FAQ

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.

In recent years, DDS has developed the ability to quickly access VA medical records electronically, which should be triggered when you fill out the electronic application (specifically the SSA-3368 Adult Disability Report) and document that the applicant received treatment from the Veterans Health Administration. An electronically signed SSA-827 will also need to be in the file. When SSA transfers the case to DDS and it is noted that the applicant received VHA care, the system automatically sends an electronic request for records to VHA. The full process they use is here, and it's pretty interesting: https://secure.ssa.gov/poms.nsf/lnx/0422505022.

For SSA, the only required release of information is the SSA-827. However, the VA may also require that the Veteran sign a form 10-5345 Request for and Authorization to Release Medical Records and Health Information.

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.

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.

To meet SSA’s definition of disability, the applicant’s diagnosis must be documented in medical records, laboratory reports, or other clinical findings of a physician or psychologist. DDS prefers that medical evidence come from an ongoing treatment provider. If this medical documentation is not available because the applicant has not received treatment for these conditions, we recommend that SOAR practitioners try to arrange for a physician or psychologist to conduct assessments, including documenting the applicant’s diagnosis and functioning, before submitting the SSI/SSDI application.

If it is not possible to arrange an evaluation before submitting the application, DDS may arrange for a consultative exam (CE) for the applicant, including physical or psychiatric testing based on the applicant’s alleged conditions. More information about CEs can be found here. In these instances, it is especially important that the SOAR practitioner provides comprehensive information about the applicant’s impairments in functioning through the Medical Summary Report. Collateral information from caseworkers, family members, and former employers can also be helpful in supporting an application with limited medical documentation.

Question #13 about "battery and cruelty" on the SSA-8000 applies only to immigrants and refers to domestic violence or child abuse. The SSA policy and operations manual states: "The alien claimant, the alien claimant's child, or the alien claimant's parent, must be determined to have been battered or subjected to extreme cruelty while residing in the U.S..."

DDS stands for Disability Determination Services. DDS is the state agency charged with making the medical determinations for SSI/SSDI claims. They gather medical information and can order additional testing or consultative exams. DDS operates under Federal SSA guidelines and functions under various state agencies (e.g. Dept. of Labor, Vocational Services, or Educational Services).

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

This letter applies to an individual’s eligibility for Social Security Disability Insurance (SSDI). SSDI is an insurance program that you pay into when you work through a portion of FICA payroll taxes. As such, when you stop working, you stop paying into this program and eventually your “insured” status will expire. The date your insured status for SSDI expires is known as the “date last insured.” For SSDI, applicants need to show that they were disabled before the date last insured in order to be eligible for benefits. For the letter in this question, it was found that the applicant was not disabled before his/her date last insured. If the applicant decides to appeal the decision, locating medical records the document an earlier onset of disability (if applicable) and checking the applicant’s earnings record to see if any earnings were missing are key strategies to pursue.

If the applicant’s disability arose after the date last insured, s/he may still be eligible for SSI, if h/she meets SSI resource and income requirements.

If the claimant does not have an impairment that is not described in the Listings, First, SSA will find the Listing (or Listings) that is closely analogous to the claimant’s impairment. SSA will then take the medical findings related to the claimant’s impairment and compare them to those in the closely analogous listed impairment. The claimant will equal the Listing if the medical findings related to his impairment are at least of equal medical significance to those in the closely analogous listed impairment.

Under Social Security regulations, an impairment will be found medically equivalent to a Listed impairment “if the medical findings are at least equal in severity and duration to the Listed impairments.” This is done by comparing the claimant’s symptoms, signs, and lab findings with those specific for the Listed impairment; or if the condition is not Listed, with that Listing most similar to the claimant’s impairment.