Aug. 1st, 2017

shira: (Default)
A summation of the process of applying for disability:
Apply!
Be denied.
Appeal!
Be denied.
Request a hearing!

This is the first time I’ve gotten to step 5. Let me unpack my experience a little for the new folks or for those who have reasonably lost track through time. Note: I now know that I have Ehlers-Danlos Syndrome type IV, Vascular (vEDS), which is a connective tissue disorder that focuses its fuckery on the cardiovascular system and hollow organs and has secretly been the link re: what my body has been doing this whole time, but I didn’t know that until late 2014.

So. I have always been A Sickly Child, and my lungs pretty much stopped functioning normally when I was 4, and I spent most of my adolescence with a series of ankle sprains, and I tore my L5S1 disc at 17 in that abusive “wilderness survival camp”, migraines, etc., but within the realm of basic functionality until 2003. In 2003, either the seizures started or they started to become noticeable. My seizures are simple partial and complex partial, not tonic-clonic, so brief seizures could have passed notice; my mother claimed, upon hearing about this, that I was always a “spacey” child, but we’ll never know if that was early seizure activity of just me daydreaming about being the secret ruler of a gemstone kingdom. Whatevs. What really impacted me starting in 2003, though, wasn’t even the seizures (although they meant I couldn’t drive or cook), but the anti-seizure medications. Completely brainfucked. Side effects included sudden and severe weight loss, intense vertigo, scrolling vision, massive fatigue, brainfog to the point where I was incapable of completing sentences, et cetera.

I was on various anti-seizure meds until 2012. As I moved up to Boston in 2006 and got better doctors, I changed to meds that screwed me up less. Why did I stop in 2012? I ran out of anti-seizure meds that did not, sooner or later, make me suicidal. (Which is a known side effect in the prescribing information.)
An overlap! In 2004, The Pain hit. All of a sudden, hideous full-body unstoppable pain. My body would stiffen up after sitting for five minutes. It was horrifying and no explanation could be found. I got a diagnosis-by-exclusion of fibromyalgia, a prescription for muscle relaxants, and a sympathetic look.
This is when I went from full-time to part-time at work. I was later fired (in 2006) due to issues with my disabilities, but I didn’t have the energy to sue them... or to follow through on my first disability application, so that stalled out at step 4, because I was also suddenly planning a move to Boston from my hospital bed (video EEG monitoring to see if brain surgery to cut out the lesion on my left hippocampus would be a good idea, since my epilepsy was Medically Resistant).

So! Boston! Minus the brain surgery. We knew when we moved up here that I couldn’t work, but we were determined to make it work. New England had most of our chosen family, and Boston in particular had a great variety of doctors and a public transit system that made it possible for me to get to them. (Ask me sometime about the nightmare neurologist in Atlanta who, when I was down to 85 pounds, refused to try me on Depakote, which has weight gain as a side effect. Because she would rather I be hospitalized with a feeding tube than take the slightest chance that I might decide to disregard all the warnings and up and get pregnant; Depakote causes birth defects. “I know how condoms work,” I told her. “Yes, but you’re a newlywed and will want babies,” she said. “I have a ten-year-old and don’t want more kids,” I said. “You’ll change your mind,” she said. Am I glad I left the Bible Belt? Yes. Yes, I am.) Matters continued as previously stated for some time; instead of a day job, I had managing my pain, fatigue, and side effects.

In 2009, everything changed! I switched to a medication that had fewer side effects, and I was given steroids for a full-body itch - which knocked out a lot of my pain, thereby showing that the underlying cause was almost certainly autoimmune! Verdict after testing: celiac disease. Which is the best autoimmune disorder to have, if you have to have one, because it’s the only one whose trigger is known and avoidable! I stopped consuming gluten and had a wave of energy and much less pain and I was like “hey, I could work now!” So I got a part-time job at BARCC.

Oh hahaha I thought I could work.

As it turns out, you only have governmental disability “insurance” for ~5 years after you stop working, and part-time work counts less, so my “date last insured”, unbeknownst to me, was in 2013. I mention this here because at the hearing, we had to focus almost entirely on the question of “was Shira disabled between 2011 and 2013? should their disability claim of 2014, within the window, have been denied, or was there an error on the face of that? does the new diagnosis establish now sufficient disability present six years ago?” Which is challenging considering I was only told that a week ago so all last week was spent mining memories of those specific two years and tracing shit backwards and forwards in time. What’s relevant? Where do I focus?

Why can’t I work? And why could I not work in 2011, when I left BARCC?

