Social Security Questions and Answers

NMM · July 2011

Merilee,

Honestly I have no idea where you stand. You obviosuly have some postive SSA factors fgoing on..over 50...dx with BC..getting zapped with RX...having an additonal mentla impairment.

So just like SpecialK if you showed up to my office with those facts and medical records supporting with a denial letter...then yeah that is the type of client I would take..ecaue I don't know if we can win...but there are facts that support such a finding.

Let me know what happens and I will see if we know of someone in your neck of the woods who can help you if you get denied.

Steven

NMM · July 2011

SpecialK

When did you first get DX with BC. I migjht use that one.

But otherwise I would use 10/29/10 date or actually use 10/1/10.

"Total of 8 months off. Returned to work on 7/1 and will work until 7/19 and then have more surgery. I will have worked 12 days and made about $800. After this surgery I am not going back - can't handle it, too chaotic and physical, also inflexible on time off and I am still in active treatment. "

What you write here answers your own quesiton about onset. The fact that you worked 8 days and made some money is not as important as the fact that you stopped because

"can't handle it, too chaotic and physical, also inflexible on time off and I am still in active treatment. "

So I would use 10/10 or maybe DX date.

Let em know how it goes

Steven

texasrose361 · July 2011

Steven

I really appreciate you posting your wealth of knowledge, most of us get so lost trying to navigate this on our own.

I have a very specific question regarding SSI- i applied and was approved late last year (october) in jan we moved to an apartment where my husband was working in exchange for rent, i dutifully reported this change to the SSI, they reduced my payment, then in may they requested my husbands pay stubs, which i turned over to them, when they pulled up the social security apparently this apartment complex company is paying into social security and reporting it as wages (even though we dont see a paycheck from them at all only a free apartment) So in june i get a letter saying that i owe them almost every cent they paid out to me. And they reduced my payment it only $3 a month. Which they keep to pay themselves back (gonna take 60 years)

The paperwork said in order for me to appeal i needed to prove BOTH A- that it wasnt my fault that the over payment occured and B- that the amount they are keeping will dramatically affect us financially, but they reduced our payment to only $3 so i am not sure if i can appeal or not. To be honest we barely qualify based on gross, but because of my health insurance take home is A LOT less but of course they dont go off of that, and we are in the negative about $200 every month

My question- is it worth me appealing? If so what should i have with me?

petjunkie · July 2011

Steven, I'm confused about dates and wondering if I did something wrong and could have gotten disability earlier. When I applied, I put the date of disability as the date that I was diagnosed stage IV by the PET scan-- NOT the date of my original stage 1 diagnosis, two years before. If I wasn't working, like your wife was not, should i have put the date I found the lump? Would that be considered disability even though the SS website says Stage IV is the disability? I'm not sure that my medical records would have supported a disability claim when I was first diagnosed, as physically I was able to work. And most do work through stage I and after. But should I have tried to use that date and go back to earn two more years of disability payments? I was working up until my initial diagnosis in 2007.

NMM · July 2011

Pet junkie

At this pointit is all water under the bridge unless your app is still pending and then you can amend it.

You have a complicated question so I will try and deal with the most recent first, which is stage iv Dx.

You don't give exact dates so I will make some up to illustrate. Assume stage I Dx in June 2009. Assume pet scan confirms stage iv in June 2011.

Obviously odds are that you did not go stage iv on the very same day you not pet.

Question is what is medically reasonable to infer you went stage iv prior to pet in June 2011. One month, 6 months, 1 year? I am not an MD so you would need to find that out and I would use that date.

Or lets say you had a clean pet in June 2010 that was not confirming to stage iv. So now we have 2 fixed dates that narrow it to a one year period. So we can just splitnthe difference and put down AOD (alleged onset of disability in SSA speak) Jan 2011 as medically reasonable. Again as an attorney I am not a doctor, so whoever I am looking for as much certainty as possible, I willing with what is reasonable.

Of course this all dependsnwhen you applied because you can't get it but one year prior to app date.

