Listing 11207 Somatoform Eating and Tic Disorders Children

See the comments under adult Listing 12.07. Here, parts 3 and 4 match parts 2 and 3 in the adult Listing, with an additional section for digestive symptoms or symptoms of waste elimination such as chronic constipation. Eating disorders such as anorexia nervosa and bulimia require the use of weight tables found in a specific medical book which must be the most recent edition. Doctors caring for children would probably have this book, as would medical school libraries and some large bookstores....

DProblematic Claims Examiners

They cut corners everywhere they can and do the minimum amount of work necessary. One DDS director lowered state performance standards so the worst examiners could keep their jobs. Other examiners might try to manipulate medical determinations by removing written medical opinions they don't like from files and then taking the claim to a different doctor, hoping for a different decision. Their supervisors may do the same thing. Additionally, examiners like medical...

BResidual Functional Capacity

Even if your case does not qualify under the listing, make sure you receive a careful RFC, taking into account all of the problems you may have tremors, lack of coordination, difficulty with balance or walking or speaking clearly or emotional problems such as depression. All of these factors can influence your ability to return to prior work or find other work. Whether you are able to stand six to eight hours daily is always an important question, because inability to do so will automatically...

Appeal Basics

Enclosed with the notice from the SSA denying or terminating your benefits will be information on how to appeal the decision. You must appeal in writing within 60 days of the date that you receive the notice. The SSA assumes that you received the letter five days after the date on the letter, unless you can show you received it later. If you fail to appeal within 60 days, you probably lose your right to appeal the SSA rarely makes exceptions. Of course, if you have a problem like an unexpected...

SSA Approval of Fee Agreements

The SSA must approve in writing all fee agreements between claimants and their authorized representatives. Your representative can accept money from you to be placed in an escrow account. The basic reason a representative would want to do this is to assure that you pay. For example, in SSI claims unlike SSDI claims the SSA does not withhold some of a claimant's approved disability benefits to pay the representatives. Therefore, the representative has to collect it from the claimant himself...

Refiling an Initial Claim

If you lose your appeal (no matter at what level), you have the option to file another initial claim. Just go to your local Social Security Field Office and start the process over again. Your chance of being granted benefits will improve if a change in your condition such as a worsening of impairments or new impairments warrants a different disability decision. A possible legal barrier to filing a subsequent claim is called res judicata, which means the thing has been adjudicated. The DDS can...

Info

(If you have filed for workers' compensation and have received an award, please bring a copy of the award notice, redemption order, or settlement to your hearing.) Form HA-4486 Claimant's Statement When Request for Hearing Is Filed and the Issue Is Disability (Page 3) *I also take Timoptic eyedrops twice a day for glaucoma. As I said on Form HA-501, the DDS did not consider either my osteoporosis or my glaucoma. Furthermore, the opinions of my treating doctors were ignored. My back hurts all...

Listing 11208 Personality Disorders Children

See the comments under adult Listing 12.08. Part of this listing is the same as 12.08, except for an additional part 7, mentioning perfectionism and inflexibility, which are abnormalities associated with obsessive-compulsive personality disorder. Personality disorders in children that meet the listing are manifested by pervasive, inflexible and maladaptive personality traits, which are typical of the child's long-term functioning and not limited to discrete episodes of illness. The required...

Listing 1103 Epilepsy Nonconvulsive Petit Mal Psychomotor or Focal Adults

See comments under Listing 11.02 regarding epilepsy in general and the type of documentation needed. This listing is for seizures that are not individually as severe as the major motor (convulsive) seizures described in Listing 11.02. Petit mal seizures are genetically caused, brief seizures lasting up to about 30 seconds. They are also called absence seizures, because they appear to make the person mentally absent for a brief period of time with no other evidence of anything being wrong. A...

Listing 1204 Affective Mood Disorders Adults

Affective disorders involve abnormalities of mood, which is a persistent emotion that broadly affects mental experience. The two possible extremes of mood are depression or elation. In depression, a person may have the types of abnormalities listed in part 1 below. Abnormalities characteristic of manic syndrome associated with elation are given in part The abnormalities of depression or mania can exist in various combinations. Part of the listing concerns establishing the type of affective...

