“ A thorough analysis and discussion of the requirements to qualify for Social Security disability benefits.” WALL STREET JOURNAL With Downloadable DISABILITY LISTINGS 9TH EDITION Nolo’s Guide to Social Security Disability Getting & Keeping Your Benefits • Find out if your medical condition qualifies • Apply for SSDI or SSI benefits • Estimate your monthly benefits • Request an appeal hearing and win David A Morton III, M.D Includes Major Changes to Disability Law This Book Comes With Lots of FREE Online Resources Nolo’s award-winning website has a page dedicated just to this book Here you can: KEEP UP TO DATE When there are important changes to the information in this book, we’ll post updates And that’s not all Nolo.com contains thousands of articles on everyday legal and business issues, plus GET DISCOUNTS ON NOLO PRODUCTS Get a plain-English law discounts on hundreds of books, forms, and dictionary, all written by software Nolo experts and available READ BLOGS Get the latest info from Nolo for free You’ll also find authors’ blogs more useful books, LISTEN TO PODCASTS Listen to authors discuss timely issues on topics that interest you WATCH VIDEOS Get a quick introduction to a software, online apps, downloadable forms, plus a lawyer directory legal topic with our short videos With Downloadable DISABILITY LISTINGS Get forms and more at LAW for ALL www.nolo.com/back-of-book/QSS.html The Trusted Name (but don’t take our word for it) “ In Nolo you can trust.” THE NEW YORK TIMES “ Nolo is always there in a jam as the nation’s premier publisher of do-it-yourself legal books.” NEWSWEEK “ Nolo publications…guide people simply through the how, when, where and why of the law.” THE WASHINGTON POST “ [Nolo’s]…material is developed by experienced attorneys who have a knack for making complicated material accessible.” LIBRARY JOURNAL “ When it comes to self-help legal stuff, nobody does a better job than Nolo…” USA TODAY “ The most prominent U.S publisher of self-help legal aids.” TIME MAGAZINE “ Nolo is a pioneer in both consumer and business self-help books and software.” LOS ANGELES TIMES 9th Edition Nolo’s Guide to Social Security Disability Getting & Keeping Your Benefits David A Morton III, M.D LAW for ALL NINTH EDITION MARCH 2018 Editor BETHANY LAURENCE Cover Design SUSAN PUTNEY Book Design TERRI HEARSH Proofreading SUSAN CARLSON GREENE Indexes SONGBIRD INDEXING SERVICES MEDEA MINNICH Printing BANG PRINTING Names: Morton, David A., 1945- author Title: Nolo’s guide to social security disability : getting & keeping your benefits / David A Morton III, M.D Other titles: Guide to social security disability Description: 9th edition | Berkeley, CA : Nolo, 2018 | Includes index Identifiers: LCCN 2017043757 (print) | LCCN 2017044726 (ebook) | ISBN 9781413324853 (ebook) | ISBN 9781413324846 (paperbook) Subjects: LCSH: Disability insurance United States Handbooks, manuals, etc | Social security United States Handbooks, manuals, etc Classification: LCC HD7105.25.U6 (ebook) | LCC HD7105.25.U6 M675 2018 (print) | DDC 368.4/2 dc23 LC record available at https://lccn.loc.gov/2017043757 This book covers only United States law, unless it specifically states otherwise Copyright © 2001, 2003, 2006, 2008, 2010, 2012, 2014, 2016, and 2018 by David A Morton All rights reserved The NOLO trademark is registered in the U.S Patent and Trademark Office 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 Reproduction prohibitions not apply to the forms contained in this product when reproduced for personal use For information on bulk purchases or corporate premium sales, please contact the Special Sales Department Call 800-955-4775 or write to Nolo, 950 Parker Street, Berkeley, California 94710 Please note We believe accurate, plain-English legal information should help you solve many of your own legal problems But this text is not a substitute for personalized advice from a knowledgeable lawyer If you want the help of a trained professional—and we’ll always point out situations in which we think that’s a good idea—consult an attorney licensed to practice in your state 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, Steve Elias, and Spencer Sherman for helping to take difficult and complex areas of law and make them accessible to the general public Thank you also to Nolo editors Ilona Bray, Cathy Caputo, Janet Portman, and Bethany Laurence About the Author David A Morton has degrees in psychology (B.A.) and medicine (M.D.) For 14 years, he