Just Say No!

(This is a re-post. Maybe it can give some Aussies a place to start…)

It seems to me that the government departments that deal with disability payments (from all different countries) have a policy to just reject all claims (like the insurance company in The Rainmaker).

I know that every time I have applied for anything from Centrelink (the Australian version), I have been rejected; and each time, I have either had to appeal or follow-up with many, many phone calls. But each time, I have received (finally!) what I was supposed to receive.

So, today’s post is going to try to make it easier for Aussie FM sufferers to get the Disability Support Pension. (If you are from another country and can write a post that will help others from your country, I am happy to publish it)

DISABILITY SUPPORT INFORMATION

 *** Please note – This is NOT legal advice This has been written based on my personal experience: I successfully appealed the rejection of my Disability Support Pension application.

I have put this together, hoping it will help others in the same predicament.

Basically, this is how it works:

You apply for Disability Support Pension
You must have a total impairment rating of 20 points or more under the Impairment Tables.
To get a rating you must have a permanent condition that is more likely than not to persist for more than 2 years.
You receive Disability Support Pension

 Seems easy, right?

When can a rating be assigned?

An impairment rating can only be assigned for permanent conditions which cause an impairment that is more likely than not to persist for more than 2 years.

A condition is permanent if:

  • the condition has been fully diagnosed by an appropriately qualified medical practitioner, and
  • the condition has been fully treated, and
  • the condition has been fully stabilised.

What does ‘fully diagnosed, fully treated & fully stabilised’ mean?

According to the Guide to Social Security Law (Version 1.191 – Released 12 November 2012), which is run on an Australian Government site and is therefore reliable (although you should always check for updates):

Fully diagnosed and fully treated

In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated, the following is to be considered:

  • whether there is corroborating evidence of the condition, and
  • what treatment or rehabilitation has occurred in relation to the condition, and
  • whether treatment is continuing or is planned in the next 2 years.

Fully stabilised

A condition is fully stabilised if:

  • either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next 2 years, or
  • the person has not undertaken reasonable treatment for the condition and:
  • significant functional improvement to a level enabling the person to undertake work in the next 2 years is not expected to result, even if the person undertakes reasonable treatment, or
  • there is a medical or other compelling reason for the person not to undertake reasonable treatment.

This is the point where most of our applications are rejected.

I suggest that, when writing a letter of appeal (or even your first statement), you address each point clearly and concisely.

When you get past this point, you can move on to your impairment…

Assessment of Impairment Ratings

As part of the qualification for a Disability Support Pension (DSP), a person must have one or more physical, intellectual or psychiatric impairment(s) that attract a total impairment rating of 20 points or more under the Impairment Tables.

For the purposes of DSP, the Impairment Tables are tables designed to assess impairment in relation to work. The tables were revised earlier this year, so you need to make sure that you are looking at the right information. (The Centrelink representative will always ask you if you looked at the most recent tables!)

The Tables:

    • are function based rather than diagnosis based,
    • describe functional activities, abilities, symptoms and limitations, and
    • are designed to assign ratings to determine the level of functional impact of impairment and not to assess conditions.

A claimant who has a total impairment rating of at least 20 points, must also have a continuing inability to work to qualify for DSP.

Now (I have to get a little lawyer-like), as per s 6(9) (this means section 6, sub-section 9) of the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011:

(9)      There is no Table dealing specifically with pain and when assessing pain the following must be considered:

(a)    acute pain is a symptom which may result in short-term loss of functional capacity in more than one area of the body; and

(b)    chronic pain is a condition and, where it has been diagnosed, any resulting impairment should be assessed using the Table relevant to the area of function affected; and

(c)      whether the condition causing pain has been fully diagnosed, fully treated and fully stabilised for the purposes of subsections 6(5) and (6).

The statements in BOLD are what is important to us. We can use ALL the tables to get a total of 20 as we have a number of conditions that cause our impairment!

Section 10(5) states:

(5)                Where two or more conditions cause a common or combined impairment, a single rating should be assigned in relation to that common or combined impairment under a single Table.

(6)                Where a common or combined impairment resulting from two or more conditions is assessed in accordance with subsection 10(5), it is inappropriate to assign a separate impairment rating for each condition as this would result in the same impairment being assessed more than once.