Listing 1209 Substance Addiction Disorders Adults

Substance addiction disorders are evaluated under whatever listings are most appropriate to the complications produced by the abuse of drugs. Alcohol abuse is a frequent cause of complications. Chronic cocaine use can cause significant mental abnormalities (such as personality changes and paranoia). Federal law prohibits payment of SSDI or SSI benefits and Medicare or Medicaid coverage based on those benefits to people who are disabled because of drug addiction and or alcoholism (DAA) to the...

Evidence Related to Symptoms

Evidence of symptoms will include the following kinds of information provided by your treating doctor and other sources. Your daily activities what you do during a typical day. Especially important is how these activities of daily living (called ADLs in SSA lingo) are affected by your pain and other symptoms. The location, duration, frequency and intensity of the pain or other symptoms where you have pain or other symptoms, how long the symptoms last, how often the symptoms occur and the...

D Activities of Daily Living

The claims representative or interviewer may give you forms asking detailed questions about your activities of daily living, called ADLs. The ADL form asks specific questions about what you do during a typical day to give the SSA an idea of how your impairment affects your daily life. ADLs are important in all kinds of disabilities, especially mental disorders. Questions typically deal with your ability to do household chores, cook, shop, visit friends, attend social activities and attend to...

Listing 509 Liver Transplant Adults

About 87 of patients survive for one year after a liver transplant. At five years, the post-transplant survival rate de creases by approximately 10 . In adults, acquired disorders like alcoholic cirrhosis and viral hepatitis are the main causes of liver failure and the need for transplantation. In children, liver failure is more commonly caused by a genetic disorder (especially failure of the bile ducts to develop, a disorder known as biliary atresia). Although most livers are transplanted from...

A Listing Level Severity

The listing requires a specific medical condition that causes the growth impairment. Additionally, the child's condition must satisfy or . Sustained fall in height of greater than 15 percentiles. This listing takes into account that a child who is not growing will have a fall in their percentile ranking of height as a result of increasing age, since older children are expected to be taller. For example, a child with a growth impairment who is in the 30th percentile at age six months will be at...

Listing 11108 Meningomyelocele and Related Disorders Children

A meningomyelocele is a congenital bag-like defect of the spinal cord and membranes covering it. Meningomyeloceles may be associated with other nervous system disorders such as hydrocephalus and mental retardation. The listing also covers related disorders, meaning any kind of spinal cord defect present at birth could be considered under this listing. The child's condition must satisfy part , , or despite prescribed treatment. Motor dysfunction meeting the requirements of Listing 101.03...

Listing 11211 Attention Deficit Hyperactivity Disorder Children

Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder. It is characterized by impulsive behavior, difficulty maintaining attention and hyperactivity. Of course, these characteristics are to some extent natural in a young child and should not be confused with ADHD. ADHD children will not sit still very long and are into everything. If of school age, they typically have difficulty completing their lessons because they can't maintain their attention long enough....

Listing 1205 Mental Retardation Adults

If you care for or represent someone who is mentally retarded, or who has below-average intelligence, it is extremely important that you understand the disability determination issues involved in the use of this listing. Although large numbers of claimants are evaluated for disability un- der this listing, the SSA is prone to errors when evaluating such claims. A common mistake is diagnosing mental retardation on the basis of intelligence quotient (IQ) scores alone. A sub-average IQ say an IQ...

When the MIRS Doesnt Apply

Under certain conditions, the SSA doesn't have to apply the MIRS to your CDR evaluation. In these cases, you might be able to keep your benefits without the DDS doing a review for medical improvement. On the other hand, it is possible that without the protections of the MIRS you could lose your benefits. a. Your Impairment Meets or Equals a Listing If you are an adult and your impairment continues to meet or equal the same listing in the Listing of Impairments (see Chapter 7, Step 3), as it did...

Remain Actively Involved in Your Claim

If you become aware of a specific problem involving the handling of your claim, you are not helpless. Here are some suggestions on how to proceed. Call your claims examiner, and her supervisor, if necessary, to discuss the problem. If, for example, they did not show your claim to a medical consultant, they may change their thinking if you remind them of your right to such review and let them know you will complain to the agency director if they don't comply. Even if the law changes and medical...