Ow prior to you becoming stage iv that does not mean were not disabled but merely that you may be disabled under some other part of SS law.

Anyway family demands calling, let me know if that helps or remind me to re visit.

Steven

NMM · July 2011

Texas

No time to reply tonight but you should always appeal as it can't hurt. Will try and reply inn detail later.

Steven

petjunkie · July 2011

Thanks Steven, that makes sense. I had mastectomy in Oct 2007, but no radiation or chemo. Just tamoxifen. Reconstruction Oct 2008. Since I had only had DCIS with one microinvasion, there was no indication of mets. Follow-up mri every 6 months were fine until Oct 2009, when lymph nodes looked off and my tumor markers were suddenly sky-high. Oct 2009 is the date I used then for my SS application, since that's the date I considered myself stage IV. I suppose the mets could have been there for 6 months before that, but my medical records would not have supported that argument. And you're right, it's water under the bridge. I just hadn't realized that I could have maybe looked at a medically reasonable date that may have been a bit before the PET scan. This might help a lot of women who hit stage IV, can't work because of treatment, but have the 5-month waiting period to get through.

Thank you for all the information and support you provide to all of us!

Anonymous · July 2011

Steven, I have come up with a different thought and don't know why I didn't think about this earlier. If I would get SS disability now I would get $1,015 per month more than if I take SS retirement benefits at age 62. I will be 62 in December. Could I get my SS retirement and continue working, providing I don't make over $1,000 per month? If I could do that I would be coming out about the same and would not be totally cutting myself off from my job which I really like. I am sure I could work it out with my employers where I would just be working a day here and there. If in the event I do really go downhill and am not able to work at all and I am already getting my SS benefit, could I then switch to disability? Or is it choose now and that is what I have to stay with?

I have my appointment still on the 25th and am going to start the online paperwork. I am expecting the bone scan and CAT to be bad since there was such a big jump in my CA 27.29 ( also because I am feeling a physical lump and have never been able to feel anything before as it was all internal and deep) so if I have to start on some chemo that is really going to cause me bad SEs, that might change everything and I actually will be disabled. 13 years has been a really good run at Stage lV, but I am just afraid time is running out and that is the only reason I have started to seriously think about the SSDI.

Thanks for all your help. Marybe

Anonymous · July 2011

Marybe:

I'm not sure if this will help with your questions. I retired at 62 and intended to work part-time. I was only able to do that for three months due to stage IV complications and filed for SS disability which gave me an additional $500 monthly.

A side question is health care. I was on BC/BS and was forced to Medicare 2 years after SS disability - still adjusting to that.

In your other posts, you have talked about changing Oncs. Your Onc will be very instumental in getting a smooth approval for disability so you may want to adjust your Onc change to accommodate for that. When I filed for disability, my approval was done quickly with back benefits.

Edited to add that I became Stage IV approximately 3 or 4 months prior to retirement and 6 months prior to filing for disability.

Anonymous · July 2011

My husband has good insurance and it's a sad thing to admit but that was the reason I got married..for insurance. If I am on SS, am I forced to do mecicare after two years or can it be my supplemental? I suppose I should be happy to have either one since for years I checked every policy and plan and called those numbers on TV that say Need Insurance? Call ######, we can help and insure anybody. Yeh, anybody except someone with Stage lV BC. I am pretty sure my current onco will help me out since he has been telling me for the last 5 years I should go on disability....also my ortho doc who took my xray on Mon and noted new mets in my shoulder said he would fill out forms for me. He actually said he does the SS disability exams on Fridays, but when I asked if he could do mine he said he doubted it since I am a patient of his and it might be a conflict of interests or something like that.

It is so hot outside today it makes me tired and I don't even want to think about filling out papers. Thanks for sharing Nurse-Ann.