So I started at BARCC in 2009. Part-time - I worked mornings and went home for the afternoon. At which point I would fall asleep. Every damn day. Four hours of work, bus home, collapse into bed. So I wasn’t exactly having a functional life. But at least I could work, right? Because in our society, working is the most important thing, and it’s okay to sacrifice all other semblance of a life just so you can work for a few hours a day, right? That’s more important than taking care of your body or parenting or having relationships, right?

universalbasicincomerightfuckin’nowplease

Anyway. Towering, massive fatigue, because I was doing more than my body wanted to every damn day. Running out of sick days, then vacation days, with a quickness because of migraines, because of days when the pain was insurmountable. Spending afternoons in endless doctor appointments. Worsening pain, because unbeknownst to me, celiac was not the whole story, and just because I felt better than I *had* been feeling didn’t mean that I was all better.

So now let’s talk more about that autoimmune stuff. The thing about an autoimmune disorder is that your body deals with every minor illness with a “NUKE IT FROM ORBIT, IT’S THE ONLY WAY TO BE SURE” response. Factor in that lung fragility traceable back to the connective tissue disorder I didn’t know I had yet.

Want to know when I realized I couldn’t continue to work for BARCC? Winter/early spring 2011. When I came down with a simple winter cold that became pneumonia, that I exacerbated by trying to go back to work before I should have... and then I got norovirus (yes, while I still had pneumonia).
I had to be on mostly-bed-rest for six weeks.

And I had to accept that no company can reasonably hire an employee who can’t commit to being in the office, even just part time, and who will frequently disappear for ~a month due to every cold becoming bronchitis or pneumonia. It wasn’t just that I was run ragged and nonfunctional. It was that I had to be reasonable about what an employer could expect, and that I was just not employable.

Capitalism, amirite?

I left BARCC in 2011 and haven’t worked outside the home since. But I’m not lounging around eating bonbons. I’m managing a medication schedule that can be complex with stuff like the gastritis (carafate 4x daily, 1 hour before or two hours after food). I’m balancing multiple doctor appointments on a schedule that would not be possible if I didn’t have daytime availability (just left a message for my PCP re: the need to see an orthopod because the wrist injury from June isn’t improving; hounding cardiologist for data; gastroenterologist in two weeks; my semiannual opthalmologist visit to check on my fragile optic nerves; I should be going to hand/arm PT but sometimes it’s Too Much). I’m resting when my body needs to, which makes me able to do things I want to do, things that give me quality of life - dinners with my husband, shows, time with friends. I have time to do home PT.

At a certain level, chronic illness is a full-time job in itself.

And it’s stressful to have to keep justifying that, even to myself. (Internalized ablism is a thing, y’all!) It’s difficult to deal with the assumptions that get made because my disabling conditions aren’t externally visible. No, I don’t Look Disabled. Yes, you see me doing fun stuff - because I’ve structured the rest of my life in a way that lets me do that. You don’t see my prep time and recovery time. I spent all of December, all of April, and half of June hella sick. I’m gonna be out wearing a full face of glitter when I can.
And I’m going to keep fighting for disability benefits. Because I paid into that system when I was working and I am entitled to the money I put in now. Because living in one of the three most expensive cities in the US on a single income with a kid we’re putting through college and significant credit card debt is DIFFICULT. (Remember that if I lived somewhere cheaper, I wouldn’t have access to the doctors I need.) Because we’ve spent $3,321 on copays and prescriptions so far this year.

So the other week we were preparing for the hearing. And since my last Insured Date was in 2013, we have to prove that their previous denial was in error. My lawyer was like “in addition to showing that you were disabled prior to 2013, which would be easier if you’d had a better doctor then who documented things more,” (I found Dr. Jackpot in 2014) “we have to explain why you didn’t ask for a hearing then.” To which my answer has been that the fatigue and body issues that make me disabled in the first place made it difficult and overwhelming to pursue, but, going over the timeline with a fine-toothed comb, I was like...
“Well, I was raped and assaulted in May of 2013, and while I was going through the process of the DA deciding whether to press criminal charges, I was preparing for an emotionally difficult civil trial (because he was also my housemate and we needed to recover unpaid rent and utilities among other things), so that really didn’t help?”

And my lawyer was like “wait, you have documentation that, a month before your Date Last Insured, you underwent an experience that could reasonably be expected to give you PTSD? And your later hospitalization for major depression is tied directly to that?”

Y’know, none of which was on my list AT ALL. But that’s why lawyers, I guess.