Attorney Representation in Federal Court

It is possible to appeal your case to federal court if the SSA denies your claim and any administrative appeals. A federal court can order the SSA to allow or deny your claim, or it can instruct the SSA to obtain more information. To get your claim into federal court, you must file a formal appeal using an attorney. Fee agreements and fee petitions refer to formal payment arrangements that must be approved by the SSA. We use the term payment arrangements to refer to other aspects of the...

General Information

To establish that you have a disability based on a breathing disorder, you will have to provide the SSA with evidence including shortness of breath, laboratory test results such as pulmonary function studies and physical symptoms such as wheezing, chest pain and coughing up sputum or blood. If you have extremely advanced pulmonary disease, you may burn extra calories in breathing, and your symptoms may include a poor appetite, resulting in weight loss and malnutrition. Although shortness of...

Listing 1202 Organic Mental Disorders Adults

Organic mental disorders are those caused by physical brain damage. Examples of causes include toxins, heavy metals like lead or mercury, degenerative brain diseases like Alzheimer's disease and Huntington's chorea, strokes, trauma, tumors, cerebrovascular disease, genetic or congenital brain deformities, drugs and many other diseases. Doctors frequently refer to organic mental disorders in general as organic brain syndrome (OBS). For adults, the SSA frequently uses tests of neurological and...

Listing 507 Regional Enteritis Adults

Regional enteritis is an inflammatory disease of unknown cause affecting the small intestine. When regional enteritis affects only the large intestine it is known as granulomatous colitis, which is evaluated under Listing 5.06. When regional enteritis affects both the small and large intestines it is known as ileocolitis, which can be evaluated under either listing. For your condition to be severe enough to meet the listing, you must have regional enteritis (demonstrated by findings during...

Black Lung Benefits and Social Security Disability

Black lung benefits are payments to coal miners and their survivors who become disabled from a lung disease known as pneumoconiosis as a result of breathing fine dust-like particles of coal while working in the mines. The Federal Coal Mine Health and Safety Act of 1969 assigned initial responsibility for processing black lung benefit claims to the SSA. The Labor Department assumed eventual responsibility. If your disability claims arise out of your work in the mines, you can file your initial...

Who Decides Your Claim

Types of Claims Handled by DDS 2. When the Outcome of a Claim Is Uncertain B. DDS Claims C. Other DDS Administrative D. Medical 1. The Medical Consultant's Job 2. Reviewing the E. If Your Claim Is F. If Your Claim Is G. DDS Corruption and 1. How Corruption and Incompetence Can Influence Your 2. What You Can Do About Corruption and 3. Remain Actively Involved in Your H. Disability Redesign Coming Danger to After the Social Security Administration Field Office finds that you meet the...

The Ticket to Hire Program

The SSA has begun a national referral service to assist employers in hiring motivated, qualified workers with disabilities from the Ticket to Work Program. The Ticket to Hire system works like this 1. An employer contacts Ticket to Hire and provides information on a job vacancy. 2. The SSA contacts the employment networks (ENs) and state vocational rehabilitation agencies (SVRAs) that service the employer's local area to ask which ones have one or more qualified candidates for the position. 3....

Listing 405 Arrhythmias Adults

In adults, arrhythmias disturbances of the heart's rate or rhythm are most often caused by ischemic heart disease and other types of cardiomyopathies. In these instances, decreased blood flow to the heart's nerve conduction system, or to areas of heart muscle, interferes with the normal electrical functions in the heart. Also, the resulting scar tissue from a prior heart attack can disrupt electrical impulses spreading through the heart. One of the most frequent types of arrhythmias seen by the...

B Resource Limits

To qualify for SSI, your resources must also not exceed certain limits. A resource is cash or another asset that can be converted to cash and used for support. If you or your spouse have the right, authority or power to sell property and keep the proceeds, it will be considered a resource. Resources are categorized as either liquid or nonliquid. Liquid resources include cash and other assets that could be converted to cash within 20 working days. The most common types of liquid resources are...

Information About Your Condition

Has there been any change for better or worse in your illness or injury since you filed If Yes, describe any changes in your symptoms. High blood pressure and chest pain worse. Arthritis in hands hurts more. I'm more depressed. 2. Describe any physical or mental limitations you have as a result of your condition since you filed your claim. Can't lift as much without chest pain, or pain in my hands. I'm depressed and not interested in doing much. 3. Have any restrictions been placed on you by...