Anonymous · July 2011

Marybe:

I had free BC/BS from my husband's former employer - 36 years at Ma Bell. I was forced to go onto Medicare two years to the month after filing for disability - a year before I would have been required by age. I was really afraid because that's when my Onc decided to switch me to Eribulen - we had many discussions over that. There's a penalty if you do not switch when you are eligible. Ma Bell also required that I switch to their secondary payer (United).

Chickadee · July 2011

Another Ma Bell retiree here. When my husband reached 65, Verizon required that he make Medicare his primary and Aetna is secondary. Our prescription plan is still through Verizon benefits. Aetna picks up whatever Medicare hasn't covered. My son's disability also put him into Medicare with Aetna as secondary.

Although there can be variations, likely Medicare will become your primary and your other insurance supplemental.The upshot of that has been that we have had virtually no out of pocket expenses. We both stayed through a number of buyout offers in the phone company until we were assured that we had earned our 30 yr retirement health benefits.

Anonymous · July 2011

Chickadee:

Verizon here, too. Also a buyout. These retirement arrangements were so common many years ago and are gone today for the most part. We ended up in United the same way you ended up in Aetna.

I was nervous about Medicare at first and missed my BC/BS but I don't miss the copays.

Carol

NMM · July 2011

Marybe

Your doctor is wrong. By regulation SSA prefers the tx dr. To perform exam. It is just that so few want to put up with getting on the approved list and filing for payment which is somewhat low, I think less than ~$200 or already have a busy practice that SSA has what amount to staff examiners. Here in the southern California area there are whole clinics that only do exams or nearly so.

Don't have time to post the link but just type examination at SSA.gov and you will get this

Consultative Examinations: A Guide for Health Professionals

Part III - Consultative Examination Guidelines

If the evidence provided by the claimant's own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the treating source for additional information or clarification, or by arranging for a CE.

The treating source is the preferred source of purchased examinations when the treating source is qualified, equipped and willing to perform the additional examination or tests for the fee schedule payment and generally furnishes complete and timely reports. Even if only a supplemental test is required, the treating source is ordinarily the preferred source for this service. SSA's rules provide for using an independent source (other than the treating source) for a CE or diagnostic study if:

. The treating source prefers not to perform the examination;

. There are conflicts or inconsistencies in the file that cannot be resolved

   by going back to the treating source;

. The claimant prefers another source and has a good reason for doing

   so; or

. Prior experience indicates that the treating source may not be a

productive source.

The type of examination and/or test (s) purchased depends upon the specific additional evidence needed for adjudication. If an ancillary test (e.g., X-ray, PFS or EKG) will furnish the additional evidence needed for adjudication, the DDS will not request or authorize a more comprehensive examination. If the examination indicates that additional testing may be warranted, the medical source must contact the DDS for approval before performing such testing.

Fees for CEs are set by each State and may vary from State to State. Each State agency is responsible for comprehensive oversight management of its CE program.

Selection of a Consultative Examination Source

The DDS purchases consultative examinations only from qualified medical sources. The medical source may be the individual's own physician or psychologist, or another source. In the case of a child, the medical source may be a pediatrician.

By "qualified," we mean that the medical source must be currently licensed in the State and have the training and experience to perform the type of examination or test we request. Also, the medical source must not be barred from participation in our programs. The medical source must also have the equipment required to provide an adequate assessment and record of the existence and level of severity of the individual's alleged impairments.

Medical sources who perform CEs must have a good understanding of SSA's disability programs and their evidence requirements. The medical source chosen may use support staff to help perform the consultative examination. Any such support staff (e.g., X-ray technician, nurse, etc.) must meet appropriate licensing or certification requirements of the State.

Generally, medical sources are selected based on appointment availability, distance from a claimant's home and ability to perform specific examinations and tests.

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Consultative Examination Report Content

The examination report should include the claimant's claim number and a physical description of the claimant, to help ensure that the person being examined is the claimant.

The detail and format for reporting the results of the medical history, physical examination, laboratory findings, and discussion of conclusions should follow the standard reporting principles for a complete medical examination.

