Incorporating SOAR into a SSI/SSDI Case Involving Physical Conditions
By Amanda Starkey
July 2, 2018
The great thing about the SOAR model is that it can be used on much more than just mental health conditions! For my first several applications, I primarily focused on pouring most of my energy and my Medical Summary Reports' (MSRs') focus into clearly discussing the applicant’s functional limitations in regards to his or her psychiatric conditions. Admittedly, I dedicated a very small portion of my MSRs to addressing physical conditions. This was mostly because I was trained in mental health, and I didn’t think I had a strong enough background to thoroughly address the various physical conditions my clients presented with. I’d mention physical conditions in the MSR and try my best to provide details about past treatment and how those conditions impacted the applicant on a day-to-day basis. But, I wasn’t sure what other details I could provide beyond the basics.
Then I started working with a client who changed my perspective. He was clearly SOAR eligible; he had depression, and was living outside on a park bench. Unfortunately, he had very limited health treatment (a result of his depression), which left us with virtually no clinical records to submit on his behalf. I knew he had some issues with breathing. He had trouble walking more than a few feet, and his breathing was labored even while sitting. I consulted with a colleague, and she suggested I try to dig a little deeper into his physical health concerns.
I started by looking at listing 3.02 Chronic Respiratory Disorders in the “Blue Book.” I was met with a table that contained endless numbers and abbreviations that made no sense to me. I immediately closed the screen! After a lunch break and some time processing memories of math anxiety from my grade school days, I reopened the listing. This time I did a simple search and landed upon a POMS update, which explained (in probably more detail than I needed to know) every aspect of the chart and what each number and abbreviation meant.
I was able to use the information from the listing, with the guidance from the POMS, to make a short questionnaire about the applicant’s respiratory functioning; at the end of the questionnaire I included a signature line for his physician. I asked him to take it with him to his next appointment. A few weeks later he returned to my office with the form completed. It turned out that he met all of the clinical requirements outlined in the formidable Blue Book Listing I had previously been so overwhelmed by. I was able to incorporate these results into the “Physical Health History” section of his MSR and submitted the signed questionnaire I created as part of the medical records for his application.
All in all, I probably had fewer than 100 pages of records, which most SOAR practitioners would consider a very small amount of evidence. Fewer than 5 pages of those records related to his mental health. Despite this, he was approved for Social Security Disability Insurance within 3 months. While the extra research and effort on my end was time consuming, it resulted in a life-changing outcome for my client. From that point on, I have made it a point to thoroughly research the listings for each and every condition my clients present with. I have had remarkable outcomes using this strategy: fewer consultative exams, shorter application processing times, and more favorable decisions.
The views, opinions, and content expressed in SOAR Voices do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS). Its contents are solely the responsibility of the authors.