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Topic: Consultative Exam Request - 4 Years after ALJ Approval??  (Read 1873 times)
nextstepp1
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« on: January 05, 2017, 05:25:39 PM »

So I am not sure if this is typical or not but I think it is absolutely ridiculous.  I applied for SSDI in 2011 after sustaining a back injury that left me with permanent nerve pain in my back and legs.  I was immediately denied and when asked why I was told ďNobody gets approved the first timeĒ.  I went through all the hoops and each time they denied without giving a reason other than my file didnít support the statements that both I and my treating physician had provided.  This didnít make any sense to me until I hired an attorney and he informed me it was clearly due to my age, 30 at the time, and that we would have to go to a hearing before an Administrative Law Judge so thatís what we did.  She listened to my attorney ask me a few questions, remarks that this looks like a pretty clear cut case and we were out in less than 10 minutes, 30 days later I get a call at 7:45am informing me I had won my case.  They had strung me along for almost 3 years and cost me just about everything during this process and it was finally over, well thatís what I thought until last month when I received some paperwork that made me wonder if they are trying to challenge my approval.  The first was a Medical Questionnaire and the second was an Exertion Questionnaire, I filled them out and sent them back and now a Consultative Exam form shows up today and is telling me that I have to drive an hour away when I just told them on the previous form that I can only drive short distances.   So my question is this, how can social security act like they are reconsidering my case after all this time AND after a judge ruled that they made the wrong decision in the first place?  What worries me about this whole chain of events is that the whole process seemed to be leaning pretty heavily in their favor from the get go.  My first thought was to contact my disability attorney but I then thought perhaps someone on here would have been through this garbage before.  Any help would be greatly appreciated.
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SFVLance
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« Reply #1 on: January 05, 2017, 05:35:24 PM »

Because you were approved 4 years ago, it sounds like part of a CDR - Continuing Disability Review. There may have been something on the recent questionnaires that they want checked.

It is noted in your approval letter that your case would be reviewed, basically it is to see if you have improved.
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Name: Lance
Location: Los Angeles
Age at Application: 46
Disability: Severe Depression, Anxiety, PTSD
Date Applied: June 1, 2012
First Approval/Denial Date: Denied August 31, 2012
Reconsideration Approval/Denial Date: No Recon in my region of CA
Hearing Date: January 25, 2013; Remand Hearing March 13, 2017
ALJ Approval/Denial Date: Denied February 20, 2013; Federally Remanded, Bench Decision March 13, 2017
Additional Info: Got Federal remand; 2nd hearing postponed, rescheduled Fall 2016. Postponed again - finally held March 2017.

« Last Edit: January 05, 2017, 05:37:55 PM by SFVLance »
Helper
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« Reply #2 on: January 05, 2017, 05:45:21 PM »

https://secure.ssa.gov/poms.nsf/lnx/0428001001  you might find this link helpful.

Everyone receiving SSA Disability benefits undergoes Continuing Disability Reviews to ensure that they are still disabled.  SSA is looking to see if your medical condition has impriver enough for you to work, since your approval.  SSA also requires you to continue to receive medical treatment   (unless you have one of a few medical conditions that will not improve - like blindness).

CDRs  can be one year, 3 year, or 5-7 years (depending on what SSA thinks your odds of improvement are).  They can come early, late, or on time.

If you receive a cessation notice, you can appeal & continue benefits during the appeal  as long as you contact SSA within 10 days of the cessation notice.

I would call & confirm that the DDS examiner has received your medical records.  Typically, medical exams are ordered if there are gaps in medical treatment, inconsistent medical records (like Dr A & B don't agree), missing medical records, or the records are missing something specific that SSA wants to see.

If you skip the medical exam, you will receive a benefit cessation notice.  If you are unable to drive to the office, you can contact the number on the form about needing transportation.

Most people who hire attorneys for cessations wait until they actually receive a cessation notice.  Not all attorneys take cessation cases that do SSA cases.  And you have to pay a retainer to the representative  since there is no backpay in cessation cases (people typically report around $2000 - so you may want to start saving some money now if you don't have an emergency fund).

(And actually about 1/3rd of initial applications are approved.)
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Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations

« Last Edit: January 05, 2017, 05:58:39 PM by Helper »
Lit Love
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« Reply #3 on: January 05, 2017, 05:47:52 PM »

A CE exam would be ordered in a Long Form CDR if they felt you don't have enough current medical evidence.  

