Division of Disability DeterminationUnit 7D – Homeless and Special Project Unit

Opportunities for Ohioans with Disabilities

Social Security benefits for workers (SSDI) Social Security benefits for adults disabled

since childhood (CDB) Supplemental Security Income (SSI) for

children and adults

Types of Disability Programs

DDS Case Control Department receipts the claim in and notes any special flags.

7D Homeless / Special Project Supervisor monitors the queues

Claim is assigned to an adjudicator in the homeless unit

Application Has Been Submitted to FO and Is Now at the DDS

The adjudicator sends requests for medical evidence of record (MER) to the relevant sources of information listed on the application.

May determine a consultative examination is needed.

The adjudicative team (adjudicators, medical consultants and disability program specialists) analyzes all available evidence

The Journey of a Claim:Adjudicator Duties

The adjudicative team determines if the claimant has severe and marked limitations that meet SSA disability guidelines or that prevent all work related activities (using Sequential Evaluation).

Final decision◦ Claim typically returned to Field Office and claimant

notified of the decision. ◦ Claim can be randomly chosen for review by SSA’s

quality assurance department. If they disagree with the DDS’s decision they will return the claim for additional actions.

The Journey of a Claim:Adjudicator Duties

QDD (Quick Disability Determination) & CAL (Compassionate Allowances) are processed in our Fast Track Unit. Claims are screened in at the Field Office using software that searches for key words

Wounded Warrior/Military Casualty claims—any claimant that has served in the military from 2001-current. Processed in Fast Track and Homeless/Special Project Units Unit◦ http://www.ssa.gov/woundedwarriors/

Fast Track Claims—Screened internally as claims that appear to be a quick allowance

Homeless/Pre-Release/Special Projects Initiative—these claims are handled by one dedicated unit consisting of nine adjudicators

Special Claims

The inability to engage in Substantial Gainful Activity (i.e. work), due to a Medically Determinable Impairment (mental and/or physical), that is expected to or has lasted 12 full months or is expected to result in death.

Definition of Disability

Is the claimant engaging in Substantial Gainful Activity (SGA)?

Does the claimant have a severe impairment?

Does the impairment meet or equal the listings?◦ If no, determine the claimant’s residual

functioning capacity (Physical – RFC) and (Psychological – MRFC)

Does the impairment prevent past work? Does the impairment prevent other work?

5 Steps of Sequential Evaluation

1.00 Musculoskeletal 2.00 Special

senses/speech 3.00 Respiratory 4.00 Cardiovascular 5.00 Digestive 6.00 Genitourinary 7.00 Hematological

Physical Listings

• 8.00 Skin• 9.00 Endocrine• 10.00 Multiple

systems• 11.00 Neurological• 13.00 Neoplastic• 14.00 Immune

12.02 Organic Mental Disorders 12.03 Schizophrenia, other Psychotic

Disorders 12.04 Affective Disorders 12.05 Intellectual Disability 12.06 Anxiety Related Disorders 12.07 Somatoform Disorders 12.08 Personality Disorders 12.09 Substance Addiction Disorders 12.10 Autism and other PDD

Website for listings: http://www.ssa.gov/disability/professionals/bluebook/

MENTAL LISTINGS

Completing questions from DDD or sending medical records

Giving descriptive information about functioning and response to treatment

While only certain treating sources are considered acceptable medical sources for decision-making, all medical information is extremely valuable to the claim

The Role of Health Professionals

Psychiatrists

Acceptable Medical Sources

Licensed Clinical Psychologists

School Psychologists for Intellectual Disabilities and Other Learning Disorders

Doctors (MD/DO)

MH Counselors/Therapists Hospitals/Clinics Rehabilitation Centers Schools

Other Good Sources of Information

Dates of treatment Diagnosis and capability statement Testing/Imagery results Operative/Pathology reports Office notes Mental Status Exams IP/ER records Any available psychological testing Description of functional limitations due to

symptoms

What Information Are We Looking For?

Attend a consultative examination Contact sources for assistance in obtaining

records Forms

◦ ADL◦ Work History◦ Symptoms◦ 827 (Medical Release)

Things We May Need From the Claimant and/or Representative

Why?◦ Exams are ordered when there is not enough

information in file or the information in file is not sufficient to make a decision. Exams are only ordered after all time relevant records are requested, followed up on and all other avenues of obtaining the necessary information are exhausted. Sources never responded Medical records are not current (typically within the past

3-6 months) Possible exception would be a condition that would improve with time (e.g. ALS)

No information/evidence from an acceptable medical source

Conflicting information in file

Consultative Exams (CEs)

What?◦ We purchase one time evaluations from

psychologists, cardiologists, neurologists, medical doctors, x-rays, labs, and special studies.

◦ The doctor/facility provides a report on the evaluation.

◦ These doctors and facilities are located in areas throughout Ohio.

