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Author Topic: Denied for "lack of objectionable evidence" with great RFCs from 2 Doctors  (Read 1287 times)

KM

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I inherited the SPG4 gene which is medical slang for Heriditary Spastic Paraparesis genome 4 or something like that... For those of you without the medical education, this is basically a poor connection of the brain to the brain stem/spinal cord area effecting the extremities. It is a progressive disorder with some people experiencing no symptoms, others  being immobile at a young age, and then me with "minor" symptoms of reduced abilities at childhood that went undiagnosed due to a lack of knowledge up to now with hardly any use of my legs coupled with rather intense 24 hours of pain. Oh, and I don't respond to opioid pain meds due to an enzyme disorder. I guess I was born to be an experiment to a higher level. Anyway, I was rejected at the SSA level due to a "Lack of objectionable evidence" meaning 3 MRIs and EMGs that don't show anything are useless. I found a text that clearly states these tests specifically don't work well for SPG4. (search for NBK1160 unless a MOD wants to post a link which I will offer if needed. It's at a .gov site.) That leaves me with the RFC reports from my PCP and Neurologist stating walking a few minutes total per day, no stairs, no leaping tall buildings, etc., which were ignored as evidence due to a lack of evidence to direct those findings to... So, I have a disease that cripples me. The standard tests used to determine these limits are useless. SSA refuses to take the word of Doctors who specialize in this disorder as the Neuro has worked with several others in my family up until their deaths so he likely has a grasp of the situation at a personal level. What else can be done? How can one get through that wall of "objectionable evidence" when my Doctors don't know of any tests to meet this requirement?

Lit Love

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A Functional Capacity Evaluation might be the answer.  It will provide objective test results of your functional abilities.  More subjective evidence from family and or friends via the 3rd party forms wouldn't hurt either.

Btw, you can post any .gov links use wish, although I don't think it was necessary in this post.

Helper

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KM - I think you mean "objective" - not "objectionable".

Just Me

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Do you need someone to help you shower, grocery shop. cook, etc ? Did you write down on the forms the details of how your impairments affect your ability to do Activities Of Daily Living ? Have you discussed with your doctor the problems your having trying to function ? Did he write it in your medical records ? Do you fall frequently ? Has your doctor prescribed a cane, walker, wheelchair or shower chair ? Have you gone to the doctor or ER for injuries if you have fallen ? If you fall, have you had bruises and abrasions a doctor has noted in your medical records ?

Some impairments are diagnosed by diagnostic testing that eliminates other possibilities.

Spastic Paraplegia 4-
https://www.ncbi.nlm.nih.gov/books/NBK1160/
« Last Edit: April 17, 2017, 01:46:49 PM by Just Me »
Hope the size of a mustard seed can produce Faith that can move mountains.

KM

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To those who pointed out my brain fade of my intended "Objective Evidence", gotcha! Yep, I tend to goof up from time to time. I can't edit it so it's stuck that way.


\
Do you need someone to help you shower, grocery shop. cook, etc ? Did you write down on the forms the details of how your impairments affect your ability to do Activities Of Daily Living ? Have you discussed with your doctor the problems your having trying to function ? Did he write it in your medical records ? Do you fall frequently ? Has your doctor prescribed a cane, walker, wheelchair or shower chair ? Have you gone to the doctor or ER for injuries if you have fallen ? If you fall, have you had bruises and abrasions a doctor has noted in your medical records ?

Some impairments are diagnosed by diagnostic testing that eliminates other possibilities.

