Introduction: Your Social Security Disability Companion

Medical and Legal Questions

Medical Listings

Quick Disability Determination (QDD)

1: What Is Social Security Disability?

A. Two Different Programs

B. Defining Disabled

C. Contacting the Social Security Administration

D. Frequently Asked Questions About Social Security Disability

2: Applying for Disability Benefits

A. Preparing to Apply

B. Applying for Disability Benefits

C. The Role of Health Care Professionals

D. How Other Disability Payments May Affect Social Security Benefits

E. Availability and Disclosure of Confidential Records

F. Fraud and Other Crimes

3: Disability Benefits for Children

A. Three Benefit Programs for Children

B. Applying for SSDI or SSI Benefits

C. Disability Evaluation

D. Continuing Disability Reviews for SSI Children

E. Other Health Care Concerns

4: Getting Benefits During the Application Process (SSI)

A.  Applying for Presumptive Disability

B.  Impairments Qualifying for Presumptive Disability by Field Office

C.  Qualifying for Presumptive Disability Through the DDS

5: Proving You Are Disabled

A. Acceptable Medical Sources

B. Medical Evidence From Treating Sources

C. The Role of Consultative Examinations in Disability Determination

D. Evidence of Symptoms

E. Other Evidence

F. Expedited Determinations

6: Who Decides Your Claim?

A. DDS Basics

B. DDS Claims Examiners

C. DDS Organization

D. Medical Consultants

E. If Your Claim Is Granted

F. If Your Claim Is Denied

G. DDS Corruption and Incompetence

H. Quick Disability Determination Unit (QDD)

7: How Claims Are Decided

Step 1. Are You Engaged in Substantial Gainful Activity?

Step 2. How Severe Are Your Impairments?

Step 3. Do You Meet the Listing of Impairments?

Step 4. Can You Do Your Prior Job?

Step 5. Can You Do Any Other Job?

8: Whether You Can Do Some Work: Your RFC

A. RFC Analysis for Physical Impairments and Abilities

B. Mental Impairments and Abilities

C. Claims With Both Physical and Mental RFCs

9: How Age, Education, and Work Experience Matter

A. Age

B. Education

C. Work Experience

D. Use of Vocational Analysts

E. Vocational Rehabilitation

10: When Benefits Begin

A. Medical Evidence

B. Work Experience

C. SSDI or SSI Claimant

11: Reasons You May Be Denied Benefits

A. You Earn Too Much Income or Have Too Many Assets

B. Your Disability Won’t Last Long Enough

C. The SSA Cannot Find You

D. You Refuse to Cooperate

E. You Fail to Follow Prescribed Therapy

F. Drug Addiction or Alcoholism Contributes to Your Disability

G. You Have Been Convicted of a Crime

H. You Commit Fraud

12: Appealing If Your Claim Is Denied

A. Deciding Whether to Appeal

B. Review the Rationale and Your File From the SSA

C. Appeal Basics

D. Your Right to Representation

E. Five Levels of Appeal

F. Reopening of Decisions

G. Refiling an Initial Claim

13: Once You Are Approved

A. Disability Benefit Payments

B.  Reporting Changes—SSDI Recipients

C. Reporting Changes—SSI Recipients

D. Returning to Work

E.  Passage of the Ticket to Work and Work Incentives Improvement Act

F. Participation in the Ticket to Work Program

G. The Ticket to Hire Program

14: Continuing Disability Review

A. Frequency of Reviews

B. How the SSA Contacts You

C. Medical Improvement Review Standard

D. Children and CDRs

E. Appealing a CDR Decision

15: Your Right to Representation

A. When Do You Need an Authorized Representative?

B. What Can an Authorized Representative Do?

C. Who Can Be an Authorized Representative?

D. Should Your Authorized Representative Be an Attorney?

E. How to Find a Disability Attorney

F. Notifying the SSA of Your Choice for Representative

G. When and How Your Representative Is Paid

H. Keeping Up on the Law Yourself

Appendixes

A: Glossary of Bureaucratic Terms

B: Examples of Technical Rationales for Denials

Form SSA-4268, Denials From Initial Application

Form SSA-4268, Denials From Continuing Disability Review (CDR)

C: Medical-Vocational Rules

D: How to Use the Medical Listings on Nolo.com

List of Files on Nolo.com

Index

Introduction: Your Social Security Disability Companion

This book is about Social Security disability benefits, which are provided through a U.S. government system run by the Social Security Administration (SSA). These disability programs provide cash support for individuals with mental or physical disorders (and their dependents, in some cases) who cannot work because of the severity of their condition. This book is useful for anyone who:

• is injured or ill and wants to know if they are eligible for disability benefits
• wants to apply for disability benefits
• is already receiving disability benefits and wants to know how to protect the benefits during periodic government reviews of their condition
• wants to appeal a decision denying disability benefits, or
• is helping an adult or child apply for or keep current benefits.

