Welcome to the Find Empathy podcast, where we discuss the interaction between health and emotions.
Make sure to subscribe, to be alerted when new episodes launch.
My name is Dr. Meghan Beier, a clinical psychologist specializing in chronic illness and disability.
We are nearing the end of our first series focused on multiple sclerosis. And our last three topics are going to focus on employment and disability, cognition, and adaptive sports.
This is the third and final episode of our employment mini series. If you haven't yet heard the first two interviews with Kathy Reagan Young and Joe Stuckey, please go back and listen to those two episodes. Both of those individuals provide amazing information about switching careers, as well as how to request accommodations and when how, or even if one should disclose their MS diagnosis to an employer.
In this final interview, I talk with Tracy Tyson Miller, a disability attorney who specializes in multiple sclerosis. Tracy takes a lot of the mystery out of the disability process, and she also speaks specifically to what mental health providers should include in letters of support, if that is requested by one of your patients.
Keep listening and consider sharing with your patients if they have questions about this process.
Tracy Tyson Miller
Tracy. Thank you so much again for agreeing to be part of this project. I'd love for you to share with me a little bit about who you are, your career and how you got to be working with multiple sclerosis.
Well, my name is Tracy Tyson Miller. I'm in Jacksonville, Florida, and I handle social security disability claims, which I've done since about 1995. Um, around the same time that I started doing this type of legal work, my sister was diagnosed with MS, and my father had previously been diagnosed with MS. So I just took an extra interest in those cases generally when they crossed my desk.
Um, after I opened up my own practice, a few years later, I got involved with the north Florida, multiple sclerosis society. And. You know, just started working more with MS people and volunteering. I did some seminars for the MS. Society, or I would also do fundraising for them, things like that. Just sort of that personal connection in connection with the work I was already doing.
So now I handle a lot of multiple sclerosis cases.
Great. Yeah. So it sort of grew organically, it sounds like.
It definitely did. I always have a law. I don't want to say a lot. I always have a, a fair, I always have multiple cases, multiple sclerosis cases going at any given time. And usually five to eight, I would say, which is a pretty large percentage of my practice. I have a pretty small practice, only handle about a hundred cases at a time.
We recently did a webinar together where we talked about financial planning, as well as applying for disability. And one of the things that I found really useful, um, that you shared was thinking about financial planning early after your diagnosis. Um, so can you share a little bit about what recommendations you would give to somebody that was newly diagnosed MS?
Absolutely. I mean, the first thing to do is obviously take care of your health. But beyond that, the thing a person shouldn't do is knee jerk and quit their job and think they can't work anymore because many times, the type of MS you have may present suddenly, but also it's sort of an episode that you're having and your symptoms will taper off. So the best thing to do is to continue to work at whatever level you can and continue to save money.
Usually if you've been diagnosed with multiple sclerosis, it's very difficult to get private disability insurance. But if you have private disability insurance prior to the onset of that impairment or the diagnosis, you want to make sure you're continuing to pay those premiums on a regular basis.
Additionally, if there is any disability that is offered by your employer, you definitely need to take advantage of that.
And you know, you had shared a lot about continuing to work and the importance of trying to keep working for as long as possible. I know a lot of people that I work with experience. Uh, challenges at work and may need to apply for accommodations. And I know that's maybe not your area of specialty, but can you just share your experience with, you know, who is eligible for job accommodations, and, what that process looks like?
Well, you know, there's a, there's a difference between being technically or legally eligible for accommodations and being personally, you know, just having those accommodations available because you are a dedicated employee. Almost any employer will help you. If you have been loyal to that employer and been a good employee showed up on time, uh, not taking excessive absences out of the office, those kinds of things.
So generally, if you're sharing that information with your employer, they will be willing to help you out to some degree. I don't know who's technically. Uh, able to have a job accommodation. I sense that you might have to work for a larger employer over 50 employees, but don't quote me on that. Um, and then there's also, uh, a family medical leave act, which you can take in order to, um, you know, take care of yourself.
And I think that you can do that with a larger employer as well. And note that your caregiver can also apply for family medical leave act for the same reason.
Oh, that's interesting. That's really helpful. Yeah. A lot of times I have people who sort of struggle with whether or not they should disclose their diagnosis to their employer. Do you have any thoughts or recommendations around that?