Now, I don’t expect you to read all the tables (although I did) but have a look at the headings for each:

  • Table 1 – Functions Requiring Physical Exertion & Stamina
  • Table 2 – Upper Limb Function
  • Table 3 – Lower Limb Function
  • Table 4 – Spinal Function
  • Table 5 – Mental Health Function
  • Table 6 – Functioning Related to Alcohol, Drug & Other Substance Use
  • Table 7 – Brain Function
  • Table 8 – Communication Function
  • Table 9 – Intellectual Function
  • Table 10 – Digestive & Reproductive Function
  • Table 11 – Hearing & Other Functions of the Ear
  • Table 12 – Visual Function
  • Table 13 – Continence Function
  • Table 14 – Functions of the Skin
  • Table 15 – Functions of Consciousness

This is where, in your letter/statement, you get personal. Address each and every one of these tables, if they affect you. Give examples. Explain how it affects your life. the more information that you give, the better.

Your Letter

  • Attach every piece of information that you have from any doctors (you can ask them for copies of correspondence to other doctors)
  • Write EVERYTHING down – don’t leave something out because you don’t think it’s important.
  • Try not to write emotionally – it will probably make you very upset to write down how badly you feel but, they don’t care. Centrelink needs it written down clearly, concisely, even impersonally.
  • Spell check (AND have some-one else read through the letter). Basically, Centrelink doesn’t see you as an individual, so this is a letter from one professional to another

I am attaching the letter that I sent to Centrelink as an example. It may not be perfect but it achieved my goal and I received DSP.

I hope it can help some others.

Just say NO!

It seems to me that the government departments that deal with disability payments (from all different countries) have a policy to just reject all claims (like the insurance company in The Rainmaker).

I know that every time I have applied for anything from Centrelink (the Australian version), I have been rejected; and each time, I have either had to appeal or follow-up with many, many phone calls. But each time, I have received (finally) what I was supposed to receive.

So, today’s post is going to try to make it easier for Aussie FM sufferers to get the Disability Support Pension. (If you are from another country and can write a post that will help others from your country, I am happy to publish it)

DISABILITY SUPPORT INFORMATION

 *** Please note – I am a first year lawyer, therefore I have not had much experience with the Social Security Act 1991. However, I successfully appealed the rejection of my Disability Support Pension application.

I have put this together, hoping it will help others in the same predicament.

Basically, this is how it works:

You apply for Disability Support Pension
You must have a total impairment rating of 20 points or more under the Impairment Tables.
To get a rating you must have a permanent condition that is more likely than not to persist for more than 2 years.
You receive Disability Support Pension

 Seems easy, right?

When can a rating be assigned?

An impairment rating can only be assigned for permanent conditions which cause an impairment that is more likely than not to persist for more than 2 years.

A condition is permanent if:

  • the condition has been fully diagnosed by an appropriately qualified medical practitioner, and
  • the condition has been fully treated, and
  • the condition has been fully stabilised.

What does ‘fully diagnosed, fully treated & fully stabilised’ mean?

According to the Guide to Social Security Law (Version 1.191 – Released 12 November 2012), which is run on an Australian Government site and is therefore reliable (although you should always check for updates):

Fully diagnosed and fully treated

In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated, the following is to be considered:

  • whether there is corroborating evidence of the condition, and
  • what treatment or rehabilitation has occurred in relation to the condition, and
  • whether treatment is continuing or is planned in the next 2 years.

Fully stabilised

A condition is fully stabilised if:

  • either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next 2 years, or
  • the person has not undertaken reasonable treatment for the condition and:
  • significant functional improvement to a level enabling the person to undertake work in the next 2 years is not expected to result, even if the person undertakes reasonable treatment, or
  • there is a medical or other compelling reason for the person not to undertake reasonable treatment.

This is the point where most of our applications are rejected.

I suggest that, when writing a letter of appeal (or even your first statement), you address each point clearly and concisely.

When you get past this point, you can move on to your impairment…

Assessment of Impairment Ratings

As part of the qualification for a Disability Support Pension (DSP), a person must have one or more physical, intellectual or psychiatric impairment(s) that attract a total impairment rating of 20 points or more under the Impairment Tables.

