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

422  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



T



his book comes with PDF files

containing the SSA’s disability

listings that you can download here:



To use the files, your computer must have

Adobe Reader (free software available from

Adobe.com).



www.nolo.com/back-of-book/QSS.html



List of Files on Nolo.com

To download the following Medical Listings, go to: www.nolo.com/back-of-book/QSS.html

Part Name



File Name



Musculoskeletal Disorders and Growth Impairments



Part1.pdf



Vision, Balance, Hearing, and Speech



Part2.pdf



Breathing Disorders



Part3.pdf



Heart and Blood Vessel Diseases



Part4.pdf



Digestive System Disease



Part5.pdf



Kidney Disease



Part6.pdf



Blood Diseases



Part7.pdf



Skin Diseases



Part8.pdf



Hormone Disorders



Part9.pdf



Multiple Body System Disorders



Part10.pdf



Nervous System Disorders



Part11.pdf



Mental Disorders



Part12.pdf



Cancer



Part13.pdf



Immune System Disorders



Part14.pdf



l



Index

A



ABLE (Achieving a Better Life Experience)

Act, 17

AC (Appeals Council) review, 231, 281–285

Accommodation visual ability for RFC, 178,

179

Accurate medical records, 122, 123

Achieving a Better Life Experience (ABLE)

Act, 17

Activities of daily living (ADLs)

describing on continuing disability review

report, 352

effect of pain and other symptoms,

134–135

form for reporting, 71–72

Adaptation ability for RFC, 185

Administrative law judge (ALJ)

overview, 261–262, 393

AC setting aside decision of, 282

for appealing denial of benefits, 76

appealing the decision from, 231

Administrative law judge hearing, 261–281

overview, 261–262

attending the hearing, 270, 273

Attorney Advisor holds prehearing

proceeding, 265–266

benefits stop if denial is upheld, 257

expense reimbursement requests, 268–269

forms for requesting, 262–264

hearing procedures (See below)

hearing venue or video hearing, 267–268

medical experts, 76, 276, 277, 279–280

prehearing conference, 264–265



preparing for the hearing, 269–270

reconvening on another day, 280, 281

scheduling the hearing, 266–267

waiting for a decision, 280

Administrative law judge hearing procedures,

273–281

medical experts, 76, 276, 277, 279–280

order of the hearing, 273–274

vocational experts, 276, 278, 280,

283–284

your witnesses, 274–275

Adult children and SSDI, 106–107

Adult Disability Starter Kit (SSA), 30

Advanced practice registered nurses (APRNs),

121

Adverse effect of knowledge about your

medical condition, 80, 81

Age

age-based eligibility for SSI from work

credits, 10–11

and decision to appeal a denial, 223

and MIRS in CDR, 372

as vocational factor, 188–190, 192–193

AIME (average indexed monthly earnings),

291–292

Alabama, 149–150, 156, 233, 327–328

Alaska, 149–150, 156, 233

Alcohol and antiepileptic drugs, 214. See also

Drug addiction or alcoholism

Alien beneficiaries and SSDI payments,

13–14, 298

ALJ. See Administrative law judge

Alleged onset date (AOD), 73, 204, 393

American Board of Vocational Experts, 278



424  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



Amyotrophic lateral sclerosis (ALS), 24, 116,

295

Appeals

overview, 22, 230–232

amount of time before a response,

231–232

Appeals Council review, 231, 281–285

and authorized representative, 380

claimants manipulating choice of ALJ, 267

claimant’s right to representation,

232–233

DDS director holds back finished claims,

preventing appeals, 154–155

decision on whether to appeal, 222–226

federal Court of Appeals, 286

and medical evidence used for denial, 81

reasons for (See Appeals, reasons for)

receiving benefits during, 232, 257, 261

refiling an initial claim, 287–288

reopening decisions vs., 152, 153,

286–287

reviewing rationale and your file,

226–230

SSA statistics on success of claimants, 222,

225

streamlined process in ten states, 233

See also entries beginning with

“Administrative law judge”; entries

beginning with “Request for

reconsideration”