It's such a personal individual choice. Some people are very uncomfortable talking about their medical problems with an employer, and sometimes your employer can be your best friend, literally and figuratively in these kinds of situations. Almost everybody knows somebody who has MS. It is A very sympathetic impairment.
Everyone has seen somebody struggle with the problems. And while you go to your employer and explain your problem. You know, they may be sympathetic. I can help you. But on the other hand, they may have seen people who are completely incapacitated and they may be fearful about allowing you to continue to work.
So it really, really depends on your personal assessment of that relationship. And maybe how you've seen other employees treated, who have other medical issues or personal issues that come up while working.
A hundred percent. I really agree with everything that you just said, and it is very individual,
It really is. I mean, my secretary, my secretary came to me and said she had multiple sclerosis, I would say, great, but I really need you to be cognitively sharp. We can make a lot of accommodations for a lot of things, but I rely on you 100% to keep track of things. So unless you have a good system and I'll help you come up with one, the cognitive is much more important than the physical issues.
Yeah. And research backs that up. You know, a lot of times when I see people. Leaving their job or needing accommodations, or even needing to switch jobs. A lot of times it's for fatigue or cognitive reasons. A lot of times the physical disabilities really can be accommodated pretty well.
They really can. I mean, it would be no problem. If my assistant couldn't walk, I could work around that. If my assistant had some trouble with her hands, we could organize some dragon dictation for instance, or where she didn't have to type so much. Um, she has a headset for the phone, so she's pretty, hands-free at the phone.
Um, so it really, really, it depends on the problems you're having and. Your relationship with your employer and just your individual thoughts on, you know, what you have experienced or others have experienced with your employer.
Right. Well, and I think that kind of gets to, you know, as people are starting to struggle at work or they're experiencing symptoms that are getting in the way of work, they might start thinking, when do they apply for social security disability, or when do they think they should start thinking about that? What's your recommendations?
Well, it's interesting because I'll have people call me before they stop working and say, I'm thinking about not working. Then I'll have people who've been out of work for eight years, who haven't applied for benefits because they keep thinking they're going to get back to work. So the answer is definitely in between those two timeframes.
Um, I think it's great. If you have a situation where you think you're going to need to stop working where you think your employer is going to fire you because they can't. Uh, you can't do the job and you know, you can't work for somebody else and that you're just sort of hanging on at this job. Those are good times to call an attorney and get some general information.
Almost any social security attorney will talk to you for free. And if you call somebody that only puts you through their intake person, and won't talk to you, just try another attorney. There's definitely plenty of them who will talk to you. But I think that when you want to apply for disability, is when you feel like you are going to be unable to work for a full year. When you are getting to the sense, you know, you get to the sense where the fatigue is overtaking you.
The cognition is limiting you, your hands aren't working well. Um, you're not walking well, and you do a job that requires a lot of walking. Like, I don't know, um, like you're doing road construction or something heavy like that. What you don't want to do is immediately stop working because you have a flare up and apply for disability because those flare ups can calm down and applying for disability is ... I wouldn't say it's arduous, but there is a lot of paperwork and documents and things to keep track of. So you just want to have the sense that you're not going to be able to maintain work for at least a full year and by full year, I mean, 365 days. If you are able to return to work after 11 months and 29 days, you will not be eligible for social security benefits. You really have to be out for a full year.
Can you talk a little bit about the differences between short-term disability through a private insurer? Long-term disability through, uh, through a private insurer and social security disability?
So short-term disability can be typically anywhere from a few months to about two years. And those benefits are typically, typically "own occupation" based. So if you cannot perform the work you are doing, you can be found stabled on a short-term basis. Long-term disability typically would last until your full retirement age, which for people my age I'm 53 would be 66 years old.
And those can also be "own occupation" policies where you can't do the job that you used to do, but some of them also have a, any occupation clause, where perhaps after you've been receiving benefits for some number of months or years, they stopped looking at whether you could do your own occupation and look at whether you do any occupation that exists in the national economy.
Uh, that can be a hard standard to meet, but many people with MS really do have a combination of fatigue, cognition, and physical limitations that would prevent that from happening. Most of the disability benefits that are paid through a long-term provider. Are going to be offset by social security benefits.
So if you apply for long-term disability and let's just say, they're going to give you $1,500 a month. They may also require you to file for social security disability. and if social security gives you. Perhaps a thousand dollars a month, your long-term disability provider will reduce your benefits by $1,000.
