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Find answers to frequently asked questions.

Question:
How significant is an RFC (Residual Functional Capacity) assessment form in regards to appeals? Does one have to develop RFC evidence if the claimant meets a Listing?

RFC forms are very useful and can be a vehicle for the treating source to provide medical opinion evidence, forcing the ALJ to consider it.  Sometimes the ALJ will discount the RFC form if he/she feels that it is not supported by the medical records.  For instance, sometimes a doctor will give the opinion that the applicant “can sit for 30 minutes” but nowhere in the medical record is there anything about this at patient appointments. So, be aware of that.  Also, be sure that the answers on the form are internally consistent. 

For the second question, once DDS determines the applicant has met a Listing (at Step 3 of the Sequential Evaluation), DDS stops developing the claim for other impairments.  DDS looks at the applicant’s RFC at Step 4 and Step 5.  The applicant’s RFC is determined and compared to the physical and mental demands of the past relevant work (Step 4). When it is determined that the applicant cannot perform past relevant work, RFC, age, education and past work experience must be considered to determine if there is other less demanding work the applicant can do.

Finally, RFC forms which are designed with space for the physician to provide their medical opinion, and not merely a form with check off boxes, is most effective. 

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Question:
What is the role of the Vocational Expert (VE)? Why do VEs need to show that nationwide there is work a person can do, even if they do not live near the location of the jobs?

In order to address the question of whether an applicant is capable of returning to work performed within the past 15 years, the ALJ will generally call a VE to testify. The VE is usually a licensed professional counselor, a vocational rehabilitation specialist, or another professional whose career has involved job placement, career counseling and working with people with disabilities. Although the VE is called by the ALJ, the VE is neither a government nor an applicant’s witness. The VE’s task is to offer a neutral opinion based on (1) the evidence and (2) the ALJ’s determinations as to the applicant’s functional limitations. The VE reviews the documents in the file which pertain to work, e.g. detailed earnings record, disability report, and work history report.  The ALJ will create a hypothetical for the purpose of eliciting the VE’s opinion on the applicant’s capacity to return to past work (Step 4) or perform other work in the national economy (Step 5). For more information on cross examining the VE, please contact Pam Heine at the SOAR TA Center, pheine@prainc.com.  Read more here: https://www.ssa.gov/OP_Home/hallex/I-02/I-2-6-74.html.

For the second question, the job must exist in significant numbers in either the national or local economy, where the applicant lives. Read more at https://www.ssa.gov/appeals/public_experts/Vocational_Experts_(VE)_Handbook-508.pdf.

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Question:
While an attorney is recommended is there any benefit to a client representing themselves? If the applicant is represented by an attorney (or other individual), does the applicant have an opportunity to speak for themselves or add to the proceedings?

No, it is our opinion that all applicants should be represented at the hearing by an individual who is knowledgeable about Social Security's decision-making process at the ALJ level, whether it be a lawyer, paralegal, or a SOAR case worker. Administrative Law Judges follow fairly strict rules about how to decide disability cases and what evidence can be considered. Although applicants can represent themselves “pro se” (i.e. “for oneself”), it is in their best interest to secure representation.  The applicant may find it difficult to learn enough about Social Security law to advocate for themselves professionally at the hearing.

Yes, the applicant will have a chance to speak for him/herself. The representative will ask the applicant questions which is called “direct examination.”  This gives the applicant a chance to tell his or her story. Also, the ALJ will often begin the hearing by asking the applicant questions. Remember, the ALJ level is the first time the applicant is seen face-to-face by SSA.  The earlier stages are paper reviews.

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Question:
What does HALLEX mean?

HALLEX (Hearings, Appeals and Litigation Law Manual) is a publication from the Social Security Administration's Office of Disability Adjudication and Review (ODAR). ODAR administers hearings and appeals for people seeking reviews of their applications for disability benefits. HALLEX contains policy statements from the SSA's Appeals Council, as well as procedures directed to lower levels of the SSA for carrying out the SSA's guiding principles

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Question:
Is it true that applicants always get denied initially and then win on appeal?

This is definitely something we hear quite a bit and a very pervasive rumor that an applicant has to be denied X number or times, or can only win on appeal. The truth is that if the evidence is in the initial filing showing that an applicant meets the criteria for SSI or SSDI, he/she will be approved at the initial stage. Using the SOAR model results in higher approval rates (see our national outcomes) because we focus on getting all of the information in the file from the beginning, whereas many people who are eligible for benefits are denied because they don’t have assistance in gathering this documentation.