Appeals, reasons for

ALJ upholds decision against you,

285–286

cases decided by nonmedical personnel,

149–150, 155–156

CDR-based terminations, 254–261, 342,

378



denial of initial application, 76

of disability determination, 23

onset date, 208

for Program Manager’s failure to reinstate

you into Ticket to Work program, 336

reconsideration decision, 253–254

Appeals Council (AC) review, 231, 281–285

Applying for disability benefits. See Initial

claim for benefits

APRNs (advanced practice registered nurses),

121

Arduous and unskilled work, 197–198

ARNPs and ARPNs (nurses), 121

Assets/resources

information for benefits application, 72

in-kind income, 90

notifying SSI of increase in, 310–311

and SSI eligibility, 15–17

Attorney Advisor to ALJ, 265–266

Attorney representative, 382, 387–391. See

also Authorized representative

Attorneys, consulting with

for DDS process, 163

for Social Security disability and public

disability payments at the same time, 77

for uncooperative treating doctor, 127

Audiologists, licensed, 121

Authorized representative, 379–391

overview, 88, 380

at ALJ hearing, 269

for appeals, 232–233

attending hearings, 259–260

attorney representatives, 382, 387–391

choosing an attorney vs. a nonattorney,

382–383

communication with, as privileged

information, 122



INDEX  |  425







and federal government records about you,

79–82

fee agreements with SSA approval, 385–386

finding a competent disability attorney,

383–384

and initial claim for benefits, 29

nonattorney representatives, 382

notifying the SSA of your choice, 391

payment arrangements, 384–390

reasons for, 380–381

role of, 381

and SSA acquiring medical records from

treating sources, 83–84

Auxiliary benefits. See Dependent’s and

survivor’s benefits

Average current earnings calculation, 77–78

Average indexed monthly earnings (AIME),

291–292



B



Balancing postural exertion ability for RFC,

176, 177

Bank accounts and disability benefits, 294,

296–297, 301–302, 303, 311

Bending postural exertion ability for RFC,

176–177

Benefit Eligibility Screening Tool (BEST), 30

Benefit payments. See Social Security

disability benefits; Social Security Disability

Insurance benefit payments; Supplemental

Security Income benefit payments

Birth certificate, 31, 70

Black lung benefits and Social Security

disability benefits, 79

Blind persons

overview, 129

lawfully-admitted permanent residents, 312

presumptive disability payments for, 114



SGA income limit amount, 19, 205,

210–211

SSDI work incentives, 316–317

SSI work incentives, 320–322

state supplement amounts, 15

Ticket to Work program definition of

work, 333–334

US citizen children living outside the US,

18



C



California, 149–150, 156, 233, 312, 327–328

CALs (compassionate allowance cases),

138–142

Cardiovascular disease and environmental

restrictions, 181

Carrying exertional abilities for RFC, 174–175

CDRs. See Continuing disability reviews

Certified copies of documents for SSA, 31

CEs. See Consultative examinations

CFR (Code of Federal Regulations). See

Listing of Impairments

Change of address, 296

Check by mail distribution of payments,

293–294, 302, 303

Chief medical consultant (CMC), 155–156

Children

adopted children, 301, 307

birth weight and presumptive disability, 115

CDR evaluations for, 377–378

“crazy checks” problem at SSA, 158–159

and Listing of Impairments criteria, 167

and prescribed therapies, 213

and SSDI auxiliary benefits, 11–12, 26,

88–89

stepchildren, 89

See also Social Security disability benefits

for children



426  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



Children with Special Health Care Needs

(CSHCN), 108

Chronic kidney disease, 109, 117, 295, 344

Citizenship, 12–13, 17, 18

Claimants

overview, 393

active involvement in the handling of your

claim, 159–163

adverse effect of knowledge about your

medical condition, 80, 81

keeping up on the law, 391

letter to DDS to prevent incompetence,

159–161

making sure the RFC contains all

pertinent information, 199–200

right to representation in appeals,

232–233

Claims

DDS director holds back finished claims,

154–155

SSA internal process, 4

SSA’s decision making process, 165–169

See also Denial of benefits; Initial claim for

benefits

Claims examiners

overview, 147, 148, 394

and details, 200

and medical consultants, 150–151

potential problems associated with,

157–158

Climbing postural exertion ability for RFC,

176, 177

Closed periods of disability, 144, 393

CMC (chief medical consultant), 155–156

Code of Federal Regulations (CFR). See

Listing of Impairments

Colorado, 149–150, 156, 233

Color vision for RFC, 178, 179



Communication category for RFC

assessment, 179–180

Comparison point decision (CPD), 368–369,

375–376

Compassionate allowance cases (CALs),

138–142

Comprehensive Alcohol Abuse and Alcohol

Prevention, Treatment, and Rehabilitation

Act, 85

Concentration and persistence ability for

RFC, 184

Concurrent claims, 8, 206, 388, 393

Conditional payments (a loan) from SSI, 16

Confidential records, 79–85

Connecticut, POD test in, 327–328

Consistency of medical opinions, 125–126

Consultative examination (CE) doctor, 75,

76, 131–134, 277, 393

Consultative examinations (CEs)