There's no way around that as part of the policy it's, uh, that particular factors built into the premium. Um, so you can't, there's just no way around it. Your long-term disability providers usually do not require social security, find you disabled, just that if you are found disabled, they will reduce your benefits.
Now, social security disability benefits are sort of a combination of own occupation and any occupation. If you are under the age of 50 social security, will have to find that you cannot do occupation that exists in the national economy. If you were over 50, they start looking at the work you've done and whether your skills could transfer to other work, given the limitations that you have. So those roles relax at age 50 at age 55. Think again at 62. You just need to think about how your problems are limiting you and whether they prevent you from doing anything.
One thing that I found really helpful during our webinar was when you talked about how people could prepare to apply for social security, even if they never need it. Right. So what are some of the recommendations that you give people, uh, or you might give somebody who's newly diagnosed, in terms of preparing to potentially have to apply for social security disability?
Well, the first thing that everybody needs to do is set up an account with the social security administration. It's at ssa.gov. I think there's something called my account or something like that. They tried to brand it, but set up a social security account and go into that account and see what your disability payment would be.
And you want to make sure that you are insured for benefits by continuing to work and earn. Right now I think you have to earn about 6,500, maybe $7,000 a year to continue to be insured for disability benefits. As you pay social security taxes. It's like paying an insurance premium to the social security administration.
So you have to keep paying those premiums in order to qualify for social security disability. So some people may never qualify because they have never worked or they haven't worked prior to filing for disability. You usually have to work five out of the last 10 years. There is also a welfare component that people can apply for, which is: I can't work, I have never worked and I'm extremely poor.
And I mean, extremely. If you have any household income, or if your spouse works, or if you have more than $3,000 in the bank, $2000, if you're single, you will not qualify for this SSI welfare benefit, but it is available. Um, it's just something to, and it's a pretty minimal benefit.
It's about $800 a month and it comes with Medicaid, which is great, but to call. But when you qualify for social security disability via the taxes you paid to the social security administration, that actually comes with Medicare, which people tend to prefer. So that's the first thing, get your account and keep working.
Those are the most important things. The other thing you'll want to keep track of would be your doctors and your hospitalization. So that you can show a pattern of the problems that have led to you not working. With social security, they're really looking at when you stopped working and why you stopped working.
So some people apply because they had a heart attack and never recovered, or an MS flare and they just never got back to a level where they could work. Other people. And I would think that it's more common with people who have MS. It's just a buildup of problems. Like your employer's able to tolerate your fatigue and gives you extra breaks.
Your employer is able to tolerate your inability to walk by having other people cover some of the walking duties of your job. Like perhaps if you're in an office, somebody else is bringing you files and you don't have to lift things, but eventually. Your problems can get. So, um, limiting that you really aren't able to work and your employer can't really accommodate you anymore.
So you just sort of want to have the medical records, that document the problems. So I would say. Let's say it's January and you notice your problems are getting worse, but your employer still helping you. Make sure you report to your doctor in January. It's getting harder to do my job because I'm more fatigued because my cognition seems to be slowing because my hands aren't working, whatever it is, report the symptoms to your doctor on a regular basis prior to stopping work.
What you don't want to do is think in your head. Um, I'm really tired. I can't think straight, and I'm having more trouble walking. I'm just going to stop working and then you go to the doctor six or seven months later and report your symptoms like you really want to have the documentation in line prior to the application.
I wonder if, you know, for our system, for example, we have the epic system and we use my chart, which means. Uh, patients are able to write into us and, uh, those messages become part of their medical record. Would that be something that people could do where they could report their symptoms kind of on a semi-regular basis to their doctors that way as well?
Yes. I think that's a Great. idea, but nothing beats a focal neurological exam. Although it's true that some things just aren't showing up. If you're having cognitive problems and you go to your neurologist, they're going to ask you some pretty basic things. Like, can you spell world backwards? Do you know what date do you know the president?
mean, a lot of people know those things. It's, they're not that hard, but they still cannot focus on tasks at their job that are a little bit more complex than what day it is. And can you identify the president? So they may want to send you out for cognitive exam or something like that, which would be great, but it's not always warrented by, because if you could spell world backwards, maybe your doctor doesn't think you need that.
I would definitely hope that you would, that every person is with a doctor. They feel like they can trust in a doctor. Who's doing the best thing that, you know, the best things to provide care and documentation of the problems.
But again, yes, the symptom reporting is great, but you also want the doctors, the doctors notes about those things as well.