Reopening of Decisions

An alternative to appealing your case is requesting a reopening of your claim asking for a second look by whichever administrative level of the SSA has your claim. You can ask for a reopening in the following situations If you make your request within 12 months of the date of the notice of the initial determination by the DDS, ALJ or AC, you can ask for a reopening for any reason. If you believe that the determination to deny you or terminate your benefits was based on fraud or similar fault,...

SSDI Work Incentives

The SSDI work incentives are fairly extensive. Trial work period. If you return to work, during the first nine months you will continue to receive your SSDI benefits. At the end of nine months of work, the SSA will decide if you are doing substantial gainful activity SGA earning an average of at least 800 per month in 2003. If you are self-employed, your income may not be the best measure of whether you are doing SGA. Often, more consideration is given to the amount of time you spend in your...

Pain and Other Symptoms

Your pain and symptoms are important parts of your disability claim. SSA staff frequently hand out forms that allow you to describe your pain and symptoms in your own words. For example, you might be asked to say where you have pain, what it feels like, what activities cause it or make it worse, and how long it lasts. In addition, you might be asked what medications you are taking and what side effects they may be causing. In fact, you should be asked these questions at some point during the...

Zip Code

Form SSA-827 1-971 Use Prior Editions EF 3-391 OVERI reconsideration decision is made. If necessary, you can replace inaccurate or missing information. When reconsideration examiners receive additional information from you, they must place it in your file. Your chances of being granted benefits increase if you take an active role in monitoring the DDS's actions. Call the DDS claims examiner handling your file and set an appointment to review your file. If health or distance make it difficult...

SSI Work Incentives

Like the SSDI work incentives, the SSI work incentives are quite extensive. Continuation of SSI. If you return to work, you can continue to receive payments until your income exceeds the SSI income limits. Continuation of Medicaid. If you return to work, your Medicaid coverage will likely continue until your income reaches a certain level. The level varies from state to state and reflects the cost of healthcare in your state. If your actual healthcare costs are higher than the average for your...

Definitions

The following definitions are for words used in this section. If you need additional definitions, consult a good medical dictionary, available in most bookstores or libraries. You can also look at online medical dictionaries like the one at www.nlm.nih.gov medlineplus. Air conduction audiometry. Test of ability to hear sound transmitted through the air. Audiologist. A person specially trained to perform audiometry. Audiologists are not medical doctors. Audiometry. Hearing test, usually...

Medical Experts

If you are denied benefits and appeal, an administrative law judge ALJ in the Office of Hearings and Appeals will hear your case. To help them in their work, ALJs sometimes request expert testimony on complex medical issues from medical experts MEs . Unlike medical consultants, medical experts have no official authority regarding whether you should be allowed benefits. Each Hearing Office maintains a list of medical experts who are called to testify as expert witnesses at hearings. The SSA pays...

Review by the Appeals Council

The final step in your administrative appeals process is with the SSA's Appeals Council AC . Even if you don't appeal to the AC, the AC can select ALJ decisions for review at random or if referred from other divisions of the SSA. This means that on its own, the AC could review and grant a claim that had been denied by an ALJ, but it also means that the AC could reverse an ALJ allowance of benefits and deny your claim. When the AC decides to review a case on its own, you will be notified of its...

Episodic Respiratory Disease

Episodic respiratory illness means flare-ups of difficult breathing that may occur in people who have asthma most common , cystic fibrosis or bronchiectasis. The attacks themselves may be associated with complications of pneumonia, coughing up blood, respiratory failure or bronchitis. Whatever the nature of the attack and disorder that causes it, to qualify for disability you must provide the SSA with complete documentation of the attacks, including doctor and hospital treatment records. An...

Applying Over the Phone

If you prefer, you can call the SSA at 800-772-1213 to file an application. This is especially convenient if you live some distance from the nearest Field Office or contact station you can find the location of the nearest SSA facility by calling the 800 number listed above . If you need help, a family member, caseworker or other representative can contact the SSA for you. You do not have to give that person a power of attorney the authority to sign legal documents and make legal decisions for...