The report should be complete enough to enable an independent reviewer to determine the nature, severity and duration of the impairment, and, in adults, the claimant's ability to perform basic work-related functions. The history and physical examination must be provided as a narrative of the findings.

Conclusions in the report must be consistent with the objective clinical findings found on examination and the claimant's symptoms, laboratory studies, and demonstrated response to treatment and on all available information, including the history. The report, for adults, should include a description, based on the medical source's own findings, of the individual's ability to do basic work-related activities. It should not include an opinion as to whether the claimant is disabled under the meaning of the law.

Signature Requirements

All CE reports must be personally reviewed and signed by the medical source who actually performed the examination. The medical source doing the examination or testing is solely responsible for the report contents and for the conclusions, explanations or comments provided. The source's signature on a report annotated "not proofed" or "dictated but not read" is not acceptable. A rubber stamp signature or signature entered by another person, such as a nurse or secretary, is not acceptable.

How the DDS Reviews Consultative Examination Reports

The DDS is obligated to review the CE report to determine whether the specific information requested has been furnished.

The CE report must:

. Provide evidence that serves as an adequate basis for disability

decisionmaking in terms of the impairment it assesses.

. Be internally consistent. Are all the diseases, impairments and

   complaints described in the history adequately assessed and reported

   in the clinical findings?

. Do the conclusions correlate the medical history, the clinical examination

and laboratory tests, and explain all abnormalities?

. Be consistent with the other information available within the specialty of

the examination requested.

. Did the report fail to mention an important or relevant complaint within

   that specialty that is noted in other evidence in the file (e.g., blindness

   in one eye, amputations, pain, alcoholism, depression)?

. Be adequate as compared to the standards set out in the course of

a medical education.

. Be properly signed.

If the report is inadequate or incomplete, the DDS will contact the medical source and ask the medical source to furnish the missing information or prepare a revised report.

Steven

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Anonymous · July 2011

Wow, Steven. Thank you so much for taking the time to post all that info. He does the exams on Fridays, just two of them he said so I will try to get my appt with him. Thanks again. Marybe

Chickadee · July 2011

Marybe, I didn't need any exam. I submitted the radiology reports from MDA which stated Stage IV and mets. They didn't ask for any additional info.

Anonymous · July 2011

The previous poster jogged my memory a little. I did my application over the phone and they contacted my Onc. I didn't have to do anything else. Keep in mind though that it was already established that I could not work.

Mazy1959 · July 2011

Petjunkie, the rep at the SSI office here told me the date of stage 4 diagnosis should be the date I went into the hospital which led to PET, MRI, CT and xrays . The biopsy which made it definitive came a month later due to Dr unable to perform it sooner. So the date of my disabilty was dec 19, 2006 because that was the date I was admitted etc. I did not apply for SSDI until late february 2007 when I realized I would no longer be able to work. I suppose things may have changed etc and that may no longer be the case.Hugs, Mazy

NMM · July 2011

Mazy

Things have not changed.

You were told that by someone (SSA employee) who does not have a responsibility to maximize your result (that would be an attorney like me).

Not saying it was a wrong answer, just not the best answer.

Steven

Anonymous · July 2011

Well, for sure we are going to have to come up with a different date for me since I was diagnosed Stage lV in May (?...will have to look it up) of 1998 (and have worked ever since then) and even then it was in my liver......the bones have progressed, and the lung cleared up, but it is the liver that is causing all the concern now since the tumors are multiplying and much larger. I think I will have some new ammo after my CAT scan this morning because I am feeling yet another place and this one is tender. Right now I am just feeling bummed and don't even care if I get SS....I just want to do my scan and go back to bed. I want to find a Genie in a bottle who will make it all go away. But I do appreciate this thread.

NMM · July 2011

Marybe

Here is a link where you can look into working and getting early retirement.

http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/236

and another

http://www.socialsecurity.gov/pubs/10069.html

and

http://www.socialsecurity.gov/pubs/10035.html

Looks like max is $14,160 so at $1,000 per month YOU should be all right...but don't foeget tax issues...

from SSA

***

Your benefits may be taxable

About one-third of people who get Social Security have to pay income taxes on their benefits.