For the purposes of DSP, the Impairment Tables are tables designed to assess impairment in relation to work. The tables were revised earlier this year, so you need to make sure that you are looking at the right information. (The Centrelink representative will always ask you if you looked at the most recent tables!)

The Tables:

    • are function based rather than diagnosis based,
    • describe functional activities, abilities, symptoms and limitations, and
    • are designed to assign ratings to determine the level of functional impact of impairment and not to assess conditions.

A claimant who has a total impairment rating of at least 20 points, must also have a continuing inability to work to qualify for DSP.

Now (I have to get a little lawyer-like), as per s 6(9) (this means section 6, sub-section 9) of the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011:

(9)      There is no Table dealing specifically with pain and when assessing pain the following must be considered:

(a)    acute pain is a symptom which may result in short-term loss of functional capacity in more than one area of the body; and

(b)    chronic pain is a condition and, where it has been diagnosed, any resulting impairment should be assessed using the Table relevant to the area of function affected; and

(c)      whether the condition causing pain has been fully diagnosed, fully treated and fully stabilised for the purposes of subsections 6(5) and (6).

The statements in BOLD are what is important to us. We can use ALL the tables to get a total of 20 as we have a number of conditions that cause our impairment!

Section 10(5) states:

(5)                Where two or more conditions cause a common or combined impairment, a single rating should be assigned in relation to that common or combined impairment under a single Table.

(6)                Where a common or combined impairment resulting from two or more conditions is assessed in accordance with subsection 10(5), it is inappropriate to assign a separate impairment rating for each condition as this would result in the same impairment being assessed more than once.

Now, I don’t expect you to read all the tables (although I did) but have a look at the headings for each:

  • Table 1 – Functions Requiring Physical Exertion & Stamina
  • Table 2 – Upper Limb Function
  • Table 3 – Lower Limb Function
  • Table 4 – Spinal Function
  • Table 5 – Mental Health Function
  • Table 6 – Functioning Related to Alcohol, Drug & Other Substance Use
  • Table 7 – Brain Function
  • Table 8 – Communication Function
  • Table 9 – Intellectual Function
  • Table 10 – Digestive & Reproductive Function
  • Table 11 – Hearing & Other Functions of the Ear
  • Table 12 – Visual Function
  • Table 13 – Continence Function
  • Table 14 – Functions of the Skin
  • Table 15 – Functions of Consciousness

This is where, in your letter/statement, you get personal. Address each and every one of these tables, if they affect you. Give examples. Explain how it affects your life. the more information that you give, the better.

Your Letter

  • Attach every piece of information that you have from any doctors (you can ask them for copies of correspondence to other doctors)
  • Write EVERYTHING down – don’t leave something out because you don’t think it’s important.
  • Try not to write emotionally – it will probably make you very upset to write down how badly you feel but, they don’t care. Centrelink needs it written down clearly, concisely, even impersonally.
  • Spell check (AND have some-one else read through the letter). Basically, Centrelink doesn’t see you as an individual, so this is a letter from one professional to another

I am attaching the letter that I sent to Centrelink as an example. It may not be perfect but it achieved my goal and I received DSP.

I hope it can help some others.

After All…Tomorrow is Another Day.

 

So, it’s finally hit me…I’m home from Bali. Duh! you say, but I was able to stay in my little fantasy land for a whole week.

Despite coming home to: two telephone bills (home and mobile), a car registration notice, an invoice for three quarters of body corporate fees, an impending hospitalisation to withdraw from codeine, the spectre of a gallbladder operation (then disappearance of aforementioned operation), the new threat of a lesion on my liver, and an unexpectedly high bill from my handy-man; I was somehow able to hold onto my dream of returning to Bali for a year. Forget Eat, Pray, Love – it was just going to be Love, Love, Love!

WHO AM I KIDDING? For some unknown reason, today it hit me full force that I’m home and, most probably, staying here. I don’t know why it was today – nothing huge happened; but it slammed into me (kind of like those trucks that hit us during the night so we wake up in so much pain) – I’m on a disability pension. Yes, it is cheaper to live in Bali. Yes, I could rent out my unit. But I would still need to return every 3 months to continue receiving my pension, and airfares are not cheap.

This ‘little’ dose of reality brought back all the other stuff (above) that comes with being at home and, all of a sudden, I am overwhelmed. Too much, too quickly!

