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SSDI, questions about medical conditions


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I've had severe treatment resistant depression for 16 years, moderate/severe fatigue for 10.  I also have ADHD, which I'm starting to think is a bigger contributer to all these issues. I haven't gotten formally diagnosed yet but I'm most likely autistic as well. Those are the main issues that contribute to my disability, which my pdoc has been urging me to apply for for awhile.

My question is that I've had all kinds of medical issues over the years that may or may not be related to whatever I have that makes me like this--In my 20's (now 41) I have hypermobility and had a lot of chronic pain issues; I believe I was diagnosed with fibromyalgia at some point even though I don't think I have that. I was in and out of PT contstantly. I was diagnosed with sleep apnea, I saw a naturopath (bad idea) who claimed I had Lyme's disease and hormonal imbalances and treated me with something that made me instantly worse for an entire year.

The reason I can't work anymore is really a combination of depression, fatigue, ADHD and (likely) autism. I have no idea how easy it is to get SSDI for mental health issues; I guess I'm wondering if any of the other random medical stuff is helpful? Should I just include it all or does that extraneous stuff matter?

One reason I ask is that it'll take some work to dig up some of the medical records; also I don't know if it looks bad to throw in everything but the kitchen sink.

Also--anybody know how important/impactful it might be to get the autism diagnosis? I might have to pay for that out of pocket, not sure... I found a place that only charges $1800 which is less than half of what I normally hear it costs. But I wasn't sure if I would qualify on the depression/fatigue alone.

Last question... does anyone know how they determine the amount that you'd receive? I found an eligibility thing I think through the SSDI site that said I could receive up to $1300ish but I have no idea how it works. I mean I have no clue how people live off that but still... I'm hoping to do the Ticket to Work thing and work from home part time if I can, like I've been trying to do since I left my full time job two years ago... I'm not sure how else I could get by. I do have some cash (it's draining fast though), so I assume I don't qualify for SSI.

Any other tips or advice on apply for SSDI are very welcome, thanks!

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Even if you qualify for SSI, you do not receive SSI in addition to SSDI unless your SSDI is less than $841/month. For example, let's say you receive say, $450/month in SSDI. If you financially qualify, you could receive $391/month in SSI bringing your grand total to $841/month ($841/month is the 2022 SSI benefit). Not going to go into getting SSI to cover the 5-month waiting period for SSDI as you don't believe you qualify for SSI. You have to have less than $2,000 in resources ($3,000 for couples). 1 house and 1 car do not count toward resources. Even then, they pay the SSI back out of your backpay but sometimes it's still worth doing depending on certain things. Medical criteria is the same for SSDI and SSI (unless you're over 65, in which case you only need to meet the financial requirements for SSI). 

Setting up a SSA official account will give you the best estimate of what your SSDI amount is. The actual formulas are somewhat complicated or maybe I'm just not smart enough. There's also something called the family max. If you have children, they can sometimes get about half of your SSDI split between them. So let's say you have 2 kids under 18 at home and your SSDI benefit is $1300. Each child might get $325 each, so you'd be getting $1300+650 per month. Now, because of family max limits, some people who have fewer and/or too many low earnings years may have a low family max that means they don't get much, if anything for their kids. So it's important to know your family max because it's not always 150% of your benefit even though that's a pretty good general rule of thumb.

After a two-year waiting period (those with ALS or ESRD do NOT have a waiting period btw), you will qualify for medicare. Medicare is great IMO. However, it's not 100% free unless you financially qualify for help paying your Part B premiums (the Part B premium is $170/month as of 2022) and other costs. I could write A LOT more about medicare but I'll shelve that topic for now since that's a longer term thing to think about.

Ticket to Work (TTW) I don't think will apply much to you since their goal is to transition you to working full-time making more than SGA (substantial gainful activity) which is $1350/month for the non-blind. So yeah, the goal of TTW is to get you off the disability rolls. However, while on SSDI, you can usually fairly safely earn under $970/month working part time without potentially jeopardizing your benefits. The closer you earn to $970, the more scrutiny you may face as to whether you are purposely keeping your earnings under the Trial Work Period (TWP) threshold and could work more if you wanted. You have 9 months (nonconsecutive) in a five-year period in which you can earn from $970/month to 1 billion a month or whatever. But you only get the 9 TWPs so use them wisely (i.e. don't use them unless you are really trying to test your ability to get off SSDI). 

SSA will usually only care about the last 1-2 years of medical records prior to when are claiming your disabilities prevented you from working and earning SGA ($1350/month). They want to know about your current diagnoses and most importantly--your symptoms, treatments tried/failed, and your functioning. IMO it's more difficult to get approved if you are working currently, especially if you are earning close to SGA unless you're quadriplegic or are blind or have ESRD and so forth. However, if you're receiving special accommodations (e.g. more breaks, more days off work per month, less duties required etc. compared to a "regular" employee due to your disabilities), that is super helpful and important to document through your employer. You still can NOT be earning $1350 or more a month and qualify for SSDI (except in the instance of a closed period award, meaning you're back to normal now but there was a 1-year period or something in the recent past where you couldn't work and you qualify to get SSDI just to cover that period). Sorry about all the caveats but I feel compelled to cover all scenarios even though they likely don't apply to you personally.