was a consultant for disability determination to the Social Security Administration in Arkansas He was chief medical consultant for eight years of that time In that capacity, he hired, trained, supervised, and evaluated the work of medical doctors and clinical psychologists in determining mental disability claims He also supervised medical disability determinations of physical disorders and personally made determinations of both physical and mental disorders in adults and children in every specialty of disability medicine Since 1983, Dr Morton has authored several books on Social Security disability used by attorneys and federal judges Table of Contents Introduction Your Social Security Disability Companion Medical and Legal Questions Medical Listings Quick Disability Determination (QDD) What Is Social Security Disability? A Two Different Programs B Defining Disabled 18 C Contacting the Social Security Administration 21 D Frequently Asked Questions About Social Security Disability 22 Applying for Disability Benefits .27 A Preparing to Apply 28 B Applying for Disability Benefits .28 C The Role of Health Care Professionals .74 D How Other Disability Payments May Affect Social Security Benefits 76 E Availability and Disclosure of Confidential Records 79 F Fraud and Other Crimes 85 Disability Benefits for Children 87 A Three Benefit Programs for Children 88 B Applying for SSDI or SSI Benefits 90 C Disability Evaluation 103 D Continuing Disability Reviews for SSI Children 107 E Other Health Care Concerns .108 Getting Benefits During the Application Process (SSI) 111 A Applying for Presumptive Disability 113 B Impairments Qualifying for Presumptive Disability by Field Office 114 C Qualifying for Presumptive Disability Through the DDS .116 Proving You Are Disabled .119 A Acceptable Medical Sources 120 B Medical Evidence From Treating Sources 121 C The Role of Consultative Examinations in Disability Determination 131 D Evidence of Symptoms .134 E Other Evidence 137 F Expedited Determinations 137 Who Decides Your Claim? 145 A DDS Basics .146 B DDS Claims Examiners .148 C DDS Organization .148 D Medical Consultants 149 E If Your Claim Is Granted 152 F If Your Claim Is Denied 153 G DDS Corruption and Incompetence 153 H Quick Disability Determination Unit (QDD) .163 How Claims Are Decided 165 Step Are You Engaged in Substantial Gainful Activity? 166 Step How Severe Are Your Impairments? .166 Step Do You Meet the Listing of Impairments? 166 Step Can You Do Your Prior Job? .169 Step Can You Do Any Other Job? 169 Whether You Can Do Some Work: Your RFC 171 A RFC Analysis for Physical Impairments and Abilities 173 B Mental Impairments and Abilities 182 C Claims With Both Physical and Mental RFCs .185 How Age, Education, and Work Experience Matter 187 A Age .188 B Education 190 C Work Experience 193 D Use of Vocational Analysts 199 E Vocational Rehabilitation .201 10 When Benefits Begin 203 A Medical Evidence 204 B Work Experience 205 C SSDI or SSI Claimant 206 11 Reasons You May Be Denied Benefits 209 A You Earn Too Much Income or Have Too Many Assets 210 B Your Disability Won’t Last Long Enough .211 C The SSA Cannot Find You .211 D You Refuse to Cooperate 211 E You Fail to Follow Prescribed Therapy 212 F Drug Addiction or Alcoholism Contributes to Your Disability 217 G You Have Been Convicted of a Crime 219 H You Commit Fraud .220 12 Appealing If Your Claim Is Denied 221 A Deciding Whether to Appeal .222 B Review the Rationale and Your File From the SSA 226 434 | NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY Institutionalization and SSI payments, 311 Internal Revenue Code (IRC), 85 International Direct Deposit (IDD), 301–302 International Social Security agreements, 13–14 IPE (individualized plan for employment), 331 IRC (Internal Revenue Code), 85 IRWEs (impairment-related work expenses), 205–206, 210, 316, 317, 327–328 IWP (Individual Work Plan), 330–331 K Kansas, 149–150, 156 Kentucky, 149–150, 156 Kneeling postural exertion ability for RFC, 176, 177 L Laboratory findings, CDR evaluation of, 369 Legal issues, 2–3, See also Attorneys, consulting with; Authorized representative Less than sedentary work exertional abilities for RFC, 174, 176, 189 Less than unskilled work as a vocational factor, 196 Life-threatening situations, 76 Lifting exertional abilities for RFC, 174–175 Light RFC, 188, 189, 190, 192–193, 200, 417 Light work exertional abilities for RFC, 174, 175, 413–414, 417 Limitations and disability determination, 105 