Spastic Paraplegia 4-
https://www.ncbi.nlm.nih.gov/books/NBK1160/

No help showering (yet), I sometimes need help getting dressed. I don't shop, cook, etc, and due to my answers being similar that cost me a LOT of validity. When I was filling out the initial application I was under the impression I was being asked as if I was in need of someone stepping in to do these for me, which would be NO since I am married, and would have been YES otherwise. I noted this in my application but of course the check boxes stay the same. My misunderstanding how the questions were being asked has cost me substantially. My Drs' reports are slim at best. I had been using both a cane everywhere I go and a walker around the house for years without a script. The judge threw a minor fit over this so I now have scripts for both. Possibly too little too late, but I had no idea that was a big deal since they are so easy to get. I have used a motorized mobility scooter for any distance outside my yard as well but my neuro won't offer a script for that just yet. One impairment I have is degenerative joint disease in the shoulder. A few months ago I did fall onto concrete causing severe pain to that condition. I told my lawyer to put this in my file (yes I have one, no, she isn't very good)

Different Perspective

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Something is missing in this and the thread at http://ssdfacts.com/forum/index.php/topic,22141.msg204687/topicseen.html#new.

Adjudicators always start with the basics.  To be allowed the applicant must have a Medically Determinable Impairment that restricts function to the point that the applicant cannot be expected to perform Substantial Gainful Activity.  Spastic Paraparesis is a MDI.  It may be made by elimination of other possible causes for the symptoms observed by a M.D. but it is a MDI.  Surely there is a diagnosis of SPAST in the medical record somewhere.  It is doubtful if the applicant just pulled that diagnosis out of thin air. 

Remember, the adjudicator will is not think about looking at records going back 42 years.  Normally the adjudicator will go back and look at medical records no more than one year past the Alleged Onset Date.  On what page of what medical record records by what M.D. is the diagnosis listed?  If that exact diagnosis is not in the record within one year prior to the AOD, there is surely a statement to the effect that "the patient has a history of..." on several pages of medical records.  If not, the adjudicator may have trouble establishing "[objective] evidence". 

The next question has to be "Objective evidence of what?"  A MDI, or functional loss?  Assuming there is a MDI of SPAST in file or the applicant's representative perfected the file before going to the ALJ to show such a MDI, attention must turn to functional loss. 

When the original adjudicator and the reconsideration adjudicator both found a lack of "[objective] evidence", what efforts did the representative make to show there was objective evidence?  Did s/he point out "Page ## of Dr. NNNN's notes dated MM/DD/YYYY show a MDI of..." or did the representative use the same format to show the pages upon pages of records showing "the patient continues to complain of...  This is consistent with the history of ..."

Having reached the point where the ALJ has denied the case there remain three options:
1. Appeal the case to the Appeals Council (your current representative may/may not want to do this and you will have to find a representative who will take on the case at this late date) which means 15 months of more of waiting for the AC to take action;
2. File a new, initial case (and lose any consideration of benefits earlier than the day after the ALJ decision; or
3. Drop the whole issue and move on with the applicant's life. 

In cases 1 or 2 the applicant must carefully read the ALJ decision and understand how the ALJ can state there was no objective evidence of wherever there was no objective evidence. Once the applicant understands why the case was denied, the next step is to provide evidence to refute the ALJ's decision.

Note: at age 48 the applicant must prove s/he cannot perform even sedentary work.  Nothing in Reply #4 of thread http://ssdfacts.com/forum/index.php/topic,22142.msg204697/topicseen.html#new suggests the inability to perform sedentary work.  (https://www.ssa.gov/OP_Home/cfr20/404/404-1567.htm)

KM

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HSP was diagnosed in 2000. Narrowing it down to SPAST is a recent addition. Whether that will add any weight remains to be seen.

You speak as if I've been before the ALJ twice - I have been denied at the ALJ level once and I need to better prepare for whatever comes next, which I'm still unsure of as no one can offer this to me several months after I requested an appeal. Like I stated, I can't openly speak my feelings toward my lawyer without offending some people. A friend highly recommended her but she has proven to not be up to the challenge. I need to leave it at that as that's a positive as it gets.

Whether current records point to a history of HSP I don't remember all at the moment but I do believe that to be the case. I do know the report from the CE stated such. I just checked my Neuro's records and they mention an HSP history as well which was why my PCP referred me to him.

As for crossing on the objective evidence, we/I have never had that opportunity as those decisions were made after my hearing and only known about in the ODAR letter of which I asked for an appeal.