Breathing Disorders

Obstructive and Restrictive Breathing 2. Ventilation and Gas 3. Pulmonary Heart 4. Exercise 5. Sleep-Related Breathing Disorders 6. Episodic Respiratory 7. Effects of B. Specific Listings and Residual Functional 1. Listing 3.02 Chronic Pulmonary Insufficiency Adults 2. Listing 103.02 Chronic Pulmonary Insufficiency 3. Listing 3.03 Asthma 4. Listing 103.03 Asthma Children 5. Listing 3.04 Cystic Fibrosis 6. Listing 103.04 Cystic Fibrosis 7. Listing 3.06 Pneumoconiosis 8....

Disability Update Report

PRIVACY ACT PAPERWORK ACT NOTICE The information requested on this form is authorized by the Social Security Act, Sections 205 a and 1631 c 1 A and B ,and regulations at 20 CUR 404.1589 and 416.889. The information provided will be used to further document your claim and permit a determination about your continuing disability. Information requested on this form is voluntary. However, ifyou do not provide the required information, a decision based on the eviden ce in your file can result in a...

Field Office Observations

If you don't apply over the phone, the Field Office representative will observe you while you complete your application form. He will note how you perform reading, writing, answering, hearing, sitting, understanding, using your hands, breathing, seeing, walking and anything else that might relate to your claim. You won't be given any medical tests at the Field Office, and the person who takes your application is not a doctor. But the representative will write down what he saw. The SSA reviewers...

Appeal to Administrative Law Judge

If your request for reconsideration of an initial claim or continuing disability review termination is denied and you want to appeal further, you must request a hearing before an administrative law judge ALJ within 60 days from receipt of your denial. Since the SSA adds five days for mailing time, you actually have 65 days from the date on your denial notice. Your benefits can continue through the ALJ hearing process, if you choose that option when submitting your hearing request. But, if you...

SSDI Benefits for Adults Disabled Since Childhood

Social Security dependents' or survivors' benefits normally end when a child reaches age 18, or age 19 if the child is a full-time student. If the young adult is disabled, however, the benefits can continue as long as the recipient is disabled. the disability began prior to age 22, and the recipient be the child of someone receiving Social Security retirement or disability benefits or of someone who received Social Security retirement or disability benefits but is now deceased. Someone who...

Form SSA455 Disability Update Report

Accompanying the CDR notice will be Form SSA-455 Disability Update Report. A sample copy of the form and instructions on how to complete it follow. RV You must use forms provided by the SSA. You can t-S-J obtain them at your local SSA Field Office or by calling the SSA hotline at 800-772-1213, Monday through Friday except holidays , from 7 a.m. to 7 p.m. If you are deaf or hard of hearing, TTY service representatives are available at the same times at 800-325-0778. You can also download many...

Mental Impairments and Abilities

This section focuses on how the SSA assesses a mental RFC, including how RFC factors relate to the ability to work. See Chapter 27 for the SSA listings and RFCs for specific mental disorders. At the initial, reconsideration or CDR level, a psychologist or psychiatrist does a mental RFC assessment. On appeal, an ALJ or federal court judge can rule on mental RFCs. The SSA is looking for the degree of limitation of function a claimant has in each assessed area. All areas to be assessed are rated...

Nonmedical Eligibility Requirements

To receive disability benefits, it is not enough to have a medical disorder preventing you from working. Other things that make you unable to work may also be considered. First it must be established that you are covered under SSDI or qualified to apply for SSI benefits because of low income and resources. Then you must also satisfy the nonmedical eligibility requirements before your medical disorder is even considered by the SSA. Determining whether or not you satisfy nonmedical requirements...

Medical Improvement Review Standard

The SSA evaluates your case using what it calls Medical Improvement Review Standard MIRS . The MIRS governs how the SSA evaluates CDRs. Congress created the MIRS in the early 1980s when many disability recipients claimed that their benefits were being terminated despite the fact that they were still disabled. You need to understand the MIRS because some medical consultants, examiners and others who conduct CDRs are inadequately trained in the MIRS. Someone may incorrectly terminate your...

T

Most common type of arthritis, especially associated with aging it is characterized by bony outgrowths, such as the narrowing of joints, and spurs around joints or in the spine. Also known as hypertrophic arthritis or degenerative arthritis. Osteoporosis. Loss of bone mass that is, a thinning of bone substance. Pelvic bones pelvis . Ilium, ischium and pubis. Percentile. Method of comparing something, like height or weight, to normal expected values, in order to decide the...

