a brief overview of the disability determination process

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A Brief Overview of the Disability Determination Process. Journey o f a Claim. Claims are filed at the local Social Security offices (in person, by phone or online) The local SSA office sends the claim to the Bureau of Disability Determinations (BDD) - PowerPoint PPT Presentation


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A Brief Overview of the Disability Determination ProcessJourney of a ClaimClaims are filed at the local Social Security offices (in person, by phone or online)The local SSA office sends the claim to the Bureau of Disability Determinations (BDD)Once it is received in BDD, it is assigned to an adjudicator, who reviews the application and any other information providedJourney Continued: Adjudicator DutiesThe adjudicator determines which are the relevant sources of informationThe medical evidence of record (MER) is requested by the adjudicatorThe adjudicative team (adjudicators, medical and vocational experts, etc.) analyzes all available evidenceThe adjudicative team determines the claimants ability to do work related activities and eligibility for SSA disability benefits5 Steps of Sequential EvaluationEngaging in Substantial Gainful Activity (SGA)commonly known as work?Does the person have a severe impairment?Does the impairment meet or equal the listings?Does this prevent past work?Does this prevent other work?The Role of the Health Care ProfessionalHospitals, doctors, psychologists, case workers and other treating sources are sent questionnaires or requests for medical evidence to help document the severity of the alleged impairmentThese sources are asked to send the relevant information that they have in a timely mannerThe adjudicative team does not see the claimant and must rely on the medical records for a thorough assessment of the claimants condition(s)What information are we looking for?Dates of treatmentDiagnosis and capability statementMental health statusOffice notesIP and ER staysTherapy notesAny available testing resultsDescription of functional limitations due to symptomsWhat criteria will Social Security use to determine if a person with a Brain Injury is Disabled?Brain injury or traumatic brain injury is described under Cerebral Trauma in the Social Security Blue Book of ListingsIt is evaluated under the body systems the brain injury has affectedThe impairment may be evaluated under physical criteria or mental criteria or bothRecovery periodThe rate and extent of recovery can be highly variable and the long-term outcome may be difficult to predict in the first few months post-injuryIn some cases, evidence of a profound neurological impairment is sufficient for a finding of disability without waiting for a recovery period If not, we will defer adjudication until we have evidence regarding the impairment(s) at least 3 months post-injuryAt this point, if a finding of disability is still not possible, we will defer adjudication until 6 months post-injuryPhysical Criteria for a Brain InjurySeizuresIf the cerebral trauma has resulted in grand mal or petit mal seizures, the severity of the those seizures will be evaluated for disabilitySpeechIf the injury results in sensory or motor aphasia which is affecting speech or communication, the severity of the speech loss will be evaluatedMotor functionIf the injury results in motor dysfunction of the extremities, the extent to which it affects the persons movements or ability to stand and walk will be evaluatedMental Criteria for a Brain InjuryLoss of specific cognitive abilities or affective changes with at least one of the following:Disorientation to time and placeMemory impairmentPerceptual or thinking disturbancesChange in personalityDisturbance in moodEmotional lability and impairment in impulse controlLoss of measured intellectual ability of at least 15 I.Q. pointsWhat evidence will Social Security need to document the impairment?Medical records from the time of the TBI and follow-up servicesHead injury rehabilitation records discussing cognition, impulse control, basic mental functioning, insight, degree of supervision neededMental health consults while hospitalized or in rehabilitation/long-term careNeuropsychological evaluationsVocational rehabilitation recordsStatements from employers about changes in functioning after the Brain InjuryMental impairments and functioningResidual mental impairments after a brain injury must significantly affect a persons functioning to meet disability requirementsSignificant restrictions in activities of daily living, social functioning or in maintaining concentrationRepeated episodes of decompensationMore than minimal limitations in the ability to do basic work activities for at least 2 years due to the chronic organic mental disorderInability to function outside a highly supportive living arrangementInformation from 3rd partiesInformation regarding the claimants can also come from a 3rd party source, such as a family member, friend, social worker, case worker, etc.The 3rd party source should be familiar with the claimants daily activities and it is helpful if they are familiar with claimants functioning prior to the injury as well What can you do to help the disability decision process?Medical personnel can submit all requested records and/or information as soon as they receive the request from Social SecuritySocial workers, case workers, case managers can be advocates for their clients by helping them with them apply for benefits, encouraging their clients to cooperate with the disability process and providing functional information about their clientFamily and friends can help fill out disability forms and provide 3rd party information about the persons functioning Submitting Records/EvidenceEREElectronic Records Express

Fax Gateway


What is ERE?ERE is an initiative to offer electronic options for submitting records related to disability claims via a secure website

Records that are submitted via ERE are automatically associated with the correct disability claim foldhttp://eme.ssa.govHow secure is the ERE website?The website has restricted access

Only authorized users can access the secure website by using their assigned user ID and password

Data transmission is protected by the industry encryption standard for providing network securityUseful ResourcesResources for 3rd parties:www.ssa.gov/thirdparties.htm

Social Security Disability:www.socialsecurity.gov/disability

Listing of Impairments Adults:www.ssa.gov Search Blue Book, then click on Disability Evaluation Under Social Security

Ohio Disability Determination Services Professional Relations OfficersRebecca Billingslea614-438-1312800-282-2654, ext. 1312Rebecca.Billingslea@ssa.gov

Heidi Block614-438-1967800-282-2654, ext. 1967Heidi.Block@ssa.gov Tammy Polter614-438-1661800-282-2654, ext. 1661Tammy.Polter@ssa.gov

Raymond Rhone614-438-1904800-282-2654, ext. 1904Raymond.Rhone@ssa.gov Ohio Disability Determination Services Professional Relations OfficersMike DeNoble614-438-1381800-282-2654, ext. 1381Michael.Denoble@ssa.gov

Scott Maietta614-438-1700800-282-2654, ext. 1700Scott.Maietta@ssa.gov Michelle Rinehart614-438-1685800-282-2654, ext. 1685Michelle.Rinehart@ssa.gov

Orlando Rodriguez614-438-1354800-282-2654, ext. 1354Orlando.Rodriguez@ssa.gov

Thank you. Questions?


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