1. Social Security Disability Evaluations
C Donald Williams MD

2. Course Plan
Define SSD Exams and how they differ from other evaluations
Review criteria used by SSA to determine qualification for benefits
Outline how to conduct the exam
Review a sample exam
Sign up instructions

3. Social Security Disability
SSA evaluates applications for SSDI
SSA contracts with state agencies named Disability Determination Services—that contract for and schedule exams
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”

4. S.S. Disability definition
“The inability to engage in substantial gainful activity by reason of a medically determinable impairment which can be expected to result in death or which has lasted or can be expected to last for 12 continuous months.”
Impairments must be severe
12 months anticipated duration or longer

5. Differences from other IMEs
Social Security—Impairment only
Worker’s compensation—Impairment and causal relationship to work injury
Fitness for duty—Impairment performing the essential tasks of a specific occupation
Personal injury—Determine the nature and degree of impairment with specific tort cause

6. Entry to organizational and occupational psychiatry
All 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 relationship between work, organizations and institutions, and psychiatric health and illness

7. Other benefits
Concentrated practice in efficient assessments of wide variety of patients
Refine conceptualization and writing style
Efficient way to fill gaps in schedule
Entrée to performing other types of disability exams because of community exposure
Service to public sector with few problems

8. How to become an examiner
Telephone contact information for all states
Or type “disability determination services” in Google search engine
States have continuing need for new examiners
Review the SSA-DDS suggested outline for examiners

9. The psychiatric evaluation
Review the medical records
Evaluate applicant face-to-face
Follow the outline—child and adults
Provide specific observations
Present a data driven MSE
Use DSM-IV multi-axial diagnoses
Show respect to the examinee

10. Sample assignment letter
“The claimant alleges depression, anxiety and substance abuse. Provide a full mental status exam detailing objective data, hour by hour activities of a typical day, range of interests, degree of ability to relate to others, to care for personal needs and capability to manage own funds. With treatment, what degree of improvement can be anticipated and the time required?”

11. The form of the evaluation
Use standard format
Adult outline
Child outline
Employ economy of language
Answer the questions

12. 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 direct quotes
Avoid unsupported generalities

13. The place for templates
Create your own template—of categories, not responses--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)

14. An evaluation template
Review sample report template in your packet....turn to packet
Statement of Non-Confidentiality: 
“The claimant was advised that this interview was for evaluation purposes only and that a copy of the evaluation report would be provided to the Social Security Administration. The claimant was further advised that no doctor-patient relationship was established and claimant agreed to continue with this evaluation with that understanding.”

15. Professional conduct
Treat examinee the way you would like your relatives to be treated by a professional—”golden rule”
Provide an evaluation, not value judgments
This is harder than it seems on occasion--examples
Countertransference awareness is helpful—e.g. fear of being like the claimant can lead to devaluation or rescue–-with loss of objectivity
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

16. When the unexpected happens—transparently document the incident
You don’t realize until the exam has begun that you have known the claimant in another context—e.g. waitress at a restaurant--give claimant the choice not to proceed
The claimant is demanding and won’t leave the office—document what was said and done
The claimant becomes threatening and complaining—use your skills and call security

17. Summary SSD Exams are good IME practice, and you can start next week
Good entrée to Organizational and Occupational Psychiatry
Obtain a feel for the interface between work and psychiatry—build a mental library of professional experience

18. Where to get more information
and have many links as well as prior courses on line
Link to Social Security Bluebook
Contact your local professional relations unit for Disability Determination Services

19. Your response and questions
Comments
Criticisms