Great. Well, and you make a really good point about the cognitive test. So, um, the MOCA, the mini mental, there's good data that shows that those are not necessarily great for MS. Um, they don't pick up on subtle changes. Um, and so getting a good cognitive evaluation is really ideal if we're noticing changes in cognitive functioning.
But it's challenging, right? There's a lot of parts of the country where there's not neuropsychologists readily available, or even in our area, people are waiting up to six, seven, even eight months to get appointments with neuropsychologist to get cognitive evaluation. So it is a challenge, but I like what you said, sort of going to your doctor and sharing those symptoms, um, so that they are documented over time.
Yeah, that is a good it's generally just a good. It's a good way to show that pattern. I mean, even if a person is waiting for a neurocognitive evaluation for six or seven months, a lot of times the judges are social security will note that they have these problems and whatever problems they had. At least the doctor thought it warranted intervention.
So sometimes the date of the referral is a good date for social security to look toward in terms of when your problems were getting worse.
How do you, how does social security define disability?
So they're looking for a person who has an inability to engage in substantial gainful activity for a period of 12 months. And by substantial gainful activity, they typically mean an inability to earn more than about $1,300 a month. And that would be an gross figure, not net. So you could earn. 1300 and then they take taxes out.
But if you earn 15 or 1600, even if you received less than 1300, that is not what they're looking for. They're looking for that from gross figure of about, I think it might be 13, 10 or 1340 this year, but again, the definition of disability can be different depending on your age. So under 50, you have to be found unable to do any type of work. And over 50, there we'll look at your work skills.
There's also something called a listing. So that if your MS is so bad that, um, you meet certain requirements. Social security can find you disabled. I'm going to pull that up right now and read it too. It's very, it's very, um, I guess I would say it's sort of squishy.
It's not like, like some of the listings would be something like if you are diagnosed with metastatic breast cancer at stage four, I mean, I made that up. You will be found disabled or if you have ALS, Lou Gehrig's disease, you will be found disabled. So some things you just need a diagnosis, or maybe you broke your leg and your femur hasn't healed for over 12 months.
Like that is automatically disabling. But for multiple sclerosis, You know, a lot of the multiple sclerosis symptoms are a little soft. They're not you, can't just, x-ray somebody and say, oh, this person can't work. You can't even take a brain MRI and say, oh, there's a lesion on this part of the brain. So you can't work.
It's much more how you're affected. So I am going to read the definition.
"Disorganization of motor function in two extremities, resulting in an extreme limitation in the ability to stand up from a seated position. Balanced while standing or walking or use the upper extremities."
So you need to have that or something else. So that's the first way. Usually if you need a Walker to walk or a wheelchair, you will be found to have an extreme limitation in your balance while standing or walking, um, extreme limitation, that ability to use your upper extremities. They give a lot of examples, but it's not just you can button buttons or you can, you can cook or you can't, and you can take a shower and wash your hair, or you can, it's just sort of how everything is going.
The other way that social security can find you as automatically disabled would be if you have a marked limitation and there's a long definition of marked in physical functioning and a marked limitation in one area of cognitive functioning.
Um, there's four areas. One would be understanding, remembering or applying information. The second one is interacting with others. The third one is concentrating persisting or maintaining pace. And the last one is adapting or managing oneself. So again, those are all very, very squishy. I mean, you might, you might look at this and say, oh, I definitely, I definitely have that.
Like, I definitely have a mark limitation in my ability to understand, remember and apply information. And you can believe that your doctor can believe it, but it's still very hard to convince social security that you have that particular limitation without some solid evidence from a like a neuro-psychological report.
Let me tell everybody where to find that if you want to review it, you can just go to ssa.gov search for listings or search for multiple sclerosis listings. The listing is 11.09 and. many cross-references in this listing to, for instance, what an extreme limitation is, what a mark limitation is, what interacting with others means.
So there's 1, 2, 3, 4, 5, 6, 7, there's eight separate references.
Great. That's super helpful information. How long does it take to apply for disability or what does that process look like?
Well, it's changed, especially since COVID, I used to tell people you could apply and it would take anywhere from five to six months to get a decision. And if you were turned down, File an intermediary step, which again, would take maybe four to five months. And then you would wait for a hearing if you were turned down again.