Physical Impairments and Abilities

This section focuses on how the SSA assesses a physical RFC. In some cases, specific medical disorders are discussed simply for clarification. How the SSA combines a physical RFC with the vocational factors of age, education and work experience is discussed in Chapter 9. Chapters 16 through 26 and 28 through 29 provide the SSA listings and RFCs for specific physical disorders. When the SSA assesses your physical RFC abilities, it first makes a medical judgment about the nature and extent of...

Continuing Disability Review

How the SSA Contacts 1. Form SSA-455 Disability Update 2. Form SSA-454-BK Report of Continuing Disability Interview C. Medical Improvement Review Standard 1. MIRS 2. When the MIRS Doesn't D. Children and E. Appealing a CDR Your case will be reviewed from time to time to see if you still qualify for benefits. If you have experienced significant medical improvement and are capable of working you may lose your benefits. This review process is called continuing disability review...

Listing 207 Disturbance of Labyrinthine Vestibular Function Adults

The most frequent cause of serious labyrinthine-vestibular dysfunction is Meniere's disease. Using a caloric test, a doctor puts hot or cold water into the external ear canal the water transmits temperature changes to the vestibular apparatus on that side of the head. These temperature changes set up currents inside the fluid in the vestibular apparatus. Responses to the currents can provide information about whether the vestibular apparatus is normal. Using the caloric test, a doctor can also...

Vision

Visual abilities are described on RFCs as limited or unlimited. If an RFC gives any restrictions of vision, it must explain why the impairments justify the limitations. Visual tests and visual impairments are discussed in Chapter 17. The RFC rating for visual limitations takes into account six factors Near acuity. Near acuity is important for seeing close up, such as reading a book or typewritten papers. Cataracts and retinal diseases are the most likely causes of decreased near acuity that...

Impairments Qualifying for Presumptive Disability by Field Office

An SSA Field Office representative has the power to grant six months of presumptive disability payments when you apply if there is a reasonable basis for believing that you have a disabling impairment. Of course, Field Office representatives are not doctors, but they can award presumptive disability to claimants who are obviously disabled. This is one way the SSA is trying to speed up providing low-income disabled people financial assistance. There are three ways presumptive disability by the...

Acceptable Nonmedical Excuses

It is possible that you cannot follow a prescribed therapy for a reason that has nothing to do with your medical condition. Acceptable nonmedical excuses for failing to follow prescribed therapy are described in this section. a. Lack of Money to Pay for Treatment The SSA will not deny you benefits for failing to follow treatment prescribed by your doctor if you don't have enough money to pay for the treatment. This frequently happens with SSI applicants who have epilepsy. If you don't have...

G DDS Corruption and Incompetence

Corruption and incompetence involving the DDS are probably the last thing on earth you want or the SSA wants you to think about. Still, it's possible that your claim is or will be denied for reasons unrelated to the criteria established under Social Security disability rules and regulations. This section helps you understand why corruption and incompetence might have an impact on your claim and what you can do about it. There are two basic reasons you should be interested in corruption and...

Appealing a CDR Decision

Once the SSA makes its CDR decision, you will receive a notice. If the SSA decides you are still disabled, your benefits will continue. If the SSA determines that you are not still disabled, the SSA will send you a personalized explanation explaining how it reached its determination. If you don't appeal, your benefits will stop three months after the SSA said your disability ended, with the further condition that your benefits cannot be stopped earlier than the date of your cessation decision....

The SSA Evaluation of Pain

Pain and other symptoms often go to the heart of the restrictions on your activities of daily living. As explained in Chapter 2, you must complete forms describing what you do during an average day and what you cannot do. In back pain cases, it is important to measure how long you can sit and stand in one continuous period. Inability to sit or stand very long can be very critical to the outcome of your claim, if the SSA believes your symptoms. If your doctor writes the SSA about your back pain,...

Sedentary Work and

Claimants 55 years of age and older are especially likely to be found disabled under a medical-vocational rule for disability when they have RFCs for sedentary work. As Table 1 shows, the only not disabled claimants of this age group are those with past skilled or semiskilled work experience whose skills can be transferred to new jobs or whose education permits them to do skilled work. Also, to be found not disabled in this age group, Table 1 requires claimants to be able to do a new job with...