Limited education vocational factor, 191 Listing of Impairments overview, 3, 5, 394, 422 and appeals, 253, 279 and children, 104–105, 106–107 and combined physical and mental disorders, 371 and continuing disability review, 372–373, 375, 376 and DDS decision on your claim, 166–167, 169 on HIV infection, 116 laboratory and other tests required in, 133 marked and severe legal standard, 104 and medical consultant, 150 reading the listings guide, 168 Louisiana, 149–150, 156, 233 Lump-sum death benefits, 12 Lung disease and environmental restrictions on an RFC, 180 M Maine, 149–150, 156 Manipulation category for RFC assessment, 177–178 Marginal education vocational factor, 191 Marijuana use and SSA, 135 Marked and severe standard, 104–105, 114–115 Marked difficulty, 114 Marriage, divorce, or annulment, 304–305, 307 Maryland, 327–328 Massachusetts, SSI recipients in, 313 Maximum family benefit (MFB), 292 MAXIMUS, Inc., 330, 332, 334, 336, 337 MCs See Medical consultants MC/WW (Military Casualty/Wounded Warrior) cases, 144 Medicaid for children receiving SSI, 108 continuation of, as work incentive, 317 and disability benefits, 24–25, 295–296 health care services expansion in Ticket to Work program, 325 with presumptive disability, 112 Medical care facilities for adults, 311 Medical care facilities for children, 108–109 Medical consultants (MCs) overview, 75, 149–150, 156, 394 claimant is their patient, 151 consultative examiners vs., 132 involvement in claim determinations, 251, 253, 254 medical experts vs., 76 potential problems associated with, 156–157 and quality of your medical records, 124–125 role in disability determination, 150–151 specialty codes, 225, 251, 252 and treating doctor’s opinion, 125–126, 182, 185 verifying your file was reviewed by, 253 See also Continuing disability reviews Medical determination about your claim, 73–74, 253 Medical evidence comments from people who know you, 137 consultative examination results, 82 on DAA relevance, 217–218 designated representative for receiving, 80–82, 380 disclosure by SSA, 83–84 and medical consultants, 150–151, 394 physical evidence and claim of pain, 137 providing new information to SSA, 257–258, 260 and start date for benefits, 204 submitting with benefits application, 70–71 symptoms-based, 20, 28, 134–137 thorough criteria, 124–125 INDEX | 435 timely, accurate, and sufficient criteria, 122–124 treating source statement, 126 weight of treating doctor’s opinion, 125–126, 182, 185 See also Medical records Medical experts (MEs), 76, 276, 277, 279–280 Medical improvement expected (MIE), 343 Medical improvement not expected (MINE), 344–345 Medical improvement possible (MIP), 343–344 Medical Improvement Review Standard (MIRS), 367–377 overview, 367 age and time receiving disability considerations, 372 errors in judgment lead to lifelong benefit payments, 373 for expedited reinstatement of benefits process, 323 improvements related to your ability to work, 367–371 inapplicable under certain conditions, 372, 374–377 your ability to work, 371–372 Medical listings See Listing of Impairments Medically determinable impairment, 19–20 Medical onset date (MOD), 204 Medical records accuracy and quality of, 122, 123, 124–125 confidentiality of, 79–85 from hospitals and medical centers, 127–129 insufficient or unhelpful, 129–131 on mental impairments, 122, 128 436 | NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY and request for reconsideration, 249–250 SSA regulations on relevance, 122 timeliness of, 122–123 from treating doctor, 127 from treating sources, 74–75, 83–84, 121–131, 129 used for disability determination, 79–82 See also Medical evidence Medical sources used in evaluating your claim, 227 Medical standard of review in Ticket to Work program, 323 Medical-vocational rules/guidelines/grid overview, 185–186, 188, 413–414 and education, 192–193 light RFC, 188, 189, 190, 192–193, 200, 417 medium RFC, 190, 192–193, 224, 418–419 sedentary RFC, 188–190, 413–416 Medicare and children on SSDI, 109 continuation of, as work incentive, 316 and disability benefits, 24–25, 295–296 eligibility for, 295–296 health care services expansion in Ticket to Work program, 325 Medigap coverage and Ticket to Work law, 325–326 premiums deducted from provisional benefits, 324 Medications as evidence related to symptoms, 20, 135 listing on continuing disability review report, 351 side effects as detrimental to work ability, 182 taking to hearing with you, 270 Medigap coverage and Ticket to