Social Security Disability Application Part 2: The Doctor Evaluation

What it's like to be evaluated by a doctor for Social Security Disability Insurance (SSDI)

Social Security Disability Application Part 2: The Doctor Evaluation

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Warning for discussion of mental health issues and symptoms, including panic attacks, self-injury, and suicidal ideation.

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My city is about to go into full covid lockdown for the first time and I’m in the office of a doctor who will evaluate me for Social Security Disability.

I don’t want to be there. At this point I’ve been watching the spread of covid in other countries and I know how dangerous it can be. I’d already rescheduled non-urgent doctor appointments for myself or requested that they be done virtually. An appointment like this, with someone I’ve never met before, in an office I’ve never been in before, feels like an unnecessary danger.

But Social Security set the appointment. They sent me notification: here’s the time and place. Be there.

There was a mention that I could let them know if the time didn’t work for me but the wording of the letter heavily implied that if I couldn’t make this appointment they might reject my application.

So I go.

This is my second round of applying for SSDI. I hit the milestone of getting my first rejection which meant being able to go for round two. The company assisting me took care of all of this. They took care of all the paperwork and resubmitting it. Which is good because I would not have been able to handle it on my own. Every time I even think about it I start having a panic attack. My only option is not to think about it.

Luckily the company does the work for me. As always, I cannot imagine what it’s like for people who need to do this on their own.

Round two is an evaluation by a doctor selected by Social Security. The company helping me says this is good progress. I’m not sure if this means not everybody gets a doctor evaluation on their second try. Possibly not?

No matter when it comes this step makes sense. Social Security wants to make sure that you haven’t somehow convinced a doctor to lie on your behalf. Though I do wonder how many people who need SSDI have the money to pay for any doctors at all, let alone ones who could be convinced to lie to government agencies.

This visit doesn’t cost me anything. Social Security pays for the appointment and will also reimburse any travel expenses. The office is close enough to where I live that I don’t submit for that. It’d be a few cents’ worth of gasoline at best. Not worth triggering my anxiety over having to fill out and keep track of yet another form.

I’ve been to this building before. Another one of my doctors is in there. Because of that, I know that the building is typically not crowded and that this particular doctor’s office is close to the front door. The odds I will bump into somebody and risk covid exposure are low. (Mask wearing isn’t a thing yet, though thanks to a friend I do have some masks coming my way in the mail. Sometimes anxiety’s need to imagine the worst case scenario comes in handy.)

I use my shirt to protect my hand as I touch the door handles. I use my knuckle to push the button to ask to be let in. I’m not actually a germaphobe but it feels wise to act like one.

In the doctor’s waiting room I can hear his phone ringing off the hook. He’s had to cancel all of his upcoming appointments or move them to online sessions. I’m the only other person there so I don’t mind waiting.

At one point I grab a tissue to blow my nose. He comes racing back into the waiting room to ask me if I’m sick. I tell him it was only running due to the change in temperature from outdoors to inside.

I’ve got agoraphobia. I've been living like I'm in quarantine this whole time. It’s only with covid that my way of life is about to become everyone else’s.

Finally I’m sitting in the doctor's office. He has to pause every so often to run and get the phone to talk to a newly rescheduled patient. It gives me breaks from all of the questions so I don’t mind the interruptions.

He mentions that he regrets the sudden timing of the lockdown announcement didn’t allow us to reschedule to a virtual appointment. I say me too.

The evaluation starts by asking about my history. I’ve seen so many doctors at this point it’s a monologue I’ve had plenty of practice with. I go over everything. I talk about my illnesses, about the need for accommodations due to worsening migraines, about how it culminated in mental health issues which required me to take leave from work, about how I am barely living life in general right now, including how often I wonder if it's worth it to even live at all.

He asks about details. What accommodations did I ask for from work? What accommodations might I need from a job now?

