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How do you submit the MSR for online applications for SSDI? Also, how do you complete a SOAR application when SSA requires an applicant to go in for an interview and that is where they fill out the application? Do I use the forms I printed from training
Great questions! For the MSR, there currently isn’t a way to submit that online unless you are registered with DDS to use Electronic Records Express. Through that system, you can submit medical records and additional documentation by uploading it to the ERE system. I recommend reaching out to your DDS Professional Relations Officer, or your local SOAR contact, for details on how to register. Alternatively, DDS can generate a bar-coded cover sheet which you can use to fax the MSR and records to DDS. By using this process, the documentation will be added directly to the applicant’s file.
Applications can still use the SOAR process if applicants need to go to the SSA office for an interview. Many SSA offices waive the need for this interview if the SOAR representative fills out the disability application online and the SSI application (SSA-8000) on paper and delivers it to the SSA office. However, some SSA offices still require the applicant to attend an interview to verify the information in the SSI application. I recommend completing the online portion of the disability application at least 1-2 days before this interview, so that SSA has critical information about the case on file before the interview. You’ll then be able to provide supporting documentation on the application after the case reaches DDS.
For the application forms, use this link for working on real applications. Some of the training forms have certain parts that are fillable/not-fillable, but the link above will guide you to where the forms can be found on SSA’s website. Remember that the SSA-16 and SSA-3368 can be used as worksheets, as those will be filled out and turned in online.View
How much money can a person make and still receive SSI?
If a person is working while applying for SSI and is earning above the Substantial Gainful Activity (SGA) limit set annually by SSA, they will not be eligible for benefits.
However, SSA has many work incentive programs for SSI beneficiaries to assist their efforts to return to work. These programs exclude some income/resources so that SSI recipients can attempt work, and even earn above SGA, without fear of losing their benefits. We recommend that beneficiaries speak with a work incentives specialist to discuss how work will affects their own benefits. A good place to start to find local resources is SSA's Ticket to Work website.View
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 principlesView
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.View
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, email@example.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.View
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.View
What are video teleconferencing (VTC) hearings? Are VTC hearings being heard quicker? Can the client go to the VTC for the ALJ hearing by him/herself?
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.View
How is it that work credits expire? And how long does it take before they do start to expire?
The SSA program which concerns “work credits” is Disability Insurance Benefits (DIB or Title II). To be eligible, an applicant (who is the wage earner) needs “insured” status which depends on the quarters of coverage that have been acquired as a result of gainful, “covered“ employment [FICA taxes]. A “quarter of coverage” is based on 1 of 4 calendar year quarters, i.e. the 3-month time period that ends on March 31, June 30, September 30, or December 31.
A wage earner must have sufficient quarters of coverage to be “fully insured,” and therefore, entitled to DIB. The maximum quarters of coverage needed is 40, but 6 quarters of coverage are required at a minimum. In addition to being fully insured, the wage earner must also be “currently insured.” This is the part of your question about “expiring credits.” For the period of 40 quarters immediately preceding disability, the wage earner must have a least 20 quarters of coverage in that 40 quarter period. This is the “20/40 rule.”
In other words, the wage earner must have worked steadily and fairly recently until disability. Insured status will lapse if she or he stops working, or becomes disabled, and fails to earn quarters of coverage for 20 quarters (about 5 years). So, if the wage earner did not work steadily during the 40 quarter periods, the insured status lapses sooner than 5 years. The wage earner must be fully insured at the time of becoming eligible in the first full month of becoming disabled. Lapse in insured status means that the wage earner is not eligible for disability insurance benefits.
The date that the insured status lapsed becomes critical for establishing that disability began before that lapsed date in order to be eligible for DIB. The SSA field office can compute the wage earner’s date last insured, also known as “DLI”. Note: quarters of coverage are computed differently for younger wage earners. Read more at https://www.ssa.gov/oact/progdata/insured.htmlView
During the ALJ hearing, is it okay to have your client physically demonstrate simple movements to show physical limitations that records may not document?
Not really. There are many reasons for this. Firstly, hearings are tape recorded and physical movements won’t show up on audio. As well, any physical limitations that are the basis of a disability claim must have medical records to back it up, not just an ALJ’s observations. Courts have discounted “sit and squirm” opinions from ALJs who “eyeball” the client, and say they have no back problems, for example, because they sit in a hearing for two hours in no obvious discomfort. DDS is supposed to consider the claimant’s capacity to perform work activities on a sustained basis, not just on what they can or cannot do on a one-time basis. (See Social Security Rulings 96-8p and 96-9p) https://www.ssa.gov/OP_Home/rulings/rulfind1.html#YRT1996)View
What are the Medical-Vocational Guidelines, or "Grids"?
The “Grids” are formally known as Medical-Vocational Guidelines and can be found here. DDS evaluates an applicant using these guidelines only at Step 5, so if the applicant meets a listing at Step 3, the Medical-Vocational guidelines will not be used.
The guidelines reflect the analysis of the various vocational factors (i.e., age, education, and work experience) in combination with the individual's residual functional capacity (used to determine his or her maximum sustained work capability for sedentary, light, medium, heavy, or very heavy work) in evaluating the individual's ability to engage in substantial gainful activity in other than his or her vocationally relevant past work.View