FAQ

Great question! While we do typically advise to collect all records, 500 pages is understandably a lot! Not all applicants will have this many, but if you are seeing that certain hospitals/providers tend to send significant amounts (particularly if they aren't helpful for the application), you could ask for: Inpatient hospitalization records, discharge summaries, outpatient/emergency records, and psychiatric examinations/mental status exams. Those are all pretty key for the application. When you submit the records to DDS, I'd recommend adding a note that these were all that you requested, so that it doesn't look like you just weren't sending everything you have.

At the hearing level, many Administrative Law Judges (ALJs) will invoke ‘Rule 3.7: Lawyer/Advocate as Witness’.  Under the advocate-witness rule, you cannot serve as both advocate (via the SSA-1696) and witness.  The ‘witness’ is required to testify on the basis of personal knowledge, while an advocate is expected to explain and comment on evidence given by others. This dual role can give rise to a conflict of interest.

In your case, the ALJ viewed the 3^rd Party Function Report you completed as ‘providing witness testimony’ which can prejudice the ALJ’s decision. Often, the ALJ will recognize that the SOAR case worker is not familiar with this rule, and educate them on their options.  When there is other evidence in the file and the SOAR case worker does not need to testify themselves, they will remain the official 1696 representative. By doing so, they are able to cross examine expert witnesses and directly examine the applicant (i.e. ask them questions in front of the judge during the hearing).

The Mental Status Exam must be performed by an "Acceptable Medical Source" (AMS) in order to establish a "medically determinable physical or mental impairment."

Acceptable Medical Sources include physicians, psychologists, advanced practice nurse practitioners (APRN), or physician assistants (PA).  Further, the APRN category includes: Certified Nurse Midwife, Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist. Audiologists are also acceptable medical sources for hearing-related disorders.

Licensed Clinical Social Workers (LCSWs) are not included.

A general privacy release can be used to communicate about the applicant to friends/relatives/other service providers, etc. This can be the SOAR sample (even if it is not for medical records) or a more generic one. Here is another example from CSH.  Most agencies have a privacy release that they use at intake or for these purposes. 

Yes. By signing the MSR, the AMS is only indicating that they believe the included information to be true. It is likely that the provider has spoken with the individual about his/her mental illness, seen some records to that effect, and/or has witnessed some symptoms. In order to treat a patient properly for physical health conditions, the provider would need to be aware of medications and mental health treatment.  If the doctor does not want to sign off on anything that does not pertain to their specific field of practice, they could sign a reduced MSR that does not include reference to the other treating sources, but does include reference to all of the conditions that the doctor feels comfortable attesting to. 

An MSR that has been written based on properly released records can be shared with the primary AMS.  At the point of obtaining the signature, it is primarily a privacy issue, not HIPAA. However, it would be a best practice to have a release signed by the applicant permitting the case worker to communicate with the AMS.

The short answer is "yes." If someone asks to see their Medical Summary Report, you can provide it to them in the same manner that your agency would release a copy of their medical records to them.

However, there are some other factors to keep in mind.  Since the MSR focuses on an applicant's symptoms and functional limitations rather than their strengths, we recommend talking with them first to explain that the report is written in this manner to demonstrate how they may be eligible for SSI/SSDI and that SSA needs to see numerous examples of their limitations. Remind them that they have a lot of personal strengths and that this report is not a full reflection of that.

It is important to speak with the applicant throughout the process in order to alleviate any concerns about what information will be included in the MSR. One best practice to establish transparency and trust is to ask permission on the first interview to take notes. Tell the applicant that at any time they can ask you to stop taking notes or to see what you are writing.  Emphasize that your goal is to capture their words so that they can tell their story to SSA through this process.  Ultimately, the MSR is comprised mainly of their quotes and information they have provided to you.

Reading about one's symptoms and limitations can be very difficult and through this conversation applicants may find that they aren't prepared for that or that it would not be beneficial for their recovery. But, if after this preparation, the applicant wants to read the MSR, then that is their right to do so, following your agency's guidelines.

Absolutely!  Initiating the Online Disability Benefit Application sets the protective filing date for SSI as well as SSDI. Even without work credits, there are other ways an applicant may qualify for SSDI so we recommend applying for both programs. Further, completing the online application is an efficient way to submit medical and work information that is necessary to apply for SSI.

You should definitely send all of the medical records. SSA has a rule called the “All Evidence Rule” which requires applicants (through their representative) to submit all medical information known, which includes knowledge of impairment and/or treatment sources. 

Once you have set the Protective Filing Date (PFD), you have 60 days to submit the complete application & MSR.  Read Steps in the SSA Disability Application Process.