So waiting for a hearing would used to take 18 to 24 months. I mean, it was a very, very long process now. It's kind of reverse. The first steps can take nine or 10 months, the first two steps, and then getting a hearing is pretty quick. That can be only maybe six months now we're waiting for a hearing, but it's still, I would say generally it's taking a year and a half to get a decision or maybe more.
Just depends. If you see 10 doctors, it's harder for social security to pull your records together. If you're undergoing a lot of care and your condition is changing a lot, social security will hold your file to get those updates. And that can be, that can take a long time. Um, and then when you get to the hearings, the hearings are going much, much smoother right now.
And the wait time is not, not long, but most people have multiple sclerosis are generally saying one to three doctors. I would say that they're generally seeing a neurologist. They might be seeing a primary care physician and maybe, Maybe somebody for psychiatric or cognitive issues. They also may have some hospitalizations that are going in and out, but overall people with MS are not seeing significant number of doctors, so that can make the process go a little earlier, but still I'm floored by how long it takes social security to pull things together.
Yeah. And that's a good point for what you said earlier. If, if you can know ahead of time that this is going to take a long time, you can kind of prepare for that.
Right. That's why you do not want to be. You don't want the first time you're thinking about disability benefits to be when you need to stop working, it just goes back to needing to save some money and, um, sort of plan for that plan for that.
Right.
the most common question I probably have on a regular basis is what am I supposed to do while social securities working on my case?
And I don't really have any good answers. I mean, that's just not particularly my area. People do all sorts of things. They move in with their family. Their husband is working in support to them. They have to move to a homeless shelter. They. You know, lose their house. They are evicted. I mean, all sorts of things happen, but I don't really have any good ways for people to collect money for two years while they're waiting for a social security case to go through. So the best answer is to prepare financially for that.
Right. Well, and that brings up a good question. I often get asked if people can work during their application or after they receive social security, if they're approved. Um, do you have any good answers for that?
Uh, I have some answers. I don't know if I have the best answers. Um, I personally think, I mean, every attorney will tell you this. It is much easier to show that a person cannot work if they are not working, but. Again, the social security definition is an inability to, to engage in substantial gainful activity.
So they're looking at that $1,300 figure. So if you are earning less than $1,300, social security is not really supposed to count that.
But it really depends on what you're doing for that $1,300. If you are out doing landscaping and earning $1,300. It shows that you have some capacity to do heavier things. If you are working as a substitute teacher or a secretary who fills in when you're, you know, like through like a temporary service, those are more demonstrative of overall problems that prevent you from working regularly. Um, also, you know, you can, you know, you can have a doctor who has multiple sclerosis that goes into an office and works with people. know, one day a month and maybe, or $1,300, you also have somebody who's working a minimum wage job where they're working.
I mean, you can, I, I'm not gonna get my calculator out, but you can work a lot of hours in a month and, um, still only received $1,300. So it's sort of a balance that in those, that all that information is while you're applying for benefits, once you have received social security, There are a lot of incentives, help people work.
They can continue to work while they continued. They can start working under something called a trial work period. You can work and earn, I think up to that $1,300 point for. I think you can earn as much as you want from nine non-consecutive months in a 16 month period. So you could, you know, it allows people to take on some special projects and earn some money, but then stop working for a while.
So you can earn as much as you want for nine months. Um, but after the ninth month, if you ever go over that $1,300 figure, they stop your benefits for that month. And if you do it too frequently, they will cut your benefits off altogether. So. Best answer is to just do some minimal work.
Can you share if you, if you know what the percentages are of success for people who apply for security disability?
Well, I want to say that, uh, at the, at the first level, at the initial level, I want to say it's about 30% of people are approved. Because of many people have significant problems, not the multiple sclerosis, isn't a significant problem, but significant problems that are going to lead to death or are so objectively terrible.
You know, they have, like I say, ALS or something along those lines, or they're 62 years old and they just had their hip replaced and their past work was building houses. So. All of those are in there too, but definitely multiple sclerosis is, is an impairment that is approved more than many other impairments.
The top two, I've read this. I can't verify it, but I did read recently that the number one and two impairments that are paid the most frequently by social Security or multiple sclerosis and cancer. Which is interesting because the problem I see the most is back pain and depression. Those are the most common reasons a person is applying for disability.
but I guess they're just not being paid at the, at the rate that people who have multiple sclerosis or cancer are being paid.
Um, at the second level, the reconsideration level of social security is really just looking at, did we make a mistake? Did we miss some medical records that show something or did something new happen? Like you can apply for benefits and you're turned down and. When you're in the midst of filing that second, that second, the first appeal, the second level, the request for reconsideration, maybe you get into a car accident and all of a sudden you've broken multiple bones.