overview, 393

and ALJ hearing, 280

claimant refuses to attend, 151, 212

confidentiality of medical records, 82

fraud related to, 137

inadequate exams, 134

life-threatening conditions found during,

76

reasons for, 75, 250, 342

report contents, 133

role in disability determination, 131–134

your protections in, 133–134

Continuing disability reviews (CDRs),

341–378

overview, 25–26, 146, 393

appeal of a decision to terminate based on

CDR, 254–261, 378

for children, 377–378

comparison point decision, 368–369







continuing disability review report form,

350–352, 353–365, 366–367

disability update report form, 345,

348–349, 350

errors in judgment lead to lifelong benefit

payments, 373

evaluating symptoms, signs, and labs, 369

expatriate responsibilities, 303–304

frequency of reviews, 342–345

new impairments, 369, 377

rationales, 230

SSA Notice of Review, 345, 346–347

for SSI children, 107–108

Ticket to Work program participants

exempt from, 329

See also Medical Improvement Review

Standard; Request for reconsideration of

continuing disability claim

Copycat reconsiderations, 255

Corruption at DDS, 153–156, 159–161

CPD (comparison point decision), 368–369,

375–376

Crawling postural exertion ability for RFC,

176, 177

“Crazy checks” problem at SSA, 158–159

Crime conviction or imprisonment, 219–220,

306, 326

Crouching postural exertion ability for RFC,

176, 177

CSHCN (Children with Special Health Care

Needs), 108



D



DAA. See Drug addiction or alcoholism

Date last insured (DLI), 10, 193

DDS. See Disability Determination Service

Deaf persons, 114



INDEX  |  427



Death

fraudulent receipt of checks by survivor, 86

of insured railroad worker, 79

lump-sum death benefits, 12

of SSDI recipient, 11–12, 88–89, 307, 338

See also Impending death

Denial of benefits, 209–220

overview, 210

for crime conviction or imprisonment,

219–220

DAA as factor in your disability, 217–219

examining your file, 152

explanation from SSA, 227

for failure to cooperate, 211–212

for failure to follow prescribed therapy,

212, 377

requesting reopening and revision, 152, 153

reviewing your file for incorrect statements

or opinions, 223–224

SSA cannot find you, 211

SSI income and resource limits, 15–17,

210–211

for temporary disability, 211

and work availability, 194–195

See also Appeals

Dependent’s and survivor’s benefits

overview, 11–12, 26

amount of payment, 292

black lung benefits, 79

and death of SSDI recipient, 11–12, 307

effect of your marriage, 304–305, 307

family benefits, 11–12, 26, 88–89, 292

military personnel and, 311

program for children under 18, 88–89

receiving a government pension, 304

receiving payments outside the United

States, 298, 299–300, 301



428  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



reporting when a child leaves your care,

308

Depth perception ability for RFC, 178, 179

Designated representative, 80–82, 380

DHO (disability hearing officer), 254–255,

259–261, 393

Diagnostic and Statistical Manual of Mental

Disorders (DSM), 218

Diary, 146, 393

Dictionary of Occupational Titles (DOT), US

Department of Labor, 194–195, 278

Direct deposit distribution of payments, 294,

301–302

Direct Express card program, 294

Disability determination

overview, 18–19, 22–23, 393

acceptable medical reasons for not

following prescribed therapy, 212–213