My reaction is a quick visit to the darkness of depression…

STOP! Wipe those idiot tears. You need some control!

I can’t control any of the bills or medical hassles so my antidote is to get some control over my surroundings – 8 shelves of books going to friends or the Op shop, 2 suitcases of clothes I don’t wear (but I might one day) going to be stored in Mommy’s garage and 4 bags of trash. There is stuff everywhere (I can’t do it all in one hit – I have Fibro, remember?) and I’m unhappy about going to bed, knowing that all this stuff will be waiting for me in the morning; but my exhaustion (and gravity) is dragging me down. So, now, not only is my head a mess but, so is the house (more so than before!)

But, as Scarlett said: I can’t think about that right now. If I do, I’ll go crazy. I’ll think about that tomorrow.

 

P.S. The clean basket of laundry is still sitting on the floor of my bedroom.

P.P.S. And, maybe, I can still work out a way to Bali…

 

It’s a Blooming Miracle!

My grandmother used to have orchids. Every year, they would bloom beautifully and be displayed on the dining room table. In 1983, she died. The orchids stopped blooming. I tried to split them up and re-pot them to encourage them to bloom. My Mommy, uncle and I all got a pot. They didn’t bloom.

Just before my uncle had his operation, my pot grew a stalk. It’s going to bloom! And the operation went well.

Prior to getting my biopsy results, Mommy’s pot grew a stalk. It’s going to bloom! And the results were fine.

Last night, my uncle told me his orchid had sprouted a stalk. Wow! I told him that it must mean our luck was changing and more good things were going to happen.

Well, I have a major headache and I’m feeling totally lethargic. BUT don’t feel sorry for me…I’m just coming down from a massive high (natural, of course!)

I had a doctor’s appointment today, basically for more Centrelink paperwork, (they are just totally unable to organise all the paperwork to be done in one session!) at 3.30pm and was just leaving the house at 3pm when the phone rang. Yes, I answered it. It was the Centrelink lady (remember the one from last week?) Oh, great – just what I wanted: another conversation about how my condition is not stabilised!

BUT guess what? (and you’ve probably guessed considering I started a new paragraph for it) I got my disability support pension (with backpay from January)! Oh my! Giant sigh of relief mixed with joy. Thank you! Thank you! Thank you! She did say that Centrelink will check up along the way, in case I get better (I wish!) but that’s it – it’s mine. Thank you!

So yes, I’ve been on cloud nine for a couple of hours, unable to wipe the smile from my face. We (Mommy, my Uncle and I) like to think that my grandmother is watching over us. Corny, yes? But ever so nice.

If You Don’t Ask, You Don’t Get

Many people with FM continue to work full or part-time. But the chronic pain and debilitation (this is the word that was voted the most popular for the fatigue we feel) associated with FM often make working very difficult. If you are employed, it’s important to learn about managing the symptoms and coping with pain and debilitation.

Can People With Fibromyalgia Work?

By self-managing fibromyalgia pain and controlling daily stress, many people with FM can do almost anything they choose, by making simple modifications to your workplace that allow you to continue working.

What Type of Workplace Changes Can Help Someone With Fibromyalgia?

First, openly discuss your condition with your boss. Talk about the symptoms of pain, fatigue, and stiffness. Explain how you may have good days and bad days.

Explaining will give people at work a better idea of what you are feeling each day. Ask your boss if you can take rest periods on bad days. Or ask if you can take work home if you are feeling fatigued. Ask if you can come in on Saturday if you miss a day of work to make up the lost time and income. In addition, ask if you can put a cot in your office for a brief nap at lunchtime. Taking a midday nap helps many people with fibromyalgia and other chronic health conditions function on the job.