As I’ve said before, I cannot talk about myself. But it’s possible that someone in a similar situation to mine might need to explain to a doctor that disability accommodations were slowly chipped away. This entirely hypothetical person may have also needed to explain that, when a doctor wrote a letter to outline some possible new accommodations, such as the need for a service dog, the response was that this hypothetical person did not have a job anymore.

Not that this happened to me, of course. I’m purely talking hypotheticals.

Had I mentioned these hypotheticals to this doctor though, purely for the sake of discussion, he may have commented that those accommodations didn’t seem unreasonable for the type of job this hypothetical person previously did. It’s possible I agreed with him.

It’s also possible that immediately after saying that I worried that I may have just accidentally agreed that all of my symptoms weren’t severe enough to keep me from working.

The doctor has a checklist of things he has to go over. He asks about symptoms and how my day to day life is affected. I have to talk about how hard it’s become to cook for myself, unaware as I’m saying it how much my ability to feed myself is about to be affected by grocery shortages and the inability to get deliveries regularly or safely.

This is also when we hit the questions that would probably be invasive for most people but for me at this point are old hat. How am I doing on self care? (Badly) Can I clean my home? (Not really) How often do I clean myself? (Rarely. I only took a shower the night before because it seemed rude to show up to the appointment dirty and smelly.)

When was the last time I self-injured?

I hold up my left arm and show him that I’ve been cutting my skin with my nails this whole time.

Next is a test of sorts. Some of it is math. Things like can I calculate X percentage of a number off the top of my head.

A lot of it is memory. Granted even for me the math is memory because I have to try to keep track of the numbers to do the calculation. But other questions are straightforward tests of my ability to retain information.

One of the questions is can I say the street name of the office we’re in. I tell him yes but point out that’s because the street sign is literally right over his shoulder in the window of his office. If he asked me the cross street, which I can’t see, I wouldn’t be able to tell him.

I worry that because I was still able to answer the first question in some way it means I failed to prove how badly I’m doing.

Numbers come up a lot. As a concept I love math but short term memory issues have made it so that it’s hard for me to hold on to numbers enough to do calculations. There’s a lot of questions dealing with math. The percentages, also adding and subtracting. I do my best. I'm not allowed to write anything down to work the problems.

I try to access the math parts of my brain and talk out loud in the hopes it will help. It’s mostly calculating and two numbers at a time. Like I might not be able to calculate $239.50 plus $134.78 (or numbers like them) exactly but I can remember enough tricks to at least get close to it.

Then it becomes pure memory: Here’s five single digit numbers in no particular order. Can I recite them back?

I open my mouth to try and burst into tears.

I knew I had memory issues. I knew I had problems holding on to things. I had no idea it was so bad. This is the first time anyone has given me a pure evaluation on that skill and I can not do it. I remember maybe one number out of all of them. I can’t even say for certain it was the first one he said.

I cry so hard I can barely breathe. It’s not a full on panic attack but it’s close. This isn’t even coming from a place of a buildup of emotions from the entire evaluation. It was a pure, guttural reaction to being asked to remember these numbers.

The doctor, not unkindly, asks why I’m upset. Not because he can’t guess but because he needs to hear my take on it.

I can’t do it, I tell him. I want to but I can’t.

The evaluation wraps up. The doctor gives me a rundown of what comes next. He’ll send his report in to Social Security. Here’s the timeline of when I should hear back.

He also gives me some recommendations of things to discuss with my doctors based on what he saw. For example they should be updated on the extent of the memory issues.

All told I’m there for about an hour. When we part ways we keep our social distance and do not shake hands.

I head off to make an emergency, pre-lockdown run to the grocery store and then head home.

I’m so exhausted when I get there I collapse on the couch and sleep for hours.

Months later I get the results. I hear back on Social Security’s determination if my evaluation, one in which I self injured in front of the doctor and had an anxiety attack based on what should have been a simple question, is enough to say that yes, I am disabled.

They reject me.

My subsequent panic attack has me to the point of being suicidal.

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