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But this text is not a substitute for personal- ized advice from a knowledgeable lawyer. If you want the help of a trained professional, consult an attorney licensed to practice in your state. Nolo’s Guide to Social Security Disability Getting & Keeping Your Benefits by David A. Morton III, M.D. 2nd edition SECOND EDITION APRIL 2003 Editor ILONA BRAY Cover Design TONI IHARA Book Design TERRI HEARSH Production SUSAN PUTNEY Proofreading SUSAN CARLSON GREENE Index THÉRÈSE SHERE Printing CONSOLIDATED PRINTERS, INC. Morton, David A., 1945- Nolo’s guide to social security disability : getting & keeping your benefits / by David A. Morton 2nd ed. p. cm. Includes index. ISBN 0-87337-914-4 1. Insurance, Disability United States Handbooks, manuals, etc. 2. Social security United States Handbooks, manuals, etc. I. Title: Guide to social security disability. II. Title HD7105.25.U6M675 2003 368.4'2 dc21 2003041286 Copyright © 2001 & 2003 by David A. Morton. ALL RIGHTS RESERVED. Printed in the U.S.A. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without prior written permission. For information on bulk purchases or corporate premium sales, please contact the Special Sales Department. For academic sales or textbook adoptions, ask for Academic Sales. Call 800-955-4775 or write to Nolo, 950 Parker Street, Berkeley, CA 94710. Dedication To my mother, Mary E. Morton, and to my wife, Mary L. Morton. Acknowledgments I would like to thank Nolo founder Ralph “Jake” Warner for seeing the need for a book on Social Security disability that can be read and used by ordinary people. I would also like to thank former Nolo editors Robin Leonard and Steve Elias for helping to take difficult and complex areas of law and medicine and make them accessible to the general public. Finally, my thanks to Nolo editors Spencer Sherman and Ilona Bray for finishing what Robin and Steve began. I How to Use This Book A. Introduction I/2 B. Medical and Legal Questions I/2 C. How to Use This Book I/3 1 What Is Social Security Disability? A. Two Different Programs 1/2 B. Defining Disabled 1/8 C. Contacting the Social Security Administration 1/10 D. Frequently Asked Questions About Social Security Disability 1/11 2 Applying for Disability Benefits A. Preparing to Apply 2/2 B. Applying for Disability Benefits 2/2 C. Healthcare Professionals 2/36 D. How Other Disability Payments May Affect Social Security Benefits 2/38 E. Availability and Disclosure of Confidential Records 2/39 F. Fraud and Other Crimes 2/43 3 Disability Benefits for Children A. Three Benefit Programs for Children 3/2 B. Applying for SSDI or SSI Benefits 3/3 C. Disability Evaluation 3/15 D. Continuing Disability Reviews for SSI Children 3/17 E. Other Healthcare Concerns 3/18 Table of Contents 4 Getting Benefits During the Application Process A. Applying for Presumptive Disability 4/3 B. Impairments Qualifying for Presumptive Disability by Field Office 4/3 C. Qualifying for Presumptive Disability Through the DDS 4/5 5 Proving You Are Disabled A. Acceptable Medical Sources 5/2 B. Medical Evidence From Treating Sources 5/3 C. The Role of Consultative Examinations in Disability Determination 5/8 D. Evidence of Symptoms 5/10 E. Other Evidence 5/12 6 Who Decides Your Claim? A. DDS Basics 6/2 B. DDS Claims Examiners 6/2 C. Other DDS Administrative Personnel 6/3 D. Medical Consultants 6/4 E. If Your Claim Is Granted 6/5 F. If Your Claim Is Denied 6/6 G. DDS Corruption and Incompetence 6/6 H. Disability Redesign: Coming Danger to Claimants 6/12 7 How Claims Are Decided Step 1. Are You Engaged in Substantial Gainful Activity? 7/2 Step 2. How Severe Are Your Impairments? 7/2 Step 3. Do You Meet the Listing of Impairments? 7/2 Step 4. Can You Do Your Prior Job? 7/3 Step 5. Can You Do Any Other Job? 7/4 8 If You Can Do Some Work A. Physical Impairments and Abilities 8/3 B. Mental Impairments and Abilities 8/8 C. Claims with Both Physical and Mental RFCs 8/10 [...]... Payments May Affect Social Security Benefits 2/38 1 Workers’ Compensation and Public Disability 2/38 2 Railroad Retirement Act and Social Security Disability 2/39 3 Black Lung Benefits and Social Security Disability 2/39 4 What Payments Do Not Affect Your Social Security Disability Benefits? 