Are There Workplace Modification Guidelines for People With Fibromyalgia?[i]

To address concentration issues, employers should consider:

  • providing written job instructions when possible
  • prioritizing job assignments and providing more structure
  • allowing flexible work hours and allowing a self-paced workload
  • allowing periodic rest periods to reorient
  • providing memory aids, such as schedulers or organizers
  • minimizing distractions
  • reducing job stress

To address depression and anxiety, employers should consider:

  • reducing distractions in the work environment
  • providing to-do lists and written instructions
  • reminding the employee of important deadlines and meetings
  • allowing time off for counseling
  • providing clear expectations of responsibilities and consequences
  • providing sensitivity training to coworkers
  • allowing breaks to use stress management techniques
  • developing strategies to deal with work problems before they arise
  • allowing telephone calls during work hours to doctors and others for support
  • providing information on counseling and employee assistance programs

To address fatigue and weakness, employers should consider:

  • reducing or eliminating physical exertion and workplace stress
  • scheduling periodic rest breaks away from the workstation
  • allowing a flexible work schedule and flexible use of leave time
  • allowing the employee to work from home
  • implementing ergonomic workstation design

To address migraine headaches, employers should consider:

  • providing task lighting
  • eliminating fluorescent lighting
  • providing air purification devices
  • allowing flexible work hours and work from home
  • allowing periodic rest breaks

To address issues associated with sleep disorders, employers should consider:

  • allowing flexible work hours and frequent breaks
  • allowing the employee to work from home

My employer has been very considerate and co-operative in regards to my condition. We have tried different combinations (eg: 3 hours x 3 days per week in the afternoons, working on the weekend when there are no distractions or noise, working late at night when I seem to be less distracted) however none of these have worked on a consistent basis. So far, I cannot see how I can maintain employment with FM.

If you have tried different jobs and are unable to work, you might consider applying for disability. It can be a long and arduous journey, dealing with our Human Services departments and disability may be difficult to get because of rules about work capacity.

Can I Get Disability Because of Fibromyalgia?

In Australia, a person must have an impairment rating of 20 or more (under the impairment tables in the Social Security Act (Cth) 1991) to receive the Disability Pension.

The Americans with Disabilities Act has a general definition of disability that each person must meet. Therefore, some people with FM will have a disability under the ADA and others will not.

Because fibromyalgia is extremely hard to diagnose and there are no laboratory tests to prove the ailment to a third-party, it’s important that you do your homework before you apply for disability. And remember that you may be denied but, there are avenues to appeal decisions. Be aware of your rights! And check, and double-check, time limits!

How Do I Apply for Disability?

To apply for disability benefits, call your Social Security/Centrelink office. Much of the information may be provided over the phone, by mail, or the Internet. You will be asked specific questions about how you have trouble with daily activities. And you will need to be as specific as you can, describing your limitations and why you cannot work. You will be asked to give the names and addresses of your doctors. The Social Security office will contact each one for records.

What Other Proof Must I Provide for Disability?

Describing your fibromyalgia symptoms alone will not qualify you for Social Security disability. You have to be specific about signs and physical findings related to fibromyalgia and pain and how that impacts your ability to work. The Social Security staff will consider all your symptoms, including pain.

All of this information considered together must lead to a conclusion that you are disabled before you will be granted disability with benefits.

What if I’m not Approved for Disability?

It is common that fibromyalgia patients are not approved for disability, especially with the first application. If you are not approved, you’ll have the right to appeal. Some patients find it necessary to have the help of a lawyer during the appeal process. Although it may increase your costs, the chance your case will be approved is usually better if you have legal counsel.

I have applied (as some of you may know) and was rejected because it was decided that I do not have an impairment rating of 20 or more. As such, I have started the initial phase in the appeal process.

What Type of Documentation Is Needed to Get Disability?

It’s important to get detailed documentation – reports – from your doctors, including psychologists, at the onset of your illness. Have your doctors submit documentation of all prescribed medications, therapies, and lifestyle remedies necessary to resolve your fibromyalgia symptoms. You should also be evaluated by a fibromyalgia specialist, usually a rheumatologist. This doctor will give a detailed assessment of your impairment along with a list of the many tests and treatments used in your condition.

This seemed to be the hardest part so far. My rheumatologist held on to the incomplete report for 8 weeks before Mommy and I camped out in his office and reported him to the Hospital administration. Finally, it took less than 15 minutes for him to complete the required paperwork. Thanks Doc, for all the stress and worry for no reason.

I sent the requested reports (from him and me), copies of all correspondence between my medical team and a cover letter to Centrelink, on Friday. Although I have linked my letter here, I do not know if it will be successful, so if you choose to use parts of it, I cannot guarantee an outcome.

Wish me luck.


[i] These lists come from the U.S. Department of Labour’s Job Accommodation Network. I do not believe that there is an equivalent list in Australia (yet!)