Work law, 325–326 Medium RFC, 190, 192–193, 224, 418–419 Medium work exertional abilities for RFC, 174, 175, 224, 413–414, 418–419 Memory and understanding ability for RFC, 184 Mental abilities as a vocational factor, 195–199 Mental impairments and failure to follow prescribed therapy, 212 medical improvement, 370 obtaining medical records for, 122, 128 and presumptive disability, 117 RFC assessment, 182–185, 370–371 and unskilled work capability, 195–196, 197 when physical evidence doesn’t support a claim of pain, 137 witnesses at hearings, 275 MEs (medical experts), 76, 276, 277, 279–280 MFB (maximum family benefit), 292 Michigan, 149–150, 156, 233, 313, 327–328 MIE (medical improvement expected), 343 Military Casualty/Wounded Warrior (MC/ WW) cases, 144 Military service and alien SSDI beneficiaries, 13 SSI benefits for dependent children, 311 and SSI eligibility, 18 SSI for blind or disabled child of parent assigned outside of the US, 18 Wounded Warriors, 144 MINE (medical improvement not expected), 344–345 INDEX | 437 MIP (medical improvement possible), 343–344 MIRS See Medical Improvement Review Standard Missouri, 149–150, 156, 233 MOD (medical onset date), 204 MSS (Medical Support Staff) of AC, 284–285 N Near acuity visual ability for RFC, 178–179 Nebraska, 327–328 Nevada, 149–150, 156 New Hampshire, 149–150, 156, 233 New York, 149–150, 156, 233, 313 Noise as an environmental restriction on an RFC, 181 Nonattorney representatives, 382 See also Authorized representative Nonblind persons SGA income limit amount, 19, 205, 210–211 and Ticket to Work program definition of work, 333–334 Noncitizens receiving benefits outside the United States, 298 and SSDI, 9, 13, 298, 301 and SSI, 9, 17–18 See also Immigrants Nonmedical eligibility requirements overview, 73 for adult children, 106–107 complexity of, 148 See also Dependent’s and survivor’s benefits Nonmedical sources used in evaluating your claim, 227 North Carolina, 149–150, 156 Notice of Disability Review, 271–272 Notices from SSA, 226–227 See also Form letters or notices from SSA or DDS Not severe/nonsevere, 105, 166, 394 Nurses (ARPNs or ARNPs), 121 O Office of Inspector General, 162 Online application for disability benefits, 30 Onset date, 73, 204–207, 208, 395 “On the record” of a parent and children’s benefits, 88–89 Optometrists, 120–121 Overpayments from SSA, 112–113, 294, 296 P Pain and other symptoms, 20, 136, 181–182 PA (Privacy Act), 84–85 Parent of an eligible worker who dies, 12 Parent of minor and surviving spouse of an eligible worker, 11 PAs (physician assistants), 121 PASS (Plan for Achieving Self-Support) program, 317–319 Past-due benefits, 310–311, 387–390 PD See Presumptive disability Penalties for disclosure law violations, 84–85 for failure to make timely reports of changes, 308 for fraud, 86 for representative payee’s misuse of funds, 306 Pennsylvania, 149–150, 156, 233 Peripheral vision ability for RFC, 178, 179 Persistence and concentration ability for RFC, 184 Personalized explanation rationales for denials, 227–229 Personal mobility issues, 114, 352 438 | NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY Personal needs and grooming issues, 366 Pharmaceuticals See Medications Phone interview to apply for disability benefits, 29 Physical impairment MIRS and RFC exertional level, 369–370, 371 projected rating, 395 See also Residual functional capacity, physical impairments assessment Physician assistants (PAs), 121 PIA (primary insurance amount), 291–292 Plan for Achieving Self-Support (PASS) program, 317–319 Podiatrists, 121 POD (Promoting Opportunity Demonstration Project), 327–328 POMS (Program Operations Manual System) for DDS claims examiners, 148 Postural category for RFC assessment, 176–177 Power of attorney vs representative payee, 305–306 Prehearing conference with ALJ, 264–265 Presumptive disability (PD), 111–117 overview, 112–113, 395 applying for, 113–114 for children with severe disabilities, 105–106 DDS qualifies you for, 114, 116–117 Field Office qualifies you for, 113, 114–116 Primary insurance amount (PIA), 291–292 Prisoners and SSA, 326 Privacy Act (PA), 84–85 Privacy law violations, 84–85 Program Operations Manual System (POMS) for DDS claims examiners, 148 Projected rating, 395 Promoting Opportunity Demonstration Project (POD), 327–328 Protection and Advocacy agencies, 336 Proving you are disabled, 119–144 overview, 120 acceptable medical sources, 120–121 symptoms-related evidence, 20, 28, 134–137 Wounded Warriors, 