All the scintillating details of the last couple days — adventures with Crankenstein; more spray painting; how I can’t look at the cover of David L. Lander’s multiple sclerosis memoir without laughing (because the Squiggy photo reminds me of my sister’s default selfie face) — will have to wait, because there’s been movement on the SSDI front.
As expected, my first appeal was denied. Reconsideration, as it’s called, is the stage of the disability claim process with the lowest odds of approval: between 10% and 15% in most states. Now my attorney will request an AJL hearing, where odds of approval typically range from 45% to 50%. The biggest problem continues to be my age (41); approvals for Parkinson’s usually don’t require a hearing for patients over 50.
The lawyer said I’ll have to make a couple of decisions in the coming weeks: whether to request a courtroom hearing or a remote one conducted over the phone, and whether to have one or more of my doctors write letters in support of the claim. My neurologist had previously said her office provides full support for claims but we didn’t discuss letters specifically; those are supposed to be written by the doctor, not office staff, so I’ll have to ask about that.
My rheumatologist has also offered her full support, but I’m unclear on how that would work when my contention is that I’m disabled by Parkinson’s, not the IBD or IBD-related arthritis I’ve had since childhood. I wouldn’t bother asking my GI for a letter because his office is often in disarray and the most important details of my Crohn’s disease and surgical history are already documented extensively in his records. It’s much easier to measure and convey the severity of an intestinal disease than it is to explain the individual peculiarities of Parkinson’s.
Attached to the attorney’s response were the evaluation reports submitted by the internist and psychologist I’d been sent to by the DDS adjudicator. The internist’s report was mostly copied-and-pasted lists of my diagnoses, surgical and hospitalization histories, and the medication I take. She noted my tremor and wrote that she found no muscle rigidity, which was possibly a typo since she went on to detail my stiff, immobile neck; reduced range of motion in my left arm and leg; slowness and difficulty in performing motor tasks; and reduced strength on my left side.
The psychologist’s report was much more detailed, even though the exam was considerably shorter. Despite the injury it causes my pride, he came to the same conclusion that Crankenstein and I reached months ago: I have some degree of mild cognitive impairment. It’s not the end of the world and won’t necessarily worsen; it could remain consistent or even improve in the future, particularly if my sleep and medication absorption misfortunes are reversed.*
Here were some of his impressions:
The claimant was able to spell world backward; count down from 20, performed simple calculations of 8 – 2 = 6 and 3 + 7 = 10. She was asked to perform serial 7s from 100, she made 3 mistakes during the serial 7s, and she was asked to perform serial 3s from 20 and made 2 mistakes during this task as well.
This is what I mean by ‘mild’ impairment. Normally I could perform serial 7s and 3s in my sleep, and if that’s all I’d been asked to do in the exam it wouldn’t have been a problem. The reason I had difficulty was that I’d also been given a list of words to remember. Dividing my attention in order to hold onto the words eventually distracted me from the math. Until recently, such multitasking would’ve been a breeze.
Immediate memory: Past recall of 3 objects immediately. She was able to do so, apple, penny, table. Digits forward: She could recall 4 or 5 digits, could not recall 6 or 7 digits forward. For digits backward, the claimant could recall 3 digits, could not recall 4- or 5-digit memory backwards. Recent memory, she was able to recall 3 objects after a delay of apple, penny and table. On remote memory, she was able to recall her date of birth, place of birth, and the past four presidents of Biden, Trump, Obama, and Bush.
Again, the issue here was that I was given a larger amount of information to retain. Attempting to do that while straining to remember ‘apple, penny, table’ showed some cracks in my recall.
The report was seven pages but this was the most important content from the lawyer’s perspective:
CLINICAL IMPRESSION:
1. Major depressive disorder, recurrent and severe, code 296.33.MEDICAL SOURCE OPINION:
Understanding, remembering, and applying information: Moderate limitation. Some difficulty with remembering sequences. May have some difficulty carrying out tasks and problem solving and decision making. Interactions with others: Moderate limitation. Problems with flat affect. Others have difficulty reading her emotions. Communication problems due to slow response to questions. Concentration, persistence, and pace: Marked limitation. Difficulty maintaining sustained attention – difficulty working at a consistent and appropriate pace, completing tasks without needing excessive breaks. Adapt and manage oneself: Marked limitation. Difficulty regulating emotions, proving and reading social cues and setting realistic goals and achieving them.CAPABILITY: The claimant can manage benefit payments in her own interests.
Much of that is boilerplate and I wish he’d been more specific. The full report, for example, states that I’m agreeable and in control of my emotions, that I get along well with others, that I don’t have issues with authority, etc. (All that was missing were notations that I’m housebroken and great with kids and it would read like a shelter dog’s adoption profile.) I can regulate my emotions but anxiety inflames my motor symptoms, which is standard for PD. If I get stressed in front of you, I won’t angrily lash out or curl into the fetal position and cry, but my tremor and dystonia will worsen.
“Proving and reading social cues” refers to my inexpressiveness; Parkinson’s doesn’t prevent me from reading cues but makes it increasingly difficult for others to read mine. Setting and achieving realistic goals isn’t something we discussed but I believe that goes back to what I’d told him about things taking much longer than they used to. I explained that one of my biggest complaints to the physical therapist was that housework takes an extraordinarily long time now. She couldn’t teach me to get it done faster; instead, she explained that I have to accept I can’t get everything done in a half-day anymore and to break those jobs down into smaller chunks I complete across several days.
As for his impression of “major depressive disorder,” that’s not in my actual medical record and isn’t supported by the low dose of Zoloft I’m prescribed by the neurologist, but Parkinson’s is mentioned several times in this primer on MDD, so maybe his conclusion is less strange than it sounds. It’s not easy to read any of this about yourself, or to know that strangers will skim these reports, possibly while squeezing their cheeseburger too hard at lunch and getting ketchup on their shirt as they judge your ability to provide for yourself and your family. But I hope it’s a useful peek behind the curtain of what it’s like to apply for SSDI with a neurological condition.
* It should be clear to regular readers of my work here and elsewhere that I retain a decent long-term memory and (mostly) sharp critical thinking skills when I have time to think things through; that’s why I say that mild cognitive impairment isn’t the end of the world. Writing posts like this takes much longer than in the past, and I might need more nudges to remember appointments or complete tasks, but even though I feel uncharacteristically dumb — or maybe dull’s the better word — when sleep-deprived or trying to multitask, or when I’m ‘off’ in PD parlance, my faculties are largely intact.