Proving You Are Disabled

Medical Evidence From Treating 1. Timely, Accurate and Sufficient Medical 2. Thorough Medical 3. Obtaining Records From Your Treating 4. Obtaining Records From Hospitals and Medical 5 5 5. If Your Records Are 6. Evidence the SSA Needs From Treating 7. Treating Source Statements and Medical Assessments About Your Ability to Function 5 7 C. The Role of Consultative Examinations in Disability Determination 1. Who Performs Consultative 2. If Your Treating Doctor Refuses to...

Environment

Environmental factors that might place limitations on a claimant's RFC include sensitivity to extreme cold, extreme heat, wetness, humidity, noise, vibration and fumes odors, dusts, gases, poor ventilation , and avoidance of certain dangers such as working around hazardous machinery or at unprotected heights. Limitation of exposure to a particular environmental factor can be expressed on the RFC as unlimited, avoid concentrated exposure, avoid even moderate exposure and avoid all exposure. If...

Form SSA454BK Report of Continuing Disability Interview

If the SSA chooses a full CDR, you will be sent SSA-454-BK Report of Continuing Disability Interview to complete. You can also obtain this form anytime you want simply by calling the SSA and asking for it. Along with the form will be a notice inviting you to contact a Social Security representative at your local Field Office. Such contact is meant to protect your rights and assure that you fully understand the questions on the form. It will also give you the opportunity to ask questions that...

How Age Education and Work Experience Matter

Less Than Sedentary Work and 3. Other Work Levels and 4. Age 1. How the SSA Evaluates 2. Education and Medical-Vocational Rule 3. Education C. Work 1. Information About Your 2. Work in the National 3. Skill Requirements for D. Use of Vocational E. Vocational Rehabilitation 1. Good Cause for Not Attending Vocational 2. Criteria for Not Being Referred to Vocational If you have a significant impairment, but one not severe enough to meet or equal an entry on the Listing of...

Bpv And Disability

B, If any of the above items were checked yes, describe the exact difficulty involved, b, If any of the above items were checked yes, describe the exact difficulty involved, On the other hand, if the second team decides that the decision to terminate your benefits was correct, the second team will send an advisory rating decision to the DHO stating that you be considered medically improved and capable to performing some type of work. c. Review Your File Before the Hearing You want to review...

Frequency of Reviews

How often your case is reviewed depends on the severity of your condition and the likelihood of improvement. The frequency can range from six months to seven years. The Certificate of Award of benefits you received when the SSA approved your claim shows when you can expect your first review. Exactly when that review will occur, and the times of subsequent reviews, is left to the judgment of the SSA, depending on which of the following categories you fall into Medical improvement expected MIE ....

MIRS Requirements

Under the MIRS, your CDR will be evaluated quite differently from your original application for disability benefits. During your initial application, the burden of proof to show disability was on you. But in a CDR, the burden shifts to the SSA. This means that your benefits will continue unless the SSA can clearly show that you have improved to the extent you can work. The MIRS requires two different showings before the SSA can terminate your benefits. The SSA must show that you have...

Request for Reconsideration of Continuing Disability Claim

Once you begin receiving disability benefits, your case is re-examined periodically through a continuing disability review CDR . See Chapter 14 for more on this subject. The SSA can end your benefits for a variety of reasons, including a determination that your condition has improved and you can now work, or your failure to cooperate in the CDR. This decision to terminate your benefits is made by a DDS medical consultant and examiner team. You will receive a notice and explanation from the SSA...

Manipulation

Manipulation means the ability to use the hands for various tasks. Manipulative abilities include reaching in all directions, including overhead handling gross manipulations fingering fine manipulations and feeling skin receptors . Manipulative abilities on an RFC assessment are described as limited or unlimited. An RFC with any restrictions of manipulation must explain why the impairments justify the limitations. Manipulative abilities are especially relevant when a claimant is limited to...

Continuing Disability Reviews for SSI Children

The law requires that the SSA periodically do a continuing disability review CDR to determine whether or not a child under age 18 is still disabled. The CDR must be done on the following schedule at least every three years for recipients under age 18 whose conditions are likely to improve not later than 12 months after birth for babies whose disability is based on low birth weight, and sometime during the 18th year, if the person received benefits for at least one month before turning age 18...