So they're looking for something new, something they missed, or just a flat out error. Most of those things are not happening. So I would say maybe 10% of those cases are paid at the hearing level. I think it's between 50 and 60% of the cases are being paid probably about 60. More cases are paid with an attorney.
But that's just because the attorney is pulling things together and making sure the judges aren't really overlooking anything. It doesn't really have to do with much else other than an attorney is well, like pulling together a statement from your doctor, or just like holding the judges feet to the fire on certain issues.
So, I mean, definitely. Plus I just think if you have any kind of cognitive issues at all, you should not be trying to handle your own case. Many people can handle their own cases, just fine, but. You don't know if you're one of those people. It's very similar to like selling your house on your own. Like a lot of people will sell their house without really, you know, generally receive the same amount of money, less, you know, not counting the broker fee.
Um, but there's also so many things that can be missed. So it's sort of the same thing. Obviously. I think everybody needs an attorney, but, but all attorneys say that
Yeah. Well, I often
estate agent things to meet what.
I often recommend that people work an attorney. Cause I, and I, I, again, I have a bias sample. I work with a lot of people that have cognitive challenges and they find it very overwhelming to
It is
all of the PA. Yeah. Now.
is overwhelming. I look at these files and I'm just trying to figure out, like, when did this person go, did that test ever get ordered? Where's that record? Why didn't social security? Get that record. I mean, I'm looking at a file Right. now. Somebody who doesn't have, um, just doesn't have multiple sclerosis, but they have.
Um, like they have some sort of leukemia that's causing problems, social security requested those records six times and never got them. They also never called me and said, Hey, uh, you're representing this person. Can you get those records? It wasn't until I got into the file and saw that they just sort of dropped the ball on it.
They just sent out requests, but didn't get anything. And they're important records. So. And if you go to a hearing by yourself, the judge will probably say, Hey, we don't have those records. Did you know that? And you'll say what I don't what? don't know. then they may get the records for you. They may not.
It just depends on, it depends on what they have for breakfast that morning. And if they're in a good mood, but they fought with their spouse in that morning, they're probably just trying to get your file off their desk. If they have are having a good morning, they're going to lend a hand. They're the judges, everyone is social security they're people with individual prejudices and individual predilections to the cases they like and the cases they tend to approve and how much they'll do to help people. So.
Really good to keep in mind, you know, and you, you referenced, getting information from medical providers. And I often get asked by people who are applying for social security to write letters in support of them, or to write a letter that documents their cognitive evaluation that they did with me. Can you share a few things for mental health providers or other medical proviers, if we are asked for a letter like that, what kinds of things should be included?
Well, the first thing that a person should look for, who's providing. Is if you're inclined is to look at that multiple sclerosis lift listing, and then look at what social security is looking at when they talk about the cognitive limitations. Look at what they mean by understanding, remembering, or applying information or how a person interacts with others.
So I'm just going to go to the understanding, remembering and applying information, because I think it's the most important one. So what social security says about that is: "this area of mental functioning refers to the ability to learn, recall and use information to perform work activities. Examples include understanding learning terms, instructions, procedures, following one or two step oral instructions to carry out a task, describing work activity to someone else, asking and answering questions, and providing explanations, recognizing the stakes."
These are just examples of what that means. So if a mental health provider can provide some information about that or shed some light on a person's capacity to do that, that's helpful. And a letter is great, but I also use a 10 question form that asks something like, let me grab my form real quick and I'll see what it says.
Okay, well, I used to have a longer form, but I've kind of, I've tried to tailor it to the things that really matter. So I asked mental health professionals for things like, and I asked them to, I asked them to rate a person's capacity to engage in a certain mental task of work. And I asked them to rate it from one to five.
Five means you can do it, one means you can't, you're able to do it with no limits. And then two, three, and four, just give a, they assign a percentage of time that you're able to do that at a job. So I ask about a person's capacity to remember locations and work like procedures, understand and remember, and carry out short simple instructions, capacity to maintain attention and concentration for at least two hours to perform activities within the schedule to sustain an ordinary routine without special supervision. Um, and then I just get into some other questions it's about whether you're able to get along with other people at a job.
