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 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 claims process with the lowest rate of approval, around 15%. Now my attorney will request an ALJ hearing, where odds of approval range from 45% to 50%. The biggest problem continues to be my age; it’s doubtful a hearing would’ve been necessary if I were closer to 50.
The lawyer said I’ll have to make a couple of decisions in the coming weeks: whether to request a courtroom hearing or one conducted over the phone, and whether to have one or more of my doctors write letters in support of the claim. She cautioned that letters sometimes backfire if they disagree that you’re disabled. My neurologist previously said her office would provide full support for the claim but we didn’t discuss letters specifically; those are supposed to be written by the doctor, not the 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 and she treats the IBD-related arthritis I’ve had since childhood. I won’t bother asking my GI for a letter because his office is perpetually 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 was sent to by the DDS adjudicator. The internist’s report mostly consisted of copied-and-pasted lists of my diagnoses, hospitalization history, and the medications I take. She noted my tremor but wrote that she found no muscle rigidity, which was possibly a typo since she went on to detail the stiffness and limited range of motion she observed in my neck, left arm and leg. Reduced strength on my left side was also recorded, along with slowness and clumsiness.
The psychologist’s report was much more detailed, even though the exam was considerably shorter. He came to the same conclusion that Crankenstein and I reached months ago (despite the injury it causes my pride): I have some degree of mild cognitive impairment. It’s not the end of the world and won’t necessarily worsen; it could even reverse in the future if my sleeplessness or response to medication improves.* But it’s an impairment nonetheless, one that’s noticeable to others.
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.
That’s what I mean by ‘mild’ impairment: I could normally recite serial sevens and threes 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 trouble was that I was also 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 so while straining to remember ‘apple, penny, table’ revealed 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.
It’s a boilerplate summation of a more detailed report that found no concerns with my abstract reasoning, insight, judgment, or intellectual functioning. His overall assessment of my demeanor states that I’m pleasant, cooperative, and in control of my emotions; that I work well with others and don’t have issues with authority. (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 inexpressiveness; Parkinson’s doesn’t prevent me from noticing cues but makes it harder for others to read mine. As for “setting and achieving realistic goals,” he correctly noted earlier in the report that I’m goal-directed; what he’s referring to are frustrations in accepting my limitations. I related that one of my biggest complaints to the physical therapist was that many physical tasks, including housework, are now enormously time-consuming. There’s no magical fix for that; instead, she advised me to split the work into chunks completed across several days.
His clinical impression of “major depressive disorder” is only that; his opinion, based on our short conversation and his reading of a form the adjudicator sent and notes from my most recent neurology checkup. It’s not a diagnosis I’ve received and isn’t supported by the low dose of Zoloft I’m prescribed by the MDS, but Parkinson’s is mentioned several times in this primer on MDD, so maybe his conclusion is less strange than it sounds.
It’s upsetting to read any of this about yourself and 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 scrutinize your ability to provide for yourself and your family. But I hope this was 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 one 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 and trying to multitask, or when I’m ‘off’ in PD parlance, my faculties are largely intact.