If you file a federal tax return as an "individual," and your combined income* is between $25,000 and $34,000, you may have to pay taxes on 50 percent of your Social Security benefits. If your combined income* is more than $34,000, up to 85 percent of your Social Security benefits is subject to income tax.

If you file a joint return, you may have to pay taxes on 50 percent of your benefits if you and your spouse have a combined income* that is between $32,000 and $44,000. If your combined income* is more than $44,000, up to 85 percent of your Social Security benefits is subject to income tax.

If you are married and file a separate return, you probably will pay taxes on your benefits.

***

Also regarding your other quesiton one alsways must apply for disability if they want it until the reach full retirement age even when they get early retirment first.

As far as genie...do a search for Dr. Schulze and superfood and other things like it.

Steven

bak94 · July 2011

OT-Marybe, I miss you in the may chemo thread. Come back and visit us please!

Anonymous · July 2011

Everyone is going to think I am crazy, but I cancelled my appt at the SS office on Monday. I am just not ready to quit work. I talked to my one boss today and he said I should do what I feel is best for me, but he himself things work is good for me and also he said he selfishly wants me to stay and knows the patients would miss me. So I am going to talk to them, but just not yet.....I want to consult with my onco, see what he thinks my prognosis is now that the CAT showed so much progression in the liver and what the next treatment might be. I want Xeloda, but don't know if he will think that should be next. Then depending on how the next treatment makes me feel, I will decide what to do from there. Since I will be 62 in Dec., I could apply for regular SS even if it is less than disability and work whatever # of hours allowed or the # of hours that would add up to $1000 or whatever the max is per month. I of course would have to cut out the other job altogether since it was full days and this one is only about a total of 10 or 12 hrs per week. As I said earlier I don't want to work until I fall off my stool because I want time to go places and do things, but if I only work a day or so and this boss is content with me taking off as long as I can find a sub, I would have the time to travel.

OK, Steven, this will be my last question for awhile. If I go on regular SS will that automatically disqualify me from EVER getting SSdisability? Say I start getting SS after I turn 62 and suddenly take a turn for the worse.....would I then be able to apply for disability and switch to it providing I meet the criteria and go through the waiting period ( during which I would assume I would just not get the SS)?

We file separately and my husband gets more from his retirement fund than I ever made even when I was working 5 days a week. However, I pay the mortgage and the house is in my name so I do get to deduct that when I file ( for now at least....isn't that one of the things they are taking away?) my out of pocket medical expenses are always enough that I get to count those as well as a lot of charitable contributions and work expenses such as license, cont ed, uniforms etc. So normally I get a pretty big refund. Taxes are something that get me all worked up because paperwork and forms just make me crazy.....just as looking at all that info the wanted for disability did.

K-Lo · July 2011

Dear Marybe, Just from an admirer, you seem to thrive on working!

On the other hand, ( which is almost done peeling from Doxil), my DH says, " this is your retirement that you may not get to enjoy". I earned it! Plus it's a part-time job taking care of the patient- me.

cancerkicker · July 2011

Steven,

You are truly an angel. I hope things are going better for your wife. I am 38 and have a 4 year old son so we have lots in common. I do hope your wife is tolerating her treatments well.

I am already approved for SSDI but I hope you have an answer to this question.

I am looking at taking an "accelerated death benefit" from my LTD provider through my old job. It is my understanding that this money is not taxed and will not be counted as income. Is this right? Also, once I notify SS that I got this payment, will they count it as income against me?

I am paying tax on my benefit, but I am curious if I need to have taxes taken out on my son's benefit. Any thoughts there?

Again - THANK YOU THANK YOU THANK YOU! Best of luck to your wife!

Chickadee · August 2011

Steve, please let us know how your wife is doing? I hope that there is a positive report. We all hope the best for you.