So we did what we could. My lawyer pulled a lot of stuff from the meager records my prior doctor kept, highlighting passages about my worsening pain and insomnia (oh yeah, I haven’t slept without chemical aid since 2005, forgot to mention that); turns out I also got my pain and sleep meds increased within two months of that all-important date last insured. The data after 2014 is overwhelming, thanks to Doctor Jackpot, but what we had to show was proof that it all exists and was disabling before. Having the diagnosis absolutely helps - the two prongs of the lawyer’s attack were “the prior decision was wrong on its face” and “we have new information that Has Relevance”, that information being that what’s actually being going on is a degenerative genetic disorder that I have had my entire life.

It is disabling now. Was it disabling then? Like I said, there’s less data. But we lit a path through multiple respiratory infections and ankle sprains and prescription histories and the earliest complaints of my hands spasming and not working and...

Judge: “Tell me about your history with the chronic pain. When did that start?”

Me: “Almost certainly in childhood; it’s hard to determine, because I don’t really remember what it’s like to not be in at least mild to moderate pain. But the first time the pain became disabling was in 2005.” *describes*

Judge: “And were you on medication for that?”

Me: “Yes. I started off on Robaxin and Celebrex, and I’m now on Flexeril. I’ve taken pain medication daily since 2005.”

Building. That. Trail. Because the stated goal has been to get back pay from that 2014 application. But if I can get it from the 2006 application - because I WAS disabled and unable to work at that time...

My lawyer feels good about the hearing. I have cautious optimism, too. We were worried that the judge might be excessively conservative. I was worried about the vocational expert - a doctor who reviews the medical information that’s entered into evidence and decides, based on it, whether he thinks you can work. My information is complicated and best understood as a gestalt rather than as a bunch of test results; would this guy grok it, or would he just skim the pile of info and make a snap decision?

So the judge questioned me first, and then my lawyer did. We covered everything mentioned here, with special focus on pain, fatigue, joint subluxations, frequent long illnesses, my worsening hands, and - reluctantly, on my part - the depression and PTSD.

At the end, the judge questions the vocational expert. Her first question - “Would a hypothetical person with the claimant’s educational and [etc] history and [capabilities I don’t have] be able to work an eight-hour day doing the jobs they did previously or other jobs?”

(Digression here. Something I hadn’t considered, but would absolutely be considered by a potential employer, is my educational background. One of the first questions the judge asked, after verifying my full name and date of birth, was “twelfth grade education - do you also have a college degree?” To which the answer is no. I got a GED, not a PhD. Why did I never realize that that would probably work in my favor in this particular scenario? I don’t know, man, I’ve been kinda busy. Should employers insist on a graduate degree and discriminate against people who don’t have a degree or only have a bachelor’s degree? NOPE? Do they? YEP, undeniably.)

Vocational expert said yes. Judge then moved on to a second hypothetical. “Same hypothetical, but now assume that the hypothetical claimant has [level of restriction of hands I didn’t memorize] for lifting, grasping, and pulling. Can they do the jobs they did previously?”

Vocational expert: “No.”

I think I kept from gasping. I hope I kept from visibly reacting.

Could they do other jobs, yeah they could be a survey taker, that only requires a little mouse clicking, sure.
Third hypothetical. “Could a hypothetical claimant with the background and restrictions stipulated who also requires a period of rest and would not be able to work more than six hours of an eight-hour day [I still can’t do six, but I’m not interrupting her] be able to do the jobs they did previously or any other jobs?”

Vocational expert: “That person would not be eligible for competitive employment.”

*deep breath*

*exhale*

So that was the end of the hearing. That’s not The Answer - the judge will take some time to review my medical records, my testimony, and the vocational expert’s testimony. I should receive her decision by mail in two to three months. It could still end up being a no, and if it is, I will appeal that. But I was driving myself up a wall just *knowing* that that vocational expert was going to go “pfft, whatever, women and chronic pain, amiright?” and instead I got the weightless feeling of validation of “not eligible for competitive employment”, and I just.

I hope I get it, y’all.

This is what it would mean to get it:

To get back pay? That would all go towards the credit card I’ve had to live off of for way more of this time than I should’ve. An obscene amount of our monthly budget goes to paying off debt. To lower that, or eliminate it as I could do if they go back to the 2006 application? That would be life-changing.

To get disability benefits in general? That would mean no longer panicking or hitting the credit card or frantically fundraising when one of our pets has an emergency or our car needs an expensive repair. It would mean no longer feeling like a useless drain on our household budget. It would mean I could buy myself yarn or a book or a dress without feeling horribly guilty. Yes, obviously that money is also going towards doctor visits and prescription co-pays. But disabled people deserve books as much as able-bodied people. It would mean we could pay off the loans we’ve taken out for Elayna’s college education, that we are thus far just Not Thinking About really hard. Hell, maybe I could take a class.

So that’s where I am.

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shira: (Default)
Shira Lipkin

August 2017

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