acceptable nonmedical reasons for not

following prescribed therapy, 213–217

appealing a decision, 23

for children, 103, 104–106

compassionate allowance cases, 138–142

confirmation from another source, 115–116

and consultative examinations, 131–134

duration of disability, 20–21, 25, 211, 223,

394

erroneous decision granting disability,

375–376

expedited determinations, 137–144

experiment letting nonmedical examiners

decide cases, 149–150

health care professionals’s roles in,

74–76, 147

inability to engage in substantial gainful

activity, 19

medically determinable impairment,

19–20

®



nonmedical examiners deciding cases,

149–150, 155–156

and RFC analysis, 172–173

temporary disability, 211

terminal illness cases, 143–144

treating doctor’s role, 125–126, 130–131,

182, 185

See also Denial of benefits; Proving you are

disabled

Disability Determination Service (DDS),

145–165

overview, 146, 395

administrative personnel, bureaucracy,

148–149

bad publicity avoidance, 162

combating corruption and incompetence,

159–163

and consultative examination doctors,

133–134

contact information, 146

corruption as possible issue, 153–156

DAA considerations, 218–219

determination of medical eligibility for

claim, 73–74, 103

director, 149, 152, 153, 154, 156, 162

and evaluating claims with physical and

mental RFCs, 186

incompetence as possible issue, 147,

153–154, 156–159

nonmedical examiners deciding cases,

149–150, 155–156

presumptive disability, 113–114, 116–117

requesting a review of MCs decision, 152

reviewing request for reconsideration of

continuing disability claim, 258–259

and treating doctors, 132



INDEX  |  429







vocational analysts, 148, 199–200, 395, 413

See also Claims examiners; Continuing

disability reviews; Disability examiners;

Initial claim for benefits; Medical

consultants; Reconsideration claims

Disability examiners

and CDRs, 342

and children with HIV infection, 106

and compassionate allowance cases, 138

as disability hearing officers, 259

for help compiling medical records, 122

making medical decisions, 149–150,

163–164, 186, 367

and MC/WW cases, 144

Disability hearing officer (DHO), 254–255,

259–261, 393

Disability law experience of attorney

representative, 383

Disability service improvement process

(DSIP), 5

Disabled persons

overview, 18–19

ABLE accounts for, 17

deaf persons, 114

duration of disability, 20–21, 25, 211, 223,

394

inability to engage in SGA, 19

lawfully-admitted permanent residents,

312

medically determinable impairment,

19–20

qualifying for SSDI, 8, 10–11

See also Blind persons; Impairments;

Impending death; Severe disabilities

Disclosure law violations, 84–85

Disqualified representatives, 382

Distance acuity visual ability for RFC, 178,

179



Divorced spouse of an eligible worker, 11, 89

DLI (date last insured), 10, 193

Doctors

as acceptable medical sources, 120–121

consultative examination doctor, 75, 76,

131–134, 277, 393

and disability determination process,

74–76

doctor-patient relationship maintenance,

80, 128, 151

incorrect treatment prescribed by,

215–216

listing on continuing disability review

report, 351

medical experts, 76, 276, 277, 279–280

record keeping skills of, 124, 129–130

specialty codes, 225, 251, 252

See also Medical consultants; Treating

doctor

Drug Abuse and Treatment Act, 85

Drug addiction or alcoholism (DAA)