144 See also Consultative examination; Medical evidence; Medical records Provisional benefits while waiting for reinstatement, 324 Psychiatric Review Technique Form (PRTF), 185 Psychologists, 120 Public disability benefits, 77–78 Pulmonary disease and environmental restrictions on an RFC, 180 Pushing and pulling exertional abilities for RFC, 174, 175 Q Quick Disability Determination (QDD), 143, 147, 163–164 R Railroad Retirement Act (RRA), 78–79, 299 Rationales for denials, 227–230 RC (Report of Contact), 116 Reaching manipulative abilities for RFC assessment, 177–178 Recall and review, 152, 153 Reconsideration claims overview, 23, 163, 395 amount of time before response, 231 of EOD, 208 examples, 224–226 and RFC, 172–173, 182 See also entries beginning with “Request for reconsideration” Record keeping documenting your symptoms, 28, 135–136 by physicians, 124–125 Recreational activities and hobbies, 352 Refiling an initial claim, 287–288 Reinstatement in Ticket to Work program, 334–336 Reinstatement of benefits with Ticket to Work program, 323–325 Religious reasons for failure to follow a prescribed therapy, 214–215 Reopening and revision, 152, 153, 286–287 Reporting changes See Social Security Disability Insurance recipients reporting changes to SSA; Supplemental Security Income recipients reporting changes to SSA Report of Contact (RC), 116 Representative See Authorized representative Representative payee, 83, 88, 107, 305–306, 380 Request for reconsideration of continuing disability claim, 254–261 attending the hearing with a DHO, 259–261 DDS review, 258–259 disability hearing officer for, 254–255 forms for, 255, 256, 257–258 reviewing your file before the hearing, 255, 259 waiving your right to be at the hearing, 258, 260 Request for reconsideration of initial claim, 233–254 overview, 222, 233–234 appeal process, 247, 249 INDEX | 439 forms for, 231, 234–248 forwarding forms to the SSA, 247 Notice of Reconsideration, 226 reviewing your file before the reconsideration, 249–253 SSA denial notices with appeal information, 235–236, 253–254 SSA experiment leaving reconsideration out of the appeals process, 233 statistics on overturned denials, 222 See also Reconsideration claims Resident status, 12–13 Residual functional capacity (RFC), 171–186 overview, 172–173, 395 claims with physical and mental RFCs, 185–186 form for, 155–156 medical consultant’s responsibility for, 150 mental impairments and abilities assessment, 182–186 and MIRS analysis of improvements, 369–371 physical impairments assessment (See below) reviewing the form for accuracy and MC involvement, 199–200, 251, 253 worker’s prior work and, 169, 228 See also Medical-vocational rules/ guidelines/grid Residual functional capacity physical impairments assessment, 173–182 overview, 173–174 claims with mental RFC and, 185–186 communication, 179–180 environmental limiting factors, 180–181, 277 exertion, 174–176 440 | NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY manipulative abilities, 177–178 postural abilities, 176–177 vision, 178–179 Res judicata “the thing has been decided” doctrine, 287–288 Resources See Assets/resources Retroactive SSDI or SSI payments, 208, 291, 310–311, 387–390 RFC See Residual functional capacity Right to representation See Authorized representative RRA (Railroad Retirement Act), 78–79, 299 S School records for benefits application, 71–72 SDI or TDI (temporary disability benefits), 211 Sedentary RFC, 188–190, 413–416 Sedentary work exertional abilities for RFC, 174, 175–176, 413–416 Self-employment and SSDI, 314, 317 Semiskilled work as a vocational factor, 198 Sequential evaluation process for disability determination, 22–23 Severe disabilities children with, 105–106 and decision to appeal a denial, 222–223 as Field Office determination, 114–115 marked and severe standard, 104–105, 114–115 SGA See Substantial gainful activity Sheltered workshop earnings and SSI payments, 320 Significant medical improvement, 368 Signs, CDR evaluation of, 369 Skilled work as a vocational factor, 198 Skill requirements (mental abilities) for work, 195–199 Skin disorders and environmental restrictions on an RFC, 181 Social interaction ability, 184–185, 366 Social Security Act, 84, 108, 126, 327–328 Social Security Administration (SSA) overview, appointment of a representative payee, 305–306 average current earnings calculation, 77–78 bad publicity avoidance, 162 Benefit Eligibility Screening Tool, 30 confirming your authorized representative’s