While my daily living may look quite normal, that's where I have difficulty relaying pain and other issues as to show pain always resulted in a loss of work. Yes, I can move around the house somewhat. It happens to be near impossible without using a walker I keep by my chair to get up with, hands on the walls from one end of the house to the other with bare wood on the door frames to prove it, and so on. Degenerative Joint Disease of the shoulder makes getting up unbearable. To carry anything in the process is impossible. The main approval portion I am after comes in the part of the process of transferable skills. The VE's claims were ruled out by my Doctors' RFC reports due to their required bending, standing, etc. To not allow those reports due to the lack of objective evidence is the current hurdle. Evidence beyond SPG4 appear to be impossible unless someone here knows the missing link. That's the whole reason I signed on. The missing link is somewhere between the evidence of having SPAST and "how does it affect me". No one is questioning my having HSP. The ALJ acknowledges it early on. No one is questioning I have arthrosis in both knees with bone fragments, degenerative joint disease of the shoulder, lateral epycondilitis of the elbow, arthritis in multiple locations of the spine... Those are off the top of my head and I'm tired. My Doctors have performed multiple physicals which I have failed yet their reports aren't allowed due to whatever that missing link is between "having" HSP and "how it affects me" which was addressed yet not allowed. Everything else can be hashed and rehashed all you want but in the end my reason to be here revolves around that.

Helper

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HSP was diagnosed in 2000. Narrowing it down to SPAST is a recent addition. Whether that will add any weight remains to be seen.

You speak as if I've been before the ALJ twice - I have been denied at the ALJ level once and I need to better prepare for whatever comes next, which I'm still unsure of as no one can offer this to me several months after I requested an appeal. Like I stated, I can't openly speak my feelings toward my lawyer without offending some people. A friend highly recommended her but she has proven to not be up to the challenge. I need to leave it at that as that's a positive as it gets.

Whether current records point to a history of HSP I don't remember all at the moment but I do believe that to be the case. I do know the report from the CE stated such. I just checked my Neuro's records and they mention an HSP history as well which was why my PCP referred me to him.

As for crossing on the objective evidence, we/I have never had that opportunity as those decisions were made after my hearing and only known about in the ODAR letter of which I asked for an appeal.

While my daily living may look quite normal, that's where I have difficulty relaying pain and other issues as to show pain always resulted in a loss of work. Yes, I can move around the house somewhat. It happens to be near impossible without using a walker I keep by my chair to get up with, hands on the walls from one end of the house to the other with bare wood on the door frames to prove it, and so on. Degenerative Joint Disease of the shoulder makes getting up unbearable. To carry anything in the process is impossible. The main approval portion I am after comes in the part of the process of transferable skills. The VE's claims were ruled out by my Doctors' RFC reports due to their required bending, standing, etc. To not allow those reports due to the lack of objective evidence is the current hurdle. Evidence beyond SPG4 appear to be impossible unless someone here knows the missing link. That's the whole reason I signed on. The missing link is somewhere between the evidence of having SPAST and "how does it affect me". No one is questioning my having HSP. The ALJ acknowledges it early on. No one is questioning I have arthrosis in both knees with bone fragments, degenerative joint disease of the shoulder, lateral epycondilitis of the elbow, arthritis in multiple locations of the spine... Those are off the top of my head and I'm tired. My Doctors have performed multiple physicals which I have failed yet their reports aren't allowed due to whatever that missing link is between "having" HSP and "how it affects me" which was addressed yet not allowed. Everything else can be hashed and rehashed all you want but in the end my reason to be here revolves around that.

I think your "missing link" in documenting your limitations in an objective way is a Functional Capacity  Examination (  FCE  ) .   It is typically performed by a physical therapist & not all insurance will cover them.  If you have to pay for it, it can cost a couple hundred dollars - but it will be worth every penny if it documents your limitations objectively.  During the FCE, they test how far you can walk, how much you can lift, etc.   Then you can submit the FCE to SSA & your doctors can also use it to define your limitations.