Being approved for SSDI does not guarantee benefits forever.  People improve and are able to eturn to work.  After approval the burden shifts to SS to prove you no longer qualify.  

Have you continued to regularly see a doctor/s for your impairment?  Take meds as prescribed?  
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nextstepp1
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« Reply #4 on: January 05, 2017, 06:26:08 PM »

A CE exam would be ordered in a Long Form CDR if they felt you don't have enough current medical evidence.  

Being approved for SSDI does not guarantee benefits forever.  People improve and are able to eturn to work.  After approval the burden shifts to SS to prove you no longer qualify.  

Have you continued to regularly see a doctor/s for your impairment?  Take meds as prescribed?  

I see a pain management doctor every month since I am on high doses of MS Contin,  I couldn't go a day without it, same doctor I have had since before my approval too.
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nextstepp1
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« Reply #5 on: January 05, 2017, 06:37:54 PM »

It sounds as if its standard operating procedure which I am ok with,  I was just worried since they seemed to be able to deny me in the first place when I was clearly unable to work that they would tend to do so again. My problem has been with the way my doctor does his notes I believe.  His paperwork is far from what I would call thorough but the evidence is there.  My second round of appeals, the reviewer commented that "I doubt he could work taking as much morphine as he is currently on" and yet they still denied my case.  They didn't contact any of my surgeons or anything other than my primary physician, even though I provided them with all their information and tried giving them medical reports but they wouldn't accept them from me directly.  This is where the concern comes from on my part.
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Lit Love
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« Reply #6 on: January 05, 2017, 06:51:11 PM »

If you have the contact info for your DDS worker performing the CDR, I'd call and verify they have your current medical records.  If you're seeing a doc monthly than a CE is not usually needed.  If they don't, request a fax coversheet with a barcode be sent to you and then fax the records in yourself.

I could give you a long explanation, but the short version is that you were unlikely to be approved prior to a hearing due to your impairment type. 

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nextstepp1
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« Reply #7 on: January 05, 2017, 07:31:17 PM »

If you have the contact info for your DDS worker performing the CDR, I'd call and verify they have your current medical records.  If you're seeing a doc monthly than a CE is not usually needed.  If they don't, request a fax coversheet with a barcode be sent to you and then fax the records in yourself.

I could give you a long explanation, but the short version is that you were unlikely to be approved prior to a hearing due to your impairment type. 



I do have her information,  I will call her first thing in the morning.  Thank you all for the information so far,  its helped to put my mind at ease a bit. 
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Lit Love
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« Reply #8 on: January 05, 2017, 07:37:53 PM »

They've been known to cancel CE appointments when they receive records that were missing, so it's worth doing asap.

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Just Me
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« Reply #9 on: January 05, 2017, 07:42:53 PM »

It is doubtul your surgeons have any info in your medical records regarding your ability to function day to day. Do you drive ? What medical and non medical evidence do you have proving the side effects from the morphine would prevent you from working ? Have you discussed the side effects with your doctor that prescribes the morphine ? Did he write down what you said ? Has he had to prescribed you any medications to try and counter act the severe side effects ?
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Hope the size of a mustard seed can produce Faith that can move mountains.
Age at Application: 50
Disability: DDD, nerve damage upper & lower extremities, RA
Date Applied: First Applied Feb 2002, Denied May 2003. Applied again Oct 2003, Approved June 2004
nextstepp1
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« Reply #10 on: January 05, 2017, 08:00:56 PM »

It is doubtul your surgeons have any info in your medical records regarding your ability to function day to day. Do you drive ? What medical and non medical evidence do you have proving the side effects from the morphine would prevent you from working ? Have you discussed the side effects with your doctor that prescribes the morphine ? Did he write down what you said ? Has he had to prescribed you any medications to try and counter act the severe side effects ?