status with, 382 consulates and embassies in foreign countries, 297 contact information and tips, 21–22 “crazy checks” problem, 158–159 direct payments to child beneficiaries, 107–108 Disability Quality Branch, 152 education valuation, 190–193 electronic disability records, 249 finding job information, 194–195 on fraud, 85–86 immediate payments vs emergency payments, 113 on impending death, 20, 24 notifying of your choice for authorized representative, 391 Office of Inspector General, 162 and payment for authorized representative, 388–390 reporting other benefits to, 78 request for designated representative, 81–82 statistics on success of appeals, 222, 225 submitting documents to, 31, 70 TERI program, 143–144 work decision, 194–195 See also Disability Determination Service; Field Offices Social Security disability benefits effect of other disability benefits, 76–79 FAQs, 22–26 how long payments continue, 294–295 and Medicare or Medicaid coverage, 24–25, 295–296 payment reductions due to other benefit plans, 76–79 receiving while appealing, 232 receiving your payment, 293–294, 301–302 taxes on, 294 vocational training services, 25 See also Social Security Disability Insurance benefit payments; Supplemental Security Income benefit payments Social Security disability benefits for children, 87–109 overview, 11–12, 88, 103, 104 amount of, 292 child reaches age 18, 307 children in medical care facilities, 108–109 children with special health care needs, 108 impairments, 105 and income changes, 309–310 marked and severe standard, 104–105 and Medicaid, 108 and Medicare, 109 severe disabilities, 105–106 INDEX | 441 SSI benefits, 90, 104–106 See also Dependent’s and survivor’s benefits Social Security Disability Insurance (SSDI) overview, 2, for adult children, 106–107 for adults disabled since childhood, 89–90 alleged onset date and established onset date, 73 attorney payments for claims in federal court, 388–389 benefits (See below) citizenship or residency requirements, 12–14 eligibility, 11–12, 26, 30, 73 lump-sum death benefits, 12 Medicare eligibility, 24, 295–296 and POD, 327–328 qualifying for, 8, 10–12 reporting changes (See Social Security Disability Insurance recipients reporting changes to SSA) reporting when a child leaves your care, 308 restarting your claim, 26, 315 retroactive payments, 310–311, 387–390 SSI compared to, work incentives, 25, 314–317 Social Security Disability Insurance benefit payments 5-month waiting period, 23, 26, 142, 153, 206–207, 291 alien beneficiary exceptions, 13–14 amount of your benefits, 291–293 auxiliary benefits, 11–12, 26, 88–89 citizenship or resident status required for, 12 effect of other disability benefits, 77–78 payment amount, 14 442 | NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY retroactive payments, 208, 291 during trial work period, 210, 395 Social Security Disability Insurance recipients reporting changes to SSA, 296–308 overview, 296 appointing a representative payee, 305–306 bank accounts, 296–297, 301–302, 303 change of address, 296 child receiving benefits reaches age 18, 307 crime conviction or imprisonment, 306 death of recipient, 307 deportation or removal from the US, 308 leaving the United States, 297–304 marriage, divorce, or annulment, 304–305, 307 medical condition improvements, 297 parental status change, 307 receiving a pension, 304 receiving other disability benefits, 304 return to work, 297, 338 Social security number, 31 Social service agencies as representative payees, 306 Speaking ability for RFC, 179, 180 Specialty codes of doctors, 225, 251, 252 Specific vocational preparation (SVP), 194–195 Speech-language pathologists, 121 Spinal cord injury, 116, 117 Spouse of an eligible worker, 11 SSA See Social Security Administration SSA (Adult Disability Starter Kit), 30 SSDI See Social Security Disability Insurance; entries beginning with “Social Security Disability Insurance” SSI See Supplemental Security Income; entries beginning with “Supplemental Security Income” State policies on ABLE accounts, 17 on children’s special health care needs, 108 on Medicare for SSDI claimants, 24 protection and advocacy system for Ticket to Work program, 336 on SSI eligibility levels, 15, 90 on supplementing SSI payments, 15 supplements to SSI higher for blind persons, 15 temporary disability benefits, 211 VR agencies, 201 on workers’ compensation, 77 See also Disability Determination Service; Medicaid; Supplemental Security Income Stepchildren, 89 Stroke, 114 