You Leave the US

If you move abroad, the reporting requirements are the same as for other types of reportable changes as described in the introduction to this section. If you leave the United States and have questions about your SSDI while you are out of the country, you have several places to turn to get assistance SSA Federal Benefits Units at U.S. consulates and embassies or at the American Institute in Taiwan SSA representatives stationed at consulates and embassies in London, Athens, Rome, Mexico City,...

If Your Claim Is Granted

The DDS medical consultant approves the medical part of the determination and the examiner approves the nonmedical portions. Both sign the appropriate final disability determination form. Your file is then returned to the SSA Field Office from the DDS. The SSA will complete any outstanding nonmedical paperwork, compute the benefit amount and begin paying benefits. If a medical consultant furnishes any of the medical evidence for a particular disability case, he should disqualify himself from...

Education and Medical Vocational Rule Tables

Your education is an important vocational factor because it relates to the types of mental skills that you may be able to bring to a job. Turn again to Appendix C to see how various educational levels at sedentary, light and medium work affect the allowance or denial of a claim. Under each table, lower educational levels make allowance of benefits more likely. This is particularly true as age increases and work experience and skills decrease. A high school education or above is a critical...

Claims Folder

Form SSA-561-U2 Request for Reconsideration This form is to be used for the first request for reconsideration of the denial of an initial claim. If you are uncertain whether this is the appropriate request to file, look at the letter you received from the SSA. Use this form if the letter says you have a right to file a request for reconsideration. If you have further questions, call 800-772-1213 or contact your local SSA office. Here are instructions on how to fill out the form. A completed...

SSDI Claimants

If you are an SSDI claimant, you may be entitled to retroactive past benefits if the SSA finds that your EOD fell on a date earlier than your application date. Even if the SSA makes such a finding, however, the SSA will not automatically pay you benefits from your EOD. The SSA requires that at least five full calendar months, known as the waiting period, pass beyond your EOD before you get any benefits. Once the SSA establishes your EOD, it waits until the first day of the following month...

Forms Notices and Rationales

The SSA uses hundreds of specialized forms and notices to communicate with claimants and recipients. It is not possible to include every disability form and notice in this book or even to list them. Also, the SSA regularly makes changes in administrative procedures that affect the use of forms, notices and rationales. Forms are the way the SSA obtains basic information, such as claimant names and addresses, and dates and types of claims. The SSA also uses forms to communicate its activities,...

Acceptable Medical Sources

When considering both the existence and severity of your impairment, the SSA evaluates reports from all medical providers who have treated you, called your treating sources. These include doctors, chiropractors, naturopaths and other alternative providers. But to make an actual medical diagnosis and obtain medical information necessary for accurate disability determination, the SSA must have medical information from what it calls acceptable medical sources. Reports from these sources enhance...

A Who Qualifies

To qualify for SSDI, you must fall into one of the following categories i. You are a disabled insured worker under age 65 You must have worked both long enough and recently enough to qualify. It may not be sufficient that you worked for many years and paid Social Security taxes. When you worked is also important. The law requires that you earn a certain number of work credits in a specified time before you apply for benefits. You can earn up to four credits per year, each credit representing...

Section

YOUR ILLNESSES, INJURIES OR CONDITIONS AND HOW THEY AFFECT YOU A. What are the illnesses, injuries or conditions that limit your ability to work Arthritis right shoulder, liver problems cirrhosis , cataracts, nervous, back pain_ B. How do your illnesses, injuries or conditions limit your ability to work Hurts my shoulder to lift, push, or pull. Feel weak, can't see well. Can't concentrate because of nervousness. Back hurts to lift and bend. C. Do your illnesses, injuries or conditions cause you...

B Citizenship or Residency Requirements

If you qualify based on the criteria listed above, you may receive SSDI payments if you are a U.S. citizen or permanent resident, living in the United States or abroad. If you are neither a citizen nor a permanent resident, you still may be entitled to receive SSDI if you can show that you are lawfully present in the United States. 8 U.S.C. 1611 b 2 . If you are a citizen when you apply for SSDI, you will have to show proof of your citizenship. Acceptable forms of proof include a birth...

Disability Freeze on Earnings

Federal laws and regulations recognize that your income may have declined between the period when you worked and when 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,...

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