I was referring to my original case when referencing the surgeons and I had regular appointments with them as well, about every 2-3 months so they were well aware of my daily activity.  As far as the side effects of the morphine, I am currently up to 300mg a day.  I have had doctors freak out when they hear how much it takes to keep my pain in check.  I have documented the side effects both in a personal journal and every time I go in to the pain management doctor.  I mentioned that his record keeping was not as thorough as I think it should have and I believe that is one of the hurdles I ran into back when I applied.  We have tried everything from Norco, Vicodin, Kadian, Methadone, Fentanyl, Dilaudid, etc etc.  Mixing and matching different drugs and have settled on what I am currently taking.  The majority of the side effects simply cant be removed without removing the medication itself.
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Just Me
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« Reply #11 on: January 05, 2017, 08:26:29 PM »

Just so you know, almost all doctor are reducing patients daily dose to no more than
90 mg  Morphine/90 mg Morphine Equivalent Daily. Your doctor may not be doing this now. But, chances are very good he will be in the near future. The CDC has come out with new guidelines for prescribing opiates for chronci pain. They are doing this because of the high number of deaths on high doses and the addiction rate. It does not matter if you have never had problems with opiates. These guideliens are mainly for pcp's and doctors that are not pain management doctors. But, most pain management doctors are following this also.
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Hope the size of a mustard seed can produce Faith that can move mountains.
Age at Application: 50
Disability: DDD, nerve damage upper & lower extremities, RA
Date Applied: First Applied Feb 2002, Denied May 2003. Applied again Oct 2003, Approved June 2004
grove800
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« Reply #12 on: January 07, 2017, 03:37:04 AM »

I personally asked for a reduction due to the cost of opana on a monthly cost,
.  Went to oxicotin and oxycodone.  I had very upsetting withdrawals for about 2 weeks. I have wanted percentage of apples apples and they could not give me one even pharmaceutical company. With the calculation we figured 50 percent.  Boy it worked great but I could not justify the costs,  doing ok on this dose but your body changes and wants more the I substitute Tylenol 500mg x2. Helps.  My other option for the cheapest drug would be morphine and my PM doesn't like this one says a dirty drug.  I think one of the longest drugs around but the insurance companies like thr drug since expense is down.  My goal would be to completely be off them but I know this can never happen.
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😊
Name: Vicki
Location: IL
Age at Application: 59. Age now 62
Disability: Hypogammagobulimannenia , aggressive arthritis spine, 4 level cervical fusion, chronic pain, DDD,COPD,
Date Applied: 7/2013
First Approval/Denial Date: 11/2013
Reconsideration Approval/Denial Date: 5/2014
Date OTR requested: 6/2014
Hearing Date: January 19, 2016
Date Award Letter Received: February 3, 2016. per benefit letter on my SS website
Date Back Pay Received: February 4, 2016 direct deposit
Additional Info: fully favorable letter by mail Feb 6, 2016. Medicare started Dec 2015
nextstepp1
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« Reply #13 on: January 07, 2017, 08:22:15 PM »

Just so you know, almost all doctor are reducing patients daily dose to no more than
90 mg  Morphine/90 mg Morphine Equivalent Daily. Your doctor may not be doing this now. But, chances are very good he will be in the near future. The CDC has come out with new guidelines for prescribing opiates for chronci pain. They are doing this because of the high number of deaths on high doses and the addiction rate. It does not matter if you have never had problems with opiates. These guideliens are mainly for pcp's and doctors that are not pain management doctors. But, most pain management doctors are following this also.

I was on more at one time and have been pretty proactive in reducing my meds because of the side effects and the fact that they just don't seem to work as well as they used to.  I honestly believe I will be able to reduce my meds below that point at some point but currently I still have bad days that require the full dose of what I am taking and even then I am still feeling pain.  It never really goes away, its more like how tolerable it becomes.
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nextstepp1
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« Reply #14 on: January 07, 2017, 08:31:49 PM »

I personally asked for a reduction due to the cost of opana on a monthly cost,
.  Went to oxicotin and oxycodone.  I had very upsetting withdrawals for about 2 weeks. I have wanted percentage of apples apples and they could not give me one even pharmaceutical company. With the calculation we figured 50 percent.  Boy it worked great but I could not justify the costs,  doing ok on this dose but your body changes and wants more the I substitute Tylenol 500mg x2. Helps.  My other option for the cheapest drug would be morphine and my PM doesn't like this one says a dirty drug.  I think one of the longest drugs around but the insurance companies like thr drug since expense is down.  My goal would be to completely be off them but I know this can never happen.

I have been on Oxycontin and Oxycodone in the past but never tried Opana to my best recollection.  I've not had too many problems with morphine, its cheap which is a plus, but the drug that worked wonders for me was Kadian (just name brand extended release morphine sulfate).  I am not sure why it worked so much better than generic but it was wonderful for my pain but I couldn't justify the $550 a month price tag that came along with it.  I am seeing a surgeon in a few months in hopes of trying another spinal stimulator and/or another lumbar surgery in hopes of alleviating some of my pain.
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