FAQ

Yes, we have a number of resources on the SOAR website to help provide information and guidance through the appeals process. They can all be found in the SOAR Library. I recommend starting with the article About Appeals and then checking out the Appeals Toolkit.

• The appeal must be filed within 60 days of receipt of the initial denial notice.
• The applicant must submit the following forms:
  • SSA-561: Request for Reconsideration
  • SSA-3441: Disability Report- Appeal
  • SSA-827: Authorization to Disclose Information to SSA
• Additional medical records and evidence can be submitted
• The application will be assigned to a different disability examiner and reviewing physician at DDS

The SAMHSA SOAR TA Center recommends that you don’t cite the Listing and Grid numbers, e.g.) Ms. Jones meets Listing 12.04, and the alternative Grid rule 203.03. Rather, at the DDS level (initial and reconsideration) we suggest providing a description of how the applicant meets a particular Listing(s) or Grid rule through specific examples from the medical records, applicant quotes, and other collateral sources.

It is unfortunate when we run across physicians who are unwilling to help people access the benefits that they are entitled to, although it is a common problem.  Many doctors will say that they have not seen a person enough to support a report such as the MSR.  Sometimes doctors on ACT (Assertive Community Treatment) teams or in PSR (Psychosocial Rehab) programs may be willing to co-sign reports. When you can’t find a doctor to cosign the report, we recommend you submit the MSR as collateral information along with the medical records that you have collected that document the diagnostic information from a physician.  

You may want to find out why they are refusing to sign the report. Is it because they feel they don't know enough to sign it?  Or that it wasn't written by them so they don't want to sign it?  Are there other reasons?  One of the things we find is that the doctors often misunderstand what we are asking them to do. They believe that, by signing the report, they are "approving" the person for disability benefits. DDS makes that decision. What they're doing is simply attesting that the information contained in this report is true. It's fine if they even write a statement that they believe the information in this report is true. 

You might remind the doctor and the clinic/hospital that when someone is approved for SSI/SSDI they are also going to be eligible for Medicaid/Medicare which means retroactive reimbursement for services provided and ongoing payment for treatment and services in the future.  

One SOAR program contacted the state medical association for the names of retired physicians and asked if anyone was willing to do one assessment pro-bono.  It was fairly successful.

ALJ hearings may be conducted using video teleconferencing (VTC) equipment, rather than in-person, if there is equipment available to conduct a VTC hearing and if this would be more efficient than conducting an appearance in person. Applicants have a right to object to a VTC hearing if using the VTC model would cause undue hardship or for other reasons specified in HALLEX regulations. 

Here is a link to SSA data on length of time it takes to get a hearing, by hearing office:  https://www.ssa.gov/appeals/DataSets/01_NetStat_Report.html.   You can also see how many video vs. in person hearings a particular office does, though there is much local variation on how cases are assigned to in-person vs. video dockets. While VTC hearings generally come up quicker, this is in the context of long wait times for hearing scheduling generally.  

It is our opinion that all applicants at the hearing level should be represented by someone who is knowledgeable about preparing and presenting claims at the ALJ level.  ODAR will have a staffer who will assist with the equipment, but not much more than that. An advocate will be able to directly examine the applicant and cross examine any experts that are present, e.g. vocational and/or medical experts.

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

The SOAR process can definitely be used to assist applicants with appeals, as SOAR practitioners are often well positioned to assist given their relationships with applicants and knowledge of their impairments and related functional limitations. SOAR case managers can help by gathering additional medical records, writing a Medical Summary Report, and assisting with SSA forms specific to the appeal process. More information on assisting applicants with appeals, including a full issue brief with tips for practitioners, is available in the SOAR Library.

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.

If a person is guarded when you are interviewing them for the MSR, you can explain to them the importance of you gathering this information and providing it to Social Security as part of the SSI/SSDI application process. If they still don't want to provide you information then you can document in the MSR the person's guarded nature, their behavior and symptoms you observe, and document that you believe it to be due to the symptoms of their mental illness (paranoia, delusions, suspiciousness, etc.). You can try to obtain the information you need for the MSR from the person's medical records and if they are willing to sign ROIs, you can attempt to interview collateral sources such as family, friends, case managers, etc. to obtain information to include in the MSR. 

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.