Applying for Disability
When I was in the partial day-treatment program at the psychiatric hospital, the social worker with the program helped me to apply for social security disability. It was incredibly helpful to have assistance filling out the paperwork because it was too overwhelming for me with the depression at the time to complete all of the forms myself. She asked me each question and wrote the responses as I spoke. Most patients will not be approved for disability on the first attempt. As I was told when I was working on the application for social security disability, I did have to appeal my rejection letter. As part of the appeal process, you may be asked to come in for an examination by a disability examiner before you are granted disability. I believe my first application was submitted in June and it was November before I was approved for disability. (I did receive back-dated money to my actual date of determined disability).
Statements will be submitted from your physician, and I believe that my doctor's statement that I would likely not remain on disability was a great help to my case. Medicare is part of the disability package so you will have medical insurance while you are unable to work. My parents helped me with my Blue Cross/Blue Shield Medicare supplemental insurance premium. I was advised to not consider Medicaid in my case because I had some money in savings which I would need to spend down to qualify for Medicaid. But as difficult as it was to be dependent on food stamps for my food, it was a great help to have my food taken care of. Count it a blessing if you are eligible for food stamps and take advantage of the opportunity. Humility is a good lesson to learn.
It is very important to specifically note your functional level with objective examples on disability forms. For example, under Personal Mobility: "I find myself falling asleep for hours and sleeping most weekends away due to the fatigue of just functioning with OCD/depression"; under Personal Needs and Grooming: "I have difficulty in this area. I really have to push most days to shower and do not put on makeup or care for my skin the way I did before my illness. There are often 2-3 days a week that I don't shower because I will need that energy for other tasks during the day."; under Household Maintenance: Cleaning is difficult because of washing hands until they are red between chores. Unable to do the laundry due to anxiety."; under Other: Anxiety high when I drive at night or in the rain and I have difficulty calming down." A statement made on one of my disabilty forms shows you how far I've come (and you can too!); at the time disability was granted, I was described as follows: "...she had recurrent obsessions and compulsions that were a source of marked distress, and she had irrational fears of persons, objects and/or activities which resulted in a compelling desire to avoid those persons, objects and/or activities. At the time, she had made attempts to work part-time, and she was unable to handle the pressures of a job due to deficits in concentration caused by her continued rituals and compusions."
Upon reapplication for renewal of your disability status, be sure to be very objective as to your functional limitations. Example: I was allowed to work part-time despite never meeting the minimum production standard for a part-time employee and was allowed frequent absences. My work load was modified to reduce stress. My speed at work was affected by OCD thoughts that I was "contaminated" and some days my anxiety was so high that I had to leave early.
Mention the dosages of medications you require to function at work, the cost for these and that you must pay out-of-pocket if your insurance does not cover them (When I was disabled, Medicare and medicap insurance did not have any coverage for prescriptions). I used my salary to pay for my medicine and used my disability check for rent, food, car expenses, etc. If your doctor has given you instructions as to the work you can handle, be sure to state that. Instructions given to me, for example, were "that I was not to work alone in the office or handle office matters on the phone. My hours were to be reduced and I was not to work on Saturdays."
Be very careful once you begin working again to report to the social security office the moment you go above the amount allowed in earnings after you complete your trial work period. You will need to keep every paystub and itemized lists of all expenses necessary for you to work (e.g. prescription medications) if the total amount allowed in earnings is still determined after subtracting expenses needed to work. You will want to report your income change (if you are able to work more hours or get a raise) before you actually receive your first paycheck above the alloted amount. If you delay and actually use a disability check while receiving the higher salary, you will be required to pay back the amount of the overpayment. If at all possible, if a check is sent to you after you no longer qualify for disability, deposit the checks in savings so you may immediately pay them back.
It was quite scary when after working part-time for a number of years, I was offered the opportunity to work full time. I was really not sure I was able to handle a full-time job again, and it was terrifying to know that if I went off of disability, and wasn't able to cope, that I would not have enough income to live on my own without disability. However, it was helpful to know that it is much easier to get back on disability if you have been on it before.
Be sure to keep all correspondence regarding your disability and copies of every form you complete, letters you receive, etc. as they will help you fill out future forms and give you the dates and justifications you will need to appeal other decisions. If you require any medical care related to your diagnosis, be sure you have the name of the hospital and address, dates of admission and discharge. Also record the name of your counselor, dates of service, address and phone number for each provider. I described reasons for treatment as "increased anxiety at work and depression (frequent absenses from work)," medication management, cognitive retraining psychotherapy for major depression, anxiety, and obsessive-compulsive disorder.
I also met with a vocational counselor several times through the Disability Determination Services Voc. Rehab program. She helped me look at other work options or career areas that I would do well in that would allow me to make enough money to come off of disability.
It was extremely difficult to face leaving my chosen profession; I still grieve some over the loss. Direct patient care was triggering my OCD continuously, and on top of the pace of the job and the limitations that were placed on the time with each patient, the quick thinking required "on my feet" and the acuity of the patients, the work for which I had trained was really not a good fit for me. I finally realized when the depression was so bad that I could not longer work at all, that I could not go back to my previous job, but because the only real job skills I knew involved patient care, I would need to learn some additional skills and find another career field. A women's resource center in the city where I lived associated with a local university offered career counseling. This was so helpful to me in that the tests I took were not only scored but the counselor sat down with me to analyze the results. She told me in no uncertain terms that my career field stretched me in every possible capacity and, in and of itself, was a huge source of stress, not even counting the OCD. This helped me to begin the process of accepting that, though I truly felt I provided good care, returning to direct patient care was not a good idea for me. The counselor helped me explore several different options and the additional schooling that would be necessary. I finally decided to attend computer school for a 9-month medical computer specialist diploma. I was so thankful that my parents were able to pay my tuition and book expenses. I highly recommend taking advantage of any opportunity to work with a career counselor.
Though I have not found my niche exactly, I have a productive career now in which I help others and continue to use some of my medical knowledge base. I have worked as a medical secretary, helped with clinical research, worked coordinating and developing a physician fellowship program with a surgeon, have worked in custom design and development of an electronic medical record, have done transcription staff education/training and quality assurance at a hospital, and now work for a healthcare system in staff development for over 1000 employees. There is life after disability and the loss of a career!