So I try to do that. And if I can give, if you can give a percentage of time, it's easier to quantify. I am sitting in a hearing with a letter that says a person has difficulty with concentration, it's hard to turn that into a restriction. But if I have a letter that says a person, this person will not be able to maintain concentration for more than 15 to 20 minutes, then I can talk about that.
And whether, cause I'll be probably talking to a vocational expert and I will have to say, Hey, if a person. Cannot maintain concentration for more than 15 minutes, can they perform their past work or other work? But if I have to go to difficulty with concentration, nobody really knows what that means.
Right, right.
I mean, I know what it means.
It means you can't do it, but, but the, the person who wrote the letter is trying to be not super negative about you. I know exactly what it means, but legally it means something different.
Right. Well, and that's, that's the rub, right? When I get asked to write these letters, you know, in the rehab world, I want to help people get better. And then I'm writing a letter. That's saying they can't do things. And it's, it's a very tricky situation to be working in a position, wanting. Improve people as much as they can, but then also documenting that they can't do those things and understanding that they might read that letter and say, well, what about all these things you've been telling me about getting better?
It's it is very tricky.
No. And it's one reason I really, I used to give people their files and I will give anyone their files who wants it, but I just keep them now because nobody wants to read those things about themselves. I don't even like people reading their own social security decisions because they will say things. You know, uh, Dr.
Smith indicated that this person is completely incapable of getting along with others. I mean, it's a terrible thing to read about yourself,
Yeah. it is. And it, and it, it sometimes, um, What's the word I'm looking for it. It does sometimes change. People's motivation for working on those things as well. Um, so I talk to people as well. I'm going to write this letter, but if you read it, I want you to understand why I'm writing it in this way versus the way we've been talking about it.
Occasionally I will. Um, occasionally I will help doctors write letters and I always write the most aggressively helpful letters that I can, and then ask mental health providers to change up whatever they want. But, um, I also, I mean, I do think that. I mean, and I tell everyone, everyone with any medical problem and anything bad for your health is great for your social security case.
When you call me and say you had a stroke, I'm like, oh, oh, okay. Oh, okay. Right. I'm bad for your health breakers. Okay. If you can't do things, that's great for your case, but it is extremely demoralizing. I mean, just imagine somebody in a hospital who's told they can never walk again. I mean, are they even motivated to try?
No. They just believe one doctor, when many people really can recover some capacity to walk again. So yes, very, very tricky.
Great. Well, Tracy, thank you so much for all of this information. It's been extremely helpful and I know that anyone listening to this is going to find benefit from all the information that you provided. If they want to, if anybody listening wants to find you kind of, um, find your practice or follow of the work that you're doing, can you share where they might find.
Well, I'm sure I have a website, but I also feel pretty confident that if you, um, if you just Google Tracy Tyson, Miller, Florida lawyer, you'll find me. Let's see. Where's my website. Oh, it looks like it's Tracy Tyson miller.com. Well, it used to be, Hm. Um, do we not pay for that? What's going on there? I don't know.
Um, so now I don't really know where it is. Um, but definitely if you search for Tracy Tyson Miller, Florida lawyer, it's no problem. And it's Tracy T R a C Y.
Great. Thank you so much.
Thank you.
Conclusion
Thank you for listening to this final employment episode, we have two more episodes before we wrap up the MS series. Coming up next is an episode on managing cognitive challenges in the therapy room. And we will end the series with an episode discussing wilderness adventure programs to supplement and enhance what your patients are learning with you in therapy.
Keep listening, subscribe, and share our podcast with your friends and colleagues.
If you would like continuing education credits for listening to this episode, go to: findempathy.com/learn.
Our goal is to help people living with challenging medical conditions find the mental health providers who understand their diagnosis.
Our education, and this podcast, is focused on increasing the number of mental health providers who can help.
If you are a psychologist or a mental health provider that specializes in health populations, please consider signing up on the free Find Empathy directory. Go to findempathy.com and select "Get Listed."
We would love to connect with you on social media. Look for us on Facebook, LinkedIn, Twitter, and Instagram.
If you have suggestions for topics you would like covered by this podcast, let us know. Our email is
[email protected].
Finally, please know that the opinions expressed by the experts today are their own. We are not financially supported by any of the businesses or resources described in today's podcast.
Also remember that the content provided today is for educational purposes only. Please seek the guidance of your doctor or mental health provider for any questions you might have regarding your own health or medical condition.
Thank you so much for listening and we look forward to you joining us in the next episode.
