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Social Security Disability

Evaluations

C Donald Williams MD

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Course Plan

Define SSD Exams and how they differfrom other evaluations

Review criteria used by SSA to determinequalification for benefits

Outline how to conduct the exam

Review a sample exam

Sign up instructions

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Social Security Disability

SSA evaluates applications for SSDI

SSA contracts with state agencies named DisabilityDetermination Servicesthat contract for and scheduleexams

Determinations are based on impairments

SSDI (Insurance) based on quarters paid into FICA--amount of award proportional

SSI is needs based--like welfare

Criteria include severity and duration

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S.S. Disability definition

The inability to engage in substantialgainful activity by reason of a medically

determinable impairment which can beexpected to result in death or which haslasted or can be expected to last for 12

continuous months. Impairments must be severe

12 months anticipated duration or longer

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Differences from other IMEs

Social SecurityImpairment only

Workers compensationImpairment and

causal relationship to work injury Fitness for dutyImpairment performing

the essential tasks of a specific occupation

Personal injuryDetermine the nature anddegree of impairment with specific tortcause

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Entry to organizational and

occupational psychiatryAll psychiatrists have

Minimum necessary skills to start

The opportunity to work in this area

SSD exams provide psychiatrists

Income

On the ground exposure to the relationshipbetween work, organizations and institutions,and psychiatric health and illness

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Other benefits

Concentrated practice in efficientassessments of wide variety of patients

Refine conceptualization and writing style Efficient way to fill gaps in schedule

Entre to performing other types of

disability exams because of communityexposure

Service to public sector with few problems

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How to become an examiner

Telephone contact information for all states www.ssa.gov/disability/professionals/procontacts.htm

Or type disability determination services in Googlesearch engine

States have continuing need for new examiners

Review the SSA-DDS suggested outline for

examiners

http://www.ssa.gov/disability/professionals/procontacts.htmhttp://www.ssa.gov/disability/professionals/procontacts.htm

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The psychiatric evaluation

Review the medical records

Evaluate applicant face-to-face

Follow the outlinechild and adults

Provide specific observations

Present a data driven MSE

Use DSM-IV multi-axial diagnoses

Show respect to the examinee

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Sample assignment letter

The claimant alleges depression, anxietyand substance abuse. Provide a full

mental status exam detailing objectivedata, hour by hour activities of a typicalday, range of interests, degree of ability torelate to others, to care for personal

needs and capability to manage ownfunds. With treatment, what degree ofimprovement can be anticipated and thetime required?

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The form of the evaluation

Use standard format

Adult outline

Child outline

Employ economy of language

Answer the questions

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The conduct of the evaluation

Applicant signs disclosure forms

Advise of limitations on confidentiality

Advise that you are not their doctor

Do not criticize their medical providers

Record primary data, including directquotes

Avoid unsupported generalities

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The place for templates

Create your own templateof categories, notresponses--using the SSA format

Saves time--promotes efficiency You (or your transcriptionist) fill in the blanks

with original content

Consider using voice recognition software Requires a fast computer with 512 MB memory and a

USB DSP microphone (Plantronics)

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An evaluation template

Review sample report template in yourpacket....turn to packet

Statement of Non-Confidentiality:The claimant was advised that this interview was forevaluation purposes only and that a copy of theevaluation report would be provided to the SocialSecurity Administration. The claimant was further

advised that no doctor-patient relationship wasestablished and claimant agreed to continue with thisevaluation with that understanding.

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Professional conduct

Treat examinee the way you would like your relatives tobe treated by a professionalgolden rule

Provide an evaluation, not value judgments

This is harder than it seems on occasion--examples Countertransference awareness is helpfule.g. fear of being like

the claimant can lead to devaluation or rescue-with loss ofobjectivity

Be SAFE! If situation does not appear safe, in any respect, cancel the

evaluation Some evaluations should only be conducted in a secure facility

or in a public clinic setting

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When the unexpected happenstransparently document the incident

You dont realize until the exam has begun thatyou have known the claimant in anothercontexte.g. waitress at a restaurant--giveclaimant the choice not to proceed

The claimant is demanding and wont leave theofficedocument what was said and done

The claimant becomes threatening andcomplaininguse your skills and call security

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Summary

SSD Exams are good IME practice, andyou can start next week

Good entre to Organizational andOccupational Psychiatry

Obtain a feel for the interface between

work and psychiatrybuild a mentallibrary of professional experience

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Where to get more information

www.aoop.org andwww.cdonaldwilliamsmd.com have many

links as well as prior courses on line Link to Social Security Bluebook

www.ssa.gov/disability/professionals/bluebook/

Contact your local professional relationsunit for Disability Determination Services

http://www.aoop.org/http://www.cdonaldwilliamsmd.com/http://www.cdonaldwilliamsmd.com/http://www.aoop.org/

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Your response and questions

Questions

Comments

Criticisms