Some lawyers who take fees for assisting with disability claims specialize in appeals and don’t provide the evidence in the initial stage – they wait for the application to be denied and then work on the appeal. For an application at the appeal stage to be successful, the vast majority of the time it requires new evidence that wasn’t originally presented (there are some cases that are overturned due to oversights at DDS). So, it’s not that DDS wants to deny the case from the beginning, they just didn’t have the right information. It doesn’t save them any money to automatically deny people and then send them to appeal (in fact, it actually costs them more money in adjudicator time, medical records requests, and consultative exams).

All of that said, we understand why people think this is true. The overall national approval rate for SSI/SSDI (without SOAR) is only 29%. So yes, that means 71% of people are denied. It's not possible to know how many applicants needed more evidence and how many just didn't meet the disability criteria, but it certainly leads to many myths about the process.

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Question:
Can I use the SSA-8001 form instead of the SSA-8000 when using the SOAR model?

We recommend against using the SSA-8001 form for a SOAR application because it contains less comprehensive information about an applicant’s income and resources. As such, the applicant would still need to complete an in-person or phone interview with SSA in order to complete the SSA-8000. By completing the SSA-8000 and turning it in to SSA, you can often avoid the need for this interview.

If you find that your local SSA office is not accepting the SSA-8000 from in lieu of an interview, I encourage you to reach out to your SOAR TA Center Liaison and SOAR State Lead so that they can provide local assistance.

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Question:
I am a representative. Can I use the SOAR forms if my client is low-income but not currently homeless?

All of our resources are open-access and free to use when helping applicants. However, we request that you only use the “SOAR” label at Social Security when you are working with individuals who are experiencing or at-risk for homelessness. Read more about how we define homelessness and at-risk. If the applicants you assist do not fit this criteria, you are still welcome to use any of our materials that you find helpful, without marking the application as “SOAR” at Social Security.

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Question:
How can I find the date of onset?

We recommend using the applicant’s last day of work as their date of onset when helping someone apply for SSI/SSDI. The Social Security Administration (SSA) will examine the applicant’s medical records and prior work history to determine if any of the previous work attempts were unsuccessful (i.e.: the applicant was unable to sustain work for more than a few weeks or months due to disabling mental or physical health conditions).

If the applicant is currently working, enter the date that he or she believes the condition(s) became severe enough to prevent him or her from performing substantial gainful activity.

For individuals who have never worked, such as youth exiting foster care, SSA’s guidance is to “enter the date when he or she believes the condition(s) became severe enough to keep him or her from working.” Since youth can work before age 18, you can enter dates prior to their 18th birthday if that is relevant.

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Question:
How do you organize the paperwork for an application while in process?

We recommend creating a case-file folder for each applicant, specifically for SSA and SOAR paperwork. It is helpful if this folder has separate sections to organize your material. While you are gathering information for the application, you can store your interview notes, signed agency releases of information used to gather medical records, and any medical records or collateral information you have gathered. You can also store any completed SSA forms or worksheets in this folder. As you gather medical records, it is helpful to read through them and fill out the paper SSA-3368 Adult Disability Report as a worksheet with the key information from the records.

It may also be helpful to write a short summary of the medical records from each treatment provider as you gather them and include this in the folder. This will save time when you start to write your Medical Summary Report (MSR), as you can utilize the information from the summaries rather than re-reading the medical records. Additionally, your interview notes from the folder will be beneficial to use as a basis for your MSR.

When you are ready to submit the SSI/SSDI application, the folder will contain all the information you need to complete the disability application. Once you’ve submitted the application, place copies of the online application receipt, paper forms submitted to the SSA office (SSA-1696 and SSA-8000), and a copy of your MSR in the folder. Finally, once you receive the decision letter from SSA, include this in the folder for your records and store the information according to your agency guidelines.

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Question:
Is an individual trained in the SOAR model able to charge a fee for this service?

The expectation is that providers involved with SOAR do not charge persons applying for SSA disability benefits for their services. We work closely with providers to identify alternative sources of funding for their programs. All 50 states and the District of Columbia have identified various methods to fund SOAR activities that do not involve charging the applicant or collecting a fee from the applicant’s back pay. Resources related to SOAR funding and sustainability can be found in the SOAR Library.

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