all his records.  Now records are gone and Doctors have moved and retired.

We really never considered disability benefits for him in the past, as we were able to provide for him.  Now that we are older and the economy is bad, we can't provide all that he needs, nor leave him enough to provide for himself after we are gone.

My main concern now is that I don't want him to lose the SSI benefit he has by appealing the DAC.  He won't need the SSI if he gets the DAC.  He will need it if he loses.

I would hate for the ALJ to reverse the current finding of disabled and take away the benefit he has.

If we are really at risk of that, and we don't have a very strong case for the DAC, perhaps we should abandon the appeal.
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Name: This is for my son
Location: Arkansas
Age at Application: 29
Disability: GAD, Depression, PTSD, panic attacks, ADD, chronic back pain
Date Applied: 11/11
First Approval/Denial Date: 5/12 denied DAC, approved SSI
Reconsideration Approval/Denial Date: 7/12 denied DAC
Date OTR requested: none
Date Hearing Notice Received: Feb 2013
Hearing Date: March 20, 2013
ALJ Approval/Denial Date: 11/14/13
Date Award Letter Received: 11/26/13
Different Perspective
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« Reply #10 on: February 10, 2013, 11:50:26 AM »

Talk to your attorney.  It is possible but (without looking at he medical and non-medical evidence) improbable your son could lose his SSI.  If the records prior to age 22 are not there, they are not there. 
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Additional Info: My Different Perspective comes from a lifetime of being near, working with and for those with disabilities, working for the Easter Seal Society, working for the Disability Determination Services (20+ years) and working as a case assistant to an attorney who, until he retired, worked on SSA disability cases exclusively and have attended approximately 185 Hearings. I have great empathy for the truly disabled and greater antipathy for those who try to game or scam the system. With my background, I quickly make distinctions between the two. I am ready to admit my error as soon as the evidence proves me wrong. Any posts I make are based on my experience, memory and current research. Anything, particularly opinions, I post should be verified by someone who has access to the entire case record and not just selected shorts offered by those seeking information, preferably by a competent attorney or non-attorney representative who thoroughly understands SSA law.
Onthemove
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« Reply #11 on: February 10, 2013, 03:12:56 PM »

Thanks for your response. 

In looking back through the denial letter, I see that the only medical information they have listed is from more recent sources, so I guess that is the good news.  I do have a couple of reports from before age 22 and some other records we might be able to obtain.

I still have a month to try to pull together some of the old stuff.

I will definitely discuss this all with the attorney next week.  Thanks for your help.
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Name: This is for my son
Location: Arkansas
Age at Application: 29
Disability: GAD, Depression, PTSD, panic attacks, ADD, chronic back pain
Date Applied: 11/11
First Approval/Denial Date: 5/12 denied DAC, approved SSI
Reconsideration Approval/Denial Date: 7/12 denied DAC
Date OTR requested: none
Date Hearing Notice Received: Feb 2013
Hearing Date: March 20, 2013
ALJ Approval/Denial Date: 11/14/13
Date Award Letter Received: 11/26/13
jsm
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« Reply #12 on: February 10, 2013, 05:13:20 PM »

DP makes excellent points. However, back pay (retroactive benefits) for the CDB (DAC) should not cause an overpayment in SSI except in the month of receipt because windfall offset should reduce the CDB before it is paid by the amount that the SSI would have been had the CDB been paid on time. And if it can be established that the onset is before age 22 on the CDB, then there would also be 12 months retroactive CDB benefits due before the application date.

I also think that if since your son was found disabled for the SSI application at the initial level, it is unlikely that an ALJ will reopen it to a denial since it is statistically harder to get approved at the initial level. It is not a guarantee however.

Do what you have to do to obtain the old records, not just evidence that he was in treatment, but the treating notes and findings.
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Onthemove
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« Reply #13 on: February 15, 2013, 07:08:29 AM »

We met with my son's attorney yesterday.  I feel much more confident in his abilities after this meeting.

He has really been collecting records and he has some records that I have never seen.  Unfortunately, they are more recent doctors notes.  But it is obvious he is working hard on the case, and he is very familiar with the file.

He concedes that this is a tough case.  He said that judges do not like these older cases, but it is not impossible.  He says we don't have much from the past, but what we do have is very strong.  He would like more if we could possibly get it, so encouraged me to keep working on that.

He says my son's work record actually speaks well to his inability to hold a job.  He has lots of job starts that obviously only lasted a few days to weeks.  He said there is no way SGA will be an issue.

He said that yes there was a small risk that his current disability award could be turned over with this appeal, but he did not think that would happen.

I have 3 possibilites of some old records, that may or may not pan out.  He says that if it appears we may get something from any of those sources, but just need more time, he will request a delay in the hearing.  Otherwise, we will go with what we have and hope it is enough.

He said the judges here are all very fair.  He said a couple of them are really tough, but still fair.  So, I guess we will proceed and hope for the best.
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Name: This is for my son
Location: Arkansas
Age at Application: 29
Disability: GAD, Depression, PTSD, panic attacks, ADD, chronic back pain
Date Applied: 11/11
First Approval/Denial Date: 5/12 denied DAC, approved SSI
Reconsideration Approval/Denial Date: 7/12 denied DAC
Date OTR requested: none
Date Hearing Notice Received: Feb 2013
Hearing Date: March 20, 2013
ALJ Approval/Denial Date: 11/14/13
Date Award Letter Received: 11/26/13
Bonzai
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« Reply #14 on: February 15, 2013, 07:46:19 AM »

I really have nothing to add, but want to thank all involved for giving insight into DAC claims.

Onbthemove - I applaud your support of your son, and wish the best outcome for your endeavors.
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"If one of these engines fails, how far will the other one take us?"
"All the way to the scene of the crash!" - Ron White
Name: Bonzai
Location: TN
Age at Application: 47
Disability: BP 1, OSA, HTN, DM II, Arthritis Knee
Date Applied: Feb 08
First Approval/Denial Date: Denied Dec 08
Reconsideration Approval/Denial Date: Denied Mar 09
Hearing Date: second hearing June 2012
ALJ Approval/Denial Date: Approval - Aug 2012
Date Award Letter Received: Oct 2012
Date Back Pay Received: Late Sept 2012
Additional Info: remanded
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