alcohol and antiepileptic drugs, 214

appointment of a representative payee, 305

as factor in your disability, 217–219

federal law, 326

reporting condition to SSI, 312

DSIP (disability service improvement

process), 5

Duration of disability, 20–21, 25, 211, 223,

394



E



EAJA (Equal Access to Justice Act), 390–391

EBT (Electronic Benefits Transfer), 301–302

Education

and decision to appeal a denial, 223

student grants and SSI benefits, 320

students and SSDI, 12, 13, 89, 307



430  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



students and SSI, 18, 321–322

as a vocational factor, 190–193

Electronic Benefits Transfer (EBT), 301–302

Electronic disability records at SSA, 249

Emergency payments in SSI cases of extreme

hardship, 113

Employers, Ticket to Hire program, 340

Employment information for benefits

application, 71

Employment Network (EN), 330–332, 336

End stage renal disease (ESRD), 5, 24, 116

English ability as vocational factor, 192

Environmental limiting factors category for

RFC assessment, 180–181, 277

EOD (established onset date), 204–207, 208

EPE (extended period of eligibility), 314–315

Epilepsy

documenting seizures from, 124–125

and environmental restrictions on an

RFC, 180, 277

finding a source of free treatment for,

213–214

Equal Access to Justice Act (EAJA), 390–391

ESRD (end stage renal disease), 5, 24, 116

Established onset date (EOD), 204–207, 208

Evidence to support your claim, 29, 31,

70–72

Examiners. See Claims examiners; Disability

examiners

Exertion category for RFC assessment,

174–176

Expedited reinstatement of benefits with

Ticket to Work program, 323–325

Expense reimbursement for hearings,

268–269

Expert witnesses, ALJ hearing, 270

Explanation for claim denial, 227

Extended period of eligibility (EPE), 314–315



F



Failed work attempts, 205, 323–324

Family benefits, 292. See also Dependent’s

and survivor’s benefits

Federal benefit rate (FBR), 15

Federal Coal Mine Health and Safety Act

(1969), 79

Federal court, suing the SSA in, 285–286,

387–391

Federal laws

Achieving a Better Life Experience Act, 17

Comprehensive Alcohol Abuse and

Alcohol Prevention, Treatment, and

Rehabilitation Act, 85

and DDS claims examiners, 158

disclosure laws, 84–85

Drug Abuse and Treatment Act, 85

on drug addiction or alcoholism and SSA,

326

Equal Access to Justice Act, 390–391

Federal Coal Mine Health and Safety Act,

79

Freedom of Information Act, 84

on MC involvement in reconsiderations,

254

on prisoners and SSA, 326

Privacy Act, 84–85

Railroad Retirement Act, 78–79, 299

Social Security Act, 84, 108, 126,

327–328

Ticket to Work and Work Incentives

Improvement Act, 322

Field Offices

completing appeal forms at, 231

for disabled child entering a care facility,

109

eligibility determination made by, 73–74







for emergency advance requests, 113

help with continuing disability review

report form, 350

for immediate payments, 113

observing you while you’re in the office,

72–73, 114

presumptive disability cases, 114–116

and Wounded Warrior claims, 144

Field of vision ability for RFC, 178, 179

Financial issues of claimant, 213–214, 223

Fine manipulations and feeling abilities for

RFC assessment, 177, 178

Florida, 149–150, 156

FOIA (Freedom of Information Act), 84

Foreign countries

country-based information for SSDI,

299–300

prohibited countries, 302

SSDI payments while living in, 13–14,

297–298, 301–303

Foreign workers in the United States, 13. See

also Immigrants

Form letters or notices from SSA or DDS

overview, 5, 103, 226–227

assistance from SSA, 29–30

for denial by the Appeals Council, 231

for denial of a claim decided by ALJ, 231

for denial of initial benefits appeal, 231