The SSA uses two systems to distribute disability payments:

• Social Security Disability Insurance (SSDI), for workers who have paid into the Social Security trust fund (and their dependents), and
• Supplemental Security Income (SSI), for disabled individuals with limited incomes and assets.

It’s easy to become overwhelmed at the thought of applying for disability benefits. The SSA is one of the world’s largest bureaucracies; its regulations, rules, operating policies, and guidelines fill reams of paper. For example, one chapter of the SSA’s operating manual is about 20,000 pages long. And much of this information changes over time.

Still, it is very possible to apply for, receive, and maintain disability benefits with the help you will find here. We recognize, however, that people applying for disability benefits are most often ill or injured in a way that makes it difficult to accomplish the tasks of daily life, let alone pursue a claim for support from the government. So you may need help beyond this book. We have included an entire chapter on what to do if you need legal assistance (Chapter 15). Also, throughout the book, we’ve noted situations in which, you may need the advice and support of a family member, trusted friend, paid representative, or attorney.

Medical and Legal Questions

When deciding on your disability claim, the government considers both legal and medical issues. Social Security officials review your claim to decide whether you are legally entitled to the benefits you request. They also request and review medical opinions on your condition to see if it is severe enough to make you disabled. The government considers you disabled only if you are not able to work in your current or most recent job and you do not have the education, experience, or ability to do any other job. For example, a physically disabled 60-year-old doctor may have the ability to work in some other capacity in the medical industry and could be denied benefits for that reason. But the same doctor could not work as a field laborer picking fruit all day because he would not have the physical ability necessary for the job.

Chapters 1 through 15 lead you through the legal and practical issues of applying for disability payments, appealing if you are denied, and making sure that you retain benefits as long as you need them. For most applicants, it will be useful to read all of these chapters in the order presented. But if you have a particular issue to research (for example, you want to file an appeal), you can start with any chapter and you will be directed to important information in other parts of the book as needed. Also note that we occasionally give you references to the Social Security portions of the Code of Federal Regulations (CFR) or to the federal law, U.S. Code (U.S.C.).

Medical Listings

Information about the requirements and functionally disabling aspects of more than 200 specific medical problems that make individuals eligible for disability payments is available on Nolo’s website (free for readers of this book) at: (purchase the book for details). These are descriptions of what the SSA calls the Listing of Impairments.

Go to Nolo’s website and start with the table of contents for these listings—once you find the section that matches or most closely approximates your disability, you will find all the medical information you need to determine if your disability meets the requirements to obtain benefits. For example, if you suffer from kidney disease, you would open Part 6 and read through the listings there until you found a disorder that matches or is similar to your illness.

Each section of the medical listings begins with a list of medical definitions in plain English related to the disorders discussed in that section. Next, you’ll find general background information about the disorders discussed in that section. Finally, each section lists specific medical disorders taken from the official Listing of Impairments the SSA uses in disability claims. The number before each listing is the official number the SSA uses to identify the disability. Following the numbers is a brief discussion of the meaning and how to interpret each listing.

These medical listings contain every listing the SSA has approved for disability claims. We have revised the SSA’s wording of the listings to make them more understandable. Rest assured, however, that we made no changes that would compromise their legal meaning.

Also included in each listing are comments about what the SSA calls “residual functional capacity” (RFC). This is a type of rating given to a disability claimant who does not meet the requirements of a Listing of Impairment. The RFC says what kind of work a claimant could do, even considering his or her impairments. If no work is available anywhere in the United States that fits into a claimant’s RFC, the claimant may be approved for disability payments even though the claimant’s condition does not exactly fit the listing.

Quick Disability Determination (QDD)

In 2006, the SSA tried to improve the disability system by implementing the “disability service improvement process” (DSIP)—sometimes simply called “disability service improvement” (DSI). Most of the DSIP changes affected the way initial disability determinations and appeals are handled. Implementation of this experiment proved unworkable. In 2010, the SSA canceled DSIP, with one exception: The Quick Disability Determination (QDD) process was retained. QDD is a quicker disability determination process for those who are obviously disabled (with, for example, metastatic cancer, severe blindness, profound intellectual disability (formerly called mental retardation), severe kidney failure requiring dialysis, and the inability to walk—to name a few possibilities). Favorable decisions will be made in such cases within 20 days after the claim is received by the state disability determination agency (DDS). The average time is about 12 days. See Chapter 6 for more information about QDD.

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