Consultative Exams, (CEs)

When?◦ Requests for these exams are entered into our

case processing system. ◦ The agency’s scheduling department processes

these requests and schedules the exams as close to the claimant as possible depending on the availability of that particular specialty in an area.

◦ Typically will schedule at least 10 days and not more than 30 days in the future.

Consultative Exams (CEs)

Special Requests◦ Please let the adjudicator know of any special

requests or time limitations when they ask if the claimant is willing to attend an exam. Please keep in mind that special requests and

limitations in availability may delay the scheduling of the CE, may increase the distance of the exam from the claimant and may not be able to be accommodated at all depending on the area and consultant availability.

Consultative Exams (CEs)

Responsibilities of the representative and/or claimant:◦ Must provide own transportation◦ Must confirm via telephone that they will attend

the appointment when they receive the exam notice If no telephone contact, the adjudicator is required to

call the representative and/or claimant If there is no response to the telephone calls,

adjudicator is required to send a call in letter to the claimant and/or representatives

Consultative Exams (CEs)

Complaints◦ Report any issues or problems with the exam to

the adjudicator as soon as possible (either by phone or letter)

◦ All complaints are taken very seriously and are investigated by our Professional Relations Officers

Consultative Exams (CEs)

This form is extremely important in the process and is used primarily at step 4 and 5 of Sequential Evaluation. ◦ The evidence in file shows there is a severe impairment. The

impariment is causing limitations but not of listing level severity. Despite those limitations, the claimant has other abilities that may be used in a work environment. Step 4 – With these remaining abilities can the claimant

perform their past work as they described it or as it is done in the national economy? If yes, denial. If no, go on to step 5.

Step 5 – given their remaining abilities, their past work experience, their age and education level – can they perform other work?

Work History Report (3369)

To clearly and completely evaluate the claim at step 4 and 5 the adjudicator must have a detailed work history report for the claimant

This is important for all claims but especially for individuals 50 and older

Why? - Because the rules guiding a finding of disability change as a person ages.

Work History Report (3369)

What does a not so detailed work history report look like?◦ Contains inconsistencies◦ Very brief with no details◦ Left blank, “I don’t know” answers, question

marks◦ Vague descriptions◦ Jobs listed in the remarks section

Work History Report (3369)

What does a detailed work history report look like?◦ Contains no inconsistencies◦ Is very detailed, contains dates◦ No blanks, no “I don’t know” answers, no question

marks◦ Clear, detailed descriptions of the job and job

duties, type of business◦ Additional job listed on extra sheets (i.e. not listed

in remarks section)

Work History Report (3369)

Please be sure to include all allegations on the claimant’s application. The allegations on the summary page should be the same as the allegations on the application.

Please pay attention to the date the claimant alleged disability began when supplying records.

Other Issues

A diagnosis does not equal disability. We are a function based program and it is the severe limitations in functioning that lead to a finding of disability.◦ Example: diabetes, controlled with medication

Prior allowances – just because a claimant was allowed in the past does not necessarily mean s/he will be allowed again. Many factors could change the outcome.◦ Examples: change in listings, change in age, severity

of the condition and its limitations in functioning have changed, technical denials

Other Issues (cont.)

Look for the unit 7D on the representative bar code that is sent

Use list to identify the adjudicator who is working on the claim◦ Is it a Homeless/Special Project Adjudicator?

Is My Claim In the Homeless Unit?

Attorney Barcode Example

Attorney Barcode Example (cont.)

Liz McNany, Unit Supervisor code: EAM211, phone: 614-438-1941

Todd Gould, Claims Adjudicator 3 code: TJG896, phone: 614-438-1353

Shannon Hopp, Claims Adjudicator 3 code: SLH235, phone: 614-438-1629

Jennifer Koppelman, Claims Adjudicator 3 code: JAK536, phone: 614-438-1883

Jamie Labuda, Claims Adjudicator 3 code: JLR626, phone: 614-438-1852

Unit 7D Homeless - Special Projects - Pre-Release Claims

Debra Lorenz, Claims Adjudicator 2 code: DDL284, phone: 614-438-1231

Jennifer Nelson, Claims Adjudicator 3 code: JRE836, phone: 614-438-1573

Mary Vitek, Claims Adjudicator 2 code: MAV370, phone: 614-433-8286

Erin White, Claims Adjudicator 3 code: ENW033, phone: 614-438-1824

Dave Wolfe, Claims Adjudicator 3 code: DLW745, phone: 614-438-1364

Unit 7D Homeless - Special Projects - Pre-Release Claims

OBB COHHIO ODMH ODRC – Pre-Release Claims Wounded Warriors (if homeless or

represented by a partnership)

Special Projects/Partnerships

Resources for Third Partieshttp://www.ssa.gov/thirdparties.htm

Social Security Disabilityhttp://www.socialsecurity.gov/disability

Other Useful Resources

We sincerely enjoy working with all of you!

The service you provide to the citizens of Ohio is invaluable and we appreciate you.

Thank you!!!!