Students See Education Substantial gainful activity (SGA) overview, 19, 395 amount earned while working as determining factor, 166, 205–206 of blind people, 316–317 and disability determination, 166 inability to engage in, 19 income limit, 19, 205, 210–211 terminating benefits for SGA ability, 374, 376 Ticket to Work program revisions to SSA use of, 322–323 in trial work period, 314 and UWA period, 323–324 Sufficient medical records, 122, 123–124 Supplemental Security Income (SSI) overview, 2, 15 attorney payments for claims in federal court, 389–390 INDEX | 443 and bank accounts, 311 benefits (See below) children under age 22 who stop attending school, 312 citizenship or residency requirements, 17–18 continuing disability review for children on, 107 drug addiction or alcoholism, 312 eligibility, 10–11, 15–18, 30, 73 income and resource limits, 15–17, 210–211 and Medicaid coverage, 24–25, 296 onset date of your disability, 73 reporting changes (See below) SSDI compared to, work incentives, 25, 317–322 See also Presumptive disability Supplemental Security Income benefit payments amount of your benefits, 293 conditional payments, 16 deductions for income and job earnings, 318, 319, 320 direct payments to child beneficiaries, 107–108 emergency payments for extreme hardship, 113 emergency payments for extreme hardship cases, 113 receiving benefits outside the US, 18 retroactive payments, 310–311, 387–390 start date, 23, 207–208, 291 state policies on supplementing amount, 15 Supplemental Security Income recipients reporting changes to SSA, 308–313 assets increase, 310–311 bank accounts, 311 entering or leaving an institution, 311 income changes, 309–310 living in a foreign country, 311 marriage, separation, or divorce, 311 number of people who live with you, 308 sponsored immigrants, 312 state-based requirements, 312–313 Supportability of medical opinions, 125–126, 182 Surgery, fear of, 213 Survivor’s benefits See Dependent’s and survivor’s benefits Suspended representatives, 382 SVP (specific vocational preparation), 194–195 Symptoms addressing in RFC, 181–182 CDR evaluation of, 369 describing your medications and, 20, 135 medical evidence based on, 20, 28, 134–137 SSA evaluation of, 135–136 See also Medical evidence T Taxes on Social Security disability benefits, 294 TBI (traumatic brain injury), 225–226 TDI or SDI (temporary disability benefits), 211 Technical rationales for denials, 229–230, 251, 259, 397–411 Telephone hearings, 268 Telephone interview to apply for disability benefits, 29 Temporary disability benefits (TDI or SDI), 211 444 | NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY Terminal illness, 115, 143–144 Terminal Illness (TERI) program, 143–144 Termination of benefits and allowable income, 210 appeal of, 231–232, 257, 264 for performing SGA, 322–323 and POD, 327 SSA notice of, 226–227 Ticket to Work participation, 338–340 See also Reconsideration claims; Request for reconsideration of continuing disability claim Termination of your Ticket to Work program access, 338–340 Texas, 327–328 Therapy prescribed for disability acceptable medical reasons for not doing, 212–213 unacceptable medical reasons for not doing, 213–217 Thorough medical records, 124–125 Ticket to Hire program, 340 Ticket to Work and Work Incentives Improvement Act (TWWIIA), 322 Ticket to Work program overview, 322, 339 Employment Network, 330–332, 336 expedited reinstatement of benefits, 323–325 health care services expansion, 325–326 revisions to SSA use of SGA, 322–323 work incentives, 325 Ticket to Work program participation, 328–340 choosing an EN for vocational rehabilitation, employment, and other support services, 330–332 deciding to participate, 329 eligibility, 328 getting your ticket, 330 Individual Work Plan, 330–331 monitoring progress toward selfsupporting employment, 332–336 program manager, MAXIMUS, Inc., 330, 332, 334, 336, 337 reinstatement after deactivation for failure to make timely progress, 334–336 state protection and advocacy system, 336 termination of your ticket, 338–340 and WIPA, 336 Timely medical records, 122–123 Timely progress, 332 Transferable skills, 198–199 Transplant surgery, 24, 109, 143, 213, 295, 344 Traumatic brain injury (TBI), 225–226 Treating doctor overview, 395 ALJ’s consideration of opinion, 277, 280 and consultative examination, 131 disability documentation from, 28, 70–71 and federal judges, 285 and information required by SSA, 129–131, 250 MC and treating doctor’s opinion, 125–126, 182, 