Back to the last 1-2 years of medical records...you'll want to list any conditions and treating providers that are related to your inability to work and earn $1350 a month. You can only get SSDI going back 1 year prior, so keep that in mind. So just pick the date you became unable to work and earn $1350 (they may change this later based on your evidence). This is called your AOD (alleged onset date). Then be sure to list the providers treating you for conditions that impact your ability to work from the year or two prior to your AOD. 

The fact that you have a supportive pdoc is super helpful. Are you also seeing anyone for therapy like a counselor or psychologist?

Have you tried lots of meds, have you tried ECT or TMS, have you been inpatient in the past couple of years and if so, for how long? Have you done any IOP or PHP programs? The more treatments you've tried (and failed) the better in the eyes of SSA.

I can't say whether it's worth spending the additional money for the autism assessment/diagnosis.

I was approved for depression and anxiety (and possibly fatigue/hypersomnia too). I haven't even done ECT, been inpatient in the last decade or done anything other than I have been on the med-go-round (including trying stimulants). And I did try a IOP program, I have a long term treating relationship with a pdoc and tdoc, had a sleep study done to rule out certain physical things that could be causing fatigue, etc. That said, it took me about 2 years to be approved for SSDI as I was first denied, then denied at the reconsideration step, and then got an attorney for the hearing stage where I was thankfully approved. About 1/3 of people are approved at initial application though. That includes people with physical disabilities, mental, and those who have both. 

An attorney is paid out of your backpay and is not usually necessary unless you make it to the hearing stage since they don't often do much more than you do at the initial and reconsideration step. I went with an attorney my pdoc recommended after I was denied at the reconsideration step.

I applied for SSDI because I was on LTD (Long term disability) from my former employer and LTD eventually requires you to. I am fortunate to live for free with my mom and have some savings so I did not have as difficult a time as some do waiting to get approved.

If you have any student loans btw, you do not need to wait to be approved for SSDI to get them discharged. Your pdoc can fill out a form and usually the discharge is approved in most cases. I had already paid my student loans back before I got disabled but thought I'd mention it to others here just in case.

Not sure if I managed to answer all of your questions but hopefully I've helped somewhat.

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Posted (edited)
23 hours ago, climber47 said:

Any other tips or advice on apply for SSDI are very welcome, thanks!

First of all, it is somewhat more difficult to be approved for SSDI if you are under 50......Not impossible, but a little more difficult.

@aquarian is right that a lawyer is not absolutely necessary, but you do have a better chance of being approved if you have a lawyer.

My best advice to you is to gather all your medical records, for all your conditions, for the past 2 years, and meet with a disability lawyer......They are experts in the field and know what it takes to get approved......After looking at your records, and possibly asking you some questions, they can tell you if you have a good case or not.......They might send questionnaires to your current doctors as well.

If a disability lawyer thinks you have a good chance of approval, they will take your case......If they don't think you have a good case, they will tell you......If they don't think you have a good chance at winning, they probably won't take your case.....After all, if you don't win, they don't get paid, so they don't take on just any case.

I had a lawyer for my case, and got approved at the reconsideration stage.....Meaning I didn't have to go to court......I got approved under the conditions of depression, and anxiety disorders..

Many disability law firms offer free consultations........I highly recommend consulting a disability attorney.

Edited by CrazyRedhead
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FWIW, I was approved in my early 30s. And one of the first questions the local disability firm I used asked was, have you been denied twice. It is not unusual for disability attorneys to wait to take your case until after you've been denied at the initial and reconsideration steps, so don't get discouraged if you do decide to hire an attorney now and some won't take you because you haven't been denied yet. Also, some attorneys/firms do a better job than others at making sure to gather all of your medical records, stay on top of things, keep you in the loop, etc. so choose wisely. Some attorneys/law firms will literally kind of wait it out and do the bare minimum while you get denied at the lower stages and then suddenly spring into action when it gets close to a hearing date.

The law firm I used was local, only did disability cases, and (as CrazyRedHead mentioned) they had a short answer questionnaire they used in mental health claims that they had my pdoc and tdoc fill out.

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Posted (edited)
39 minutes ago, aquarian said:

 And one of the first questions the local disability firm I used asked was, have you been denied twice. 

That's interesting because I was never asked that by the local law firm that I used......Although I did tell them I was denied on the intial (first step) phase.

After consulting my records and my pdoc, they decided to take my case after I had only been denied once......I then was approved on reconsideration phase (second step), and as I mentioned, I never had to go to court.............I guess different law firms might have different policies they follow.

Edited by CrazyRedhead
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