Anonymous · August 2011

I have a new appt with SS next Monday....told them I am not going just to apply for disability, but want to talk to someone who will weigh the pros and cons for me of getting regular SS benefit when i am 62 (right around the bend, Dec) vs SSDI. You have been wonderful answering questions for me, Steven, and I read the link, but I am the kind of person who has to pretty much have someone draw a picture for me when it comes to figures and numbers and such.

I had an appt with my retirement investor this morning and was pleasantly surprised to find out I only lost $2000....say only because the way the news was portraying it, no one was going to have any money left. He said the media always makes it sound worse than it actually is. If I decided to get regular SS, he said I could make $14,000 gross per year and I would probably stay with the office where the boss has the profit sharing plan. If I need any money I am going to take it out of the smaller account and leave the money in the stocks alone since it will eventually go back up again, but he said it's got to hit a bottom before it goes up and that's just the way the cycle is. Now if the xeloda causes HFS and my hands are a mess, I may have to do on disability, but this is only day 5 so it's too soon to tell.

We are all hoping and praying things are going well for your wife. Marybe

TexasKaren · August 2011

wow... this thread is so awesome! I was dx Stage 4 with bone mets in Dec. 2010, (and they are progressing, on fourth chemo now), but am still planning on working until at least Oct, and maybe end of year, but it is a 'floating' target depending on how I am doing. I had TONS of SS questions, and this thread has helped me so much! I am 59 and have worked since age 17. I had planned on working until I was 65, and stopping this year will definitely have an economic impact on us. I have been working hard to pay down credit card debt since December, but losing my income will be hard.

Steven... the service that you have provided to all of us here is truly a labor of love, and thank you! I will refer to it many times again as I try to figure out my 'future' with this disease.

NMM · August 2011

Cancerkicker

Sorry I thought I responded to you. You have 2 questions one is a tax IRS questions the other SSA question.

If the accelerated death benefit is an acceleration of the payment you would receive from a life insurance policy then it is most likely not taxable as income unless it is specifically to pay for long term care. I am not a tax guy so you should double check with one.

As for SSA, that money is not income form SGA so it should not count against you, but you may still need to report it to SSA.

Re: your son's benefit...here is a FAQ from IRS website dealing with child survivor payments which is similar to disability.

****

Question: Are social security survivor benefits for children considered taxable income?

Answer: Yes, under certain circumstances, although generally a child will not receive enough additional income to make the child's social security benefits taxable.

The taxability of benefits must be determined using the income of the person entitled to receive the benefits.

If you and your child both receive benefits, you should calculate the taxability of your benefits separately from the taxability of your child's benefits.

The amount of income tax that your child must pay on that part of the benefits that belong to your child depends on the child's total amount of income and benefits for the taxable year.

***

So assuming your child does not have some other income source the amount he gets should not be taxable.

Steven

NMM · August 2011

Marybe,

your early retirement benefit is usually about 75% of your normal retirement (which is what you would get as a DIB).

So the analysis using your numbers and a hypothetical $1,000 max benefit to keep simply.

Eatrly retirement will be $750 (75% of $1,000). You say you can make $14,000 a year (that is $1,166 a month).

So that would be $1916 total.

OR

get a DIB of $1,000 and work part-time for $700 (remember $720 is max or you go into trial work period) for a total of $1,700.

now there may be other factors like you mentioned profit sharing.

but if you get early retirment and work you get $1916.

If you get disability and work you can get $1,700.

Now also do not forget that at your normal retirement age which is probably 66 if you get disability you will still get the full benefit.

But if you take early retirement then you always get reduced amount.

Example:

if a person gets early retirement at 62 for $700 a month and makes it to 72 (10 years) they would have got $84,000.

If they wait to 66 and get $1,000 a month at 72 you will have $72,000.

Break even in this example is 73.

Sorry to make it sound like it is all about the numbers.

Me persoanlly. I would do both. Get the early retirement and at same time file for disability and if they approve you get paid difference. If not then just try again.

Steven

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