185 SSA on duration of care, 216–217 statement on your mental capacity in RFC, 185 statement on your physical capacity in RFC, 182, 185 treating source statement, 126 Treating sources, medical records from, 74–75, 83–84, 121–131, 129 INDEX | 445 Treatments for relief of pain and other symptoms, 135 Trial work period (TWP), 210, 314, 333–334, 395 Trivial impairments, 371 TWWIIA (Ticket to Work and Work Incentives Improvement Act), 322 U Understanding and memory ability for RFC, 184 Unskilled work as a vocational factor, 195–198 Unsuccessful work attempts (UWAs), 205, 323–324 U.S Code (USC–federal law) V VA (Veterans Administration) benefits, 79 Vermont nonmedical examiners making disability determinations, 149–150, 156 POD test in, 327–328 SSI recipients report level of care change at living facility, 313 VEs (vocational experts) at hearings, 276, 278, 280, 283–284 Veterans Administration (VA) benefits, 79 Vibration as an environmental restriction on an RFC, 181 Video hearings, 267–268 Vision category for RFC assessment, 178–179 Vocational analysts, 148, 199–200, 395, 413 Vocational experts (VEs) at hearings, 276, 278, 280, 283–284 Vocational factors, 187–201 overview, 73, 188 age, 188–190, 192–193 education, 190–193 skill requirement levels, 195–199 work experience, 193–195 Vocational rehabilitation (VR), 201, 316, 319, 330–331 Vocational therapy related to ability to work, 374–375 Vocational training services, 25 VR agencies, 201 VR (vocational rehabilitation), 201, 316, 319, 330–331 W Waiting period for SSDI benefit payments, 23, 26, 142, 153, 206–207, 291 Waiving your right to be at a DHO hearing, 258, 260 Washington, 149–150, 156 West Virginia, 149–150, 156 Widow or widower of an eligible worker, 11 Witnesses for hearings, 259–260, 270, 274 Work, definition of, and Ticket to Work program participation, 332–334 Work availability and denial of claim, 194–195 Work credits, 10 Workers average current earnings calculation, 77–78 employment information for benefits application, 71 prior work and RFC, 169, 228 receiving a pension while covered by SSDI, 304 recording how your condition affected you on the job, 28 reporting wages to SSA, 309–310 returning to work while receiving SSDI, 297, 338 446 | NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY work history, 71, 250, 330 See also Work incentives Workers’ compensation, 76–78 Work experience overview, 193 and decision to appeal a denial, 223 and established onset date, 205–206 failed work attempts, 205, 323–324 information SSA wants, 194 transferable skills, 198–199 See also Vocational factors Work incentives, 313–322 overview, 25, 313 SSDI, 314–317 SSI, 317–322 See also Ticket to Work program Work Incentives Planning and Assistance (WIPA), 336 Work-related activities’ effect on RFC, 173–174 See also Residual functional capacity physical impairments assessment Wounded Warriors, 144 l Online Legal Forms Nolo offers a large library of legal solutions and forms, created by Nolo’s in-house legal staff These reliable documents can be prepared in minutes Create a Document • Incorporation Incorporate your business in any state • LLC Formations Gain asset protection and pass-through tax status in any state • Wills Nolo has helped people make over million wills Is it time to make or revise yours? • Living Trust (avoid probate) Plan now to save your family the cost, delays, and hassle of probate • Trademark Protect the name of your business or product • Provisional Patent Preserve your rights under patent law and claim “patent pending” status Download a Legal Form Nolo.com has hundreds of top quality legal forms available for download—bills of sale, promissory notes, nondisclosure agreements, LLC operating agreements, corporate minutes, commercial lease and sublease, motor vehicle bill of sale, consignment agreements and many, 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PRINTING Names: Morton, David A., 1945- author Title: Nolo’s guide to social security disability : getting & keeping your benefits / David A Morton III, M.D Other titles: Guide to social security disability... LOS ANGELES TIMES 9th Edition Nolo’s Guide to Social Security Disability Getting & Keeping Your Benefits David A Morton III, M.D LAW for ALL NINTH EDITION MARCH 2018 Editor BETHANY LAURENCE Cover... by a woman to whom he has never been married Is the second child entitled to some benefits as well? 26 8 | NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY T he Social Security Administration