SOAR Critical Components
By Margaret Lassiter
April 29, 2015
One of the key elements of the SSI/SSDI Outreach, Access and Recovery (SOAR) approach to completing Social Security Administration (SSA) disability benefits applications is the use of five “critical components.” These components of application assistance include:
- Using the SSA-1696 Appointment of Representative form (SSA-1696)
- Collecting and submitting medical records
- Writing and submitting a Medical Summary Report (MSR)
- Obtaining co-signature on the MSR by a qualified physician
- Completing a quality review of applications prior to submission
SOAR outcomes from across the country have proven that the use of these components significantly increases the likelihood of an approval for those who are eligible.
Using the SSA-1696, Appointment of Representative Form
By serving as the applicant's representative, a case manager helps the individual develop and submit complete and accurate information, and helps SSA and Disability Determination Services (DDS) obtain information needed for an appropriate determination. The form SSA-1696: Appointment of Representative is used to establish and authorize the role as representative. As a representative the case manager is more than a contact person. It allows the case manager to receive copies of all notices sent to the applicant, communicate directly with SSA and DDS to provide additional information needed and obtain records from the applicant's files. If SSA denies the application, the case manager can obtain a record of the decision on the application, which can then help in filing an appeal. A key component, especially for applicant’s experiencing homelessness.
Collecting and Submitting Medical Records
In order to provide sufficient evidence documenting the applicant’s disability, case managers collect and submit medical records as a part of a complete application packet to SSA. When records are collected ahead of time, it ensures that SSA and DDS receive the information that they need to make a decision. The DDS examiner does not meet with the applicant; the determinations are based solely on the medical evidence available. Case managers can often access medical records faster, ensure that the information is relevant and complete, including often-overlooked progress notes, and include information about substance use.
Writing and Submitting a Medical Summary Report
The Medical Summary Report (MSR) is a SOAR signature tool and key to a successful application. It is a letter written by the case manager and submitted as part of the SOAR application packet. It provides a succinct, comprehensive summary of the applicant’s personal and treatment history and its impact on his or her life. It links the applicant’s diagnoses to impairments in functioning that limit his or her ability to work. It gives the DDS examiner a clear picture of the applicant’s current functional level. It also addresses any substance use and its materiality to the disability claim.
Obtaining Co-Signature on a Medical Summary Report
A co-signature by a physician, psychiatrist, or psychologist raises the MSR from “collateral information” to “medical evidence,” which carries more weight in the disability determination process. While physicians, psychiatrists, and psychologists are acceptable medical sources for diagnostic purposes for SSA, it is not necessary for them to write the MSR.
Completing a Quality Review of Applications before Submission
SOAR advocates that a SOAR-trained mentor or supervisor review the application packet prior to submission to SSA. This ensures that all forms are correctly completed and that the Medical Summary Report thoroughly links the applicant’s diagnosis to his or her functional impairments.
What We Found from OAT
The SOAR Online Application Tracking (OAT) program tracks outcomes of SOAR-assisted applications and the use of the 5 critical components. Recently we looked at these data to determine if the use of critical components significantly impacted outcomes of SOAR-assisted applications.
We compared outcomes (approvals, denials) with the number of critical components, using chi-squares, cross-tabulations and correlation analyses on 3,580 cases. There was very little variability in the data, meaning that most SOAR-trained case managers are using the critical components. However we did find that applications with all five critical components were significantly (p<.001) more likely to be approved for benefits than denied for benefits. Seventy-five percent of the applicants that provided all of the critical components were approved for benefits versus 25 percent of applicants that were denied.
We also found that the MSR has an important impact on outcomes. It significantly increased the likelihood of being accepted by about 10 percent (p<.001). Further, applicants who had a cosigned medical summary were significantly (p<.001) more likely to be approved for benefits than those without a cosigned medical summary. Approximately 15 percent more applicants with a cosigned medical summary were approved for benefits than applicants without a cosigned MSR. This suggests that the combination of both the MSR and the co-signature will produce the best chances of being approved.
By doing these analyses we can say with confidence: Use all the SOAR critical components. They really do make a difference – a statistically significant one – in your outcomes!
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.