KM

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I've read about the FCE reports. On one hand, that may be THE answer. On the other hand, I don't have the money to pay for it and the prices I've heard range from $200-500 "ballpark" and my luck NEVER slides in my favor. The ALJ already rejected statement from my Doctors and I understand statements from NON-medically approved sources take a seat behind personal physicians. And to top it off some of the reports I've seen of the demands placed on those taking the tests is rather high and I have enough pain getting dressed, much less taking long physical exams under stress. (One stated the examiner reported they refused to lift a 10 pound weight citing they were not following testing protocol. They were advised NOT to lift over 5 pounds by their Dr. The statement from the examiner stuck. I can't lift my left arm shoulder height empty handed without pre-planning and patience.) I'm not against it as I said, but the negatives so far out weigh the positives. If someone has more details to show my negative fear is false, by all means show me as this is still in my "may do" list!

Lit Love

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What would a FCE show?  Do you have the capability to lift heavier things but generally don't due to your doctor's restrictions?  Do you have muscle atrophy in your legs? 

I underwent a FCE years ago and my complaint was activity using my dominant hand caused swelling and pain.  Well, the pt was able to use a water displacement test to show that swelling was occuring, and it was exactly inline with my complaints of pain.

There is a difference between medical records regarding objective and subjective evidence.  A doc is generally not taking a patient's x-rays for example, a tech is.  Although some docs perform FCE's.  You need to see where your doc would refer you and if he or she can write the Rx in a way that your insurance might cover it.

I have had to undergo tests for WC or for purposes of confirming a diagnosis that went against my primary's advice and/or restrictions.  Will doing so cause long term damage?


KM

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I don't know enough about FCEs, to know what they would show. Should I ever lift more than recommended I'll pay for it for 2 days of intense pain. The same for trying to walk or stand extra such as with my hobby. I do have severe "useful" muscle atrophy of the legs. Muscles i have no control of are rather well defined and I have to overcome those to function. (one aspect of HSP)

No insurance after a year of good coverage followed by a year of lousy coverage. Our income went below obamacare standards...

As for permanent damage? Every day I feel, "This won't bother me" only to be paying for it for 2 days. "It" might be walking, a quick stumble getting up or in the house, getting dressed, taking off socks, etc.

I left my CE exam with my eyes watering. Anyone who's been there knows full well the exams are simple and non-exertive. I was in major pain afterwards. I did get a chuckle regarding the grip test. My wife asked later if it was my shoulder she heard crack during this test. Nope! It was his hands! While my dexterity and fine motor skills have taken a hit, a lifetime of blue collar work and a CE stressing me out allowed me to show my grip hasn't suffered. His hands did a bit, though. Sorry for the sidestep. That was one of the few moments that felt "OK". Besides, he said, "Squeeze as hard as you can." Doctor's orders.

Lit Love

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I've undergone multiple tests over the years that have caused me severe pain and days to recover.  It's not ideal, but you do what you have to survive.  Btw, I had to have my FCE performed over several days because of my reaction which the pt was able to document.

Helper

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While being in pain for 2 (or more) days after a test is not ideal, sometimes you have to do things that cause pain to document your condition or obtain treatment.

 I regularly do some things that aggravate some of my conditions because they are necessary.  For example,  one of my specialists is about an hour away and it tends to be a long appointment.  Going to his office is the only thing I can do that day so I make sure I have someone drive me & pre-prepared meals ready & I know I have to plan a rest day for the day after my appointments so I can recover.  I know physical therapy appointments take a lot out of me too & increase my pain level so I plan my schedule accordingly.

 If the test was going to cause a permanent injury that would permanently worsen your condition - not just temporarily increase pain level - then I would definitely not recommend doing it.

Have you started keeping a daily journal of your activities & symptoms & any problems from activities? Like got example, if you do X & it takes you 2 days to recover documenting it in the journal.  Your lawyer may find it is helpful non-medical documentation for your appeal.

 

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