forwarding to the SSA, 247, 264

for initial termination of benefits appeal,

231–232

Notice of Disability Review, 271–272

for a reconsideration claim, 231, 234–248

Report of Contact, 116

SSA assumptions about your receipt of,

230

SSA denial of request for reconsideration,

235–236, 253–254



INDEX  |  431



Form HA-501-U5: Request for Hearing by

Administrative Law Judge, 262–264

Form HA-520-U5: Request for Review of

Decision/Order, 281–282

Form SSA-16-BK: Application for Disability

Insurance Benefits, 31, 44–48

Form SSA-454-BK: Continuing Disability

Review Report, 350–352, 366–367

sample, 353–365

Form SSA-455: Disability Update Report, 345,

348–349, 350

Form SSA-561-U2: Request for

Reconsideration, 234, 237, 238

Form SSA-632-BK: Request for Waiver of

Overpayment, 257

Form SSA-773-U4: Waiver of Right to

Appear—Disability Hearing, 260

Form SSA-773-U4: Waiver of Right to

Appear—Disability Hearing, 258

Form SSA-789-U4: Request for

Reconsideration—Disability Cessation, 255,

256, 257–258

Form SSA-827: Authorization for Source to

Release Information to SSA, 247, 248, 262

Form SSA-831: Disability Determination and

Transmittal, 153, 225, 250–251, 252

Form SSA-1696: Appointment of

Representative, 391

Form SSA-2506-BK: Psychiatric Review

Technique Form (PRTF), 251, 253

Form SSA-3368-BK: Adult Disability Report,

30–31

sample, 32–43

Form SSA-3441-BK: Disability Report—

Appeal, 238, 247, 258, 262, 264

sample, 239–246

Form SSA-3820-BK: Child Disability Report,

90, 103

sample, 91–102



432  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



Form SSA-4268: Explanation of

Determination

denials from CDR, 230, 402–411

denials from initial application, 398–402

for rationales, 227–230, 251

Form SSA-8000-BK: Application for SSI, 31

sample, 49–69

Fraud and other crimes

and consultative examination, 137

failure to report medical improvements,

297

on initial claim for benefits, 85–86

and presumptive disability payments, 112

repayment of benefits received for, 324

representative payee misuses your funds,

306

SSA detection of, 296

termination of benefits and prosecution,

220

Freedom of Information Act (FOIA), 84



G



Good cause doctrine, 287

Grants to disabled students receiving SSI, 320

Grievance procedures for EN issues, 336

Guam, nonmedical examiners making

disability determinations, 149–150, 156



H



Handling manipulative abilities for RFC

assessment, 177–178

Hawaii, SSI recipients in, 313

Headaches, 135

Health care professionals. See Doctors

Health care services in Ticket to Work

program, 325–326

Hearing ability for RFC, 179–180

Heart or blood vessel disease and

environmental restrictions on an RFC, 181



Heavy work exertional abilities for RFC, 174,

175, 413

High school education and above vocational

factor, 191–192

HIV infection, 106, 115, 116

Homeless persons get SSA help with

obtaining medical records, 122

Hospitals, obtaining medical records from,

127–129

Household maintenance issues, 366



I



IDD (International Direct Deposit), 301–302

Illegal policies at DDS, 154–156

Illiteracy vocational factor, 191

Immediate payments vs. emergency

payments, 113

Immigrants

blind, lawfully-admitted permanent

residents, 312

deportation or removal from the US, 308

foreign workers in the United States, 13

resident status required for SSDI benefit

payments, 12

sponsor’s potential responsibility for

presumptive disability payments, 113

and SSI benefits, 312

See also Noncitizens

Immobile persons, 114

Impairment-related work expenses (IRWEs),

205–206, 210, 316, 317, 327–328

Impairments

overview, 394

12-month duration requirement, 20–21,

25, 211, 223, 394

of children, 105

fluctuating severity of, 368

pain and other symptoms, 20