2/39 E Availability and Disclosure of Confidential Records 2/39 1 Your Medical Records... Local Social Security offices are where you can apply for: • Social Security benefits • SSI, black lung benefits and hospital insurance protection, and • a Social Security number You can also: • check on your earnings record • enroll for medical insurance • receive assistance in applying for food stamps • get information about your rights and obligations under the law, and • obtain forms you need to apply... Fraud and Other Crimes 2/43 2/2 NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY A Preparing to Apply You can play an active and important role in ensuring that your claim is processed accurately and quickly The best advice is to keep thorough records that document the symptoms of your illness or injury and how it affects your daily activities before you apply Then, provide this information to. .. you had to stop working because of your medical problems If you say you stopped working without a medical reason, you might not qualify to receive benefits SGA refers only to money you obtain from working, not money you obtain from other sources, such as investments or gifts 1/ 9 Pain and Other Symptoms Your pain and symptoms are important parts of your disability claim SSA staff frequently hand out... disability benefits (Chapter 2) • applying for children (Chapter 3) • getting benefits immediately (Chapter 4) • how to prove you are disabled (Chapter 5) • how claims are decided (Chapters 6 and 7) • how to keep your benefits once you get them (Chapters 10 and 14) • what to do if you have been denied benefits (Chapters 11 and 12), or • finding someone to help you (Chapter 15) Each chapter will direct you to. .. about Social Security is at www.ssa.gov The SSA’s phone lines are busiest early in the week and early in the month; if your business can wait, call at other times WHAT IS SOCIAL SECURITY DISABILITY? Have the following items handy when you call: • your Social Security number • a list of questions you want to ask • any recent correspondence you received from the SSA, and • a pencil and paper to write... pays benefits to all of his children Each child is entitled to equal benefits ■ 1/ 1 3 Chapter 2 Applying for Disability Benefits A Preparing to Apply 2/2 1 Document Your Symptoms Early and Often 2/2 2 Help Your Doctor Help You 2/2 3 Record How Your Condition Affected You on the Job 2/2 B Applying for Disability Benefits 2/2 1 What SSA Needs to Process... you stopped working because of your disability Because your SSDI benefits depend on your earnings, the SSA recognizes that it is usually to your advantage to have your earning record “frozen” to reflect the higher income before you were disabled Therefore, the SSA will exclude from your benefit calculations low income quarters of earnings resulting from a period of disability, unless it’s to your financial... North Korea and Vietnam International Social Security Agreements The United States has entered into several International Social Security agreements called totalization agreements, which have two major purposes First, they eliminate dual Social Security taxation, the situation that occurs when a worker from one country works in another country and is required to pay Social Security taxes to both countries... disability benefits and wants to know how to protect them during periodic government reviews of their condition • wants to appeal a decision denying them 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 . professional, consult an attorney licensed to practice in your state. Nolo’s Guide to Social Security Disability Getting & Keeping Your Benefits by David A. Morton III, M.D. 2nd edition SECOND EDITION. 1945- Nolo’s guide to social security disability : getting & keeping your benefits / by David A. Morton 2nd ed. p. cm. Includes index. ISBN 0-87337-914-4 1. Insurance, Disability United States Handbooks,. Contacting the Social Security Administration 1/10 D. Frequently Asked Questions About Social Security Disability 1/11 1/2 NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY T he Social Security Administration