5. Social Security Disability Assessment Reports

Author: Warren Jahn, DC, FACO, FICC
CVP Department Head - Disability & Impairment Rating
drwjahn@ix.netcom.com


Do you have the skill sets and the ability to write a complete and 
technically correct report assessing the patient廣 disability for the 
Social Security Administration?  One of the most significant 
elements of Social Security benefits for disabled persons is 
Medicare coverage, for which an individual qualifies after having 
been found disabled by the Social Security Administration (SSA).  
The chiropractor who treats the disabled person can be of invaluable 
assistance to the patient in obtaining this coverage, if his or her 
skills are up to the task.  Since the chiropractor can provide this 
vital skill after an initial rejection, the chiropractor who treats the 
disabled should be prepared to do so.  Patients have a right to the 
best professional efforts of the chiropractors who treat them.

Disability claimants, and most particularly SSI claimants, are 
persons in poor health who are unable to work and who have 
typically expended most, if not all, of their financial resources by 
the time their claim is filed. They face a determination process 
which is growing ever longer, and now approaching two years.

A chiropractor committed to assisting a patient in obtaining 
disability benefits needs to do six things:

 1. Obtain postdoctoral education in federal disability programs.  To 
get information on CCE sponsored programs e-mail the American 
Board of Forensic Professionals (ABFP) at drwjahn@ix.netcom.com  
or fax 770.619.3203.

2. Become familiar with the decision-making process which leads to 
a determination of "disabled".

3. Be prepared to write a prompt, complete report that meets the 
expectations of the Social Security Administration.  The importance 
of a well written medical report cannot be underestimated.  
Evidence of a claimant廣 impairments(s) is the most important 
evidence the claimant will put forward in support of a claim.  
Furthermore the law requires that the opinions of treating 
chiropractors must be given greater weight than that of consultative 
physicians hired by the SSA, because treating chiropractors are 
employed to cure, and have had a greater opportunity to observe the 
applicant.

4. Become proactive.  If you are treating an unemployed patient 
whose unemployment status may be related to illness or injury, 
suggest that he or she file a claim for disability benefits with a 
local Social Security Administration office.  Inform the patient that 
you should be identified as a treating chiropractor on the patient廣 
application for benefits, and be prepared to write an appropriate 
medical report if and when you are requested to do so by the SSA. 

5. If the patient has a lawyer, be willing to talk to him.  Most 
lawyers who represent Social Security claimants are people 
dedicated to helping the claimants.  Both you and the attorney have 
the patient廣 interests in mind. Discuss the patient廣 legal and 
medical situation with the attorney, and if asked to write a medical 
report, do so. 

6. If the patient does not have legal counsel, suggest that he see a 
lawyer or advocate who specializes in Social Security claims.  
Although representation is not required, claimants have a 
significantly greater chance of obtaining benefits if they are 
represented.  The reason is obvious: the "system" through which 
disability determinations are made is increasingly demanding of 
specific kinds of proof of disability, increasingly complex in its 
judgment-making process, and increasingly unforgiving of technical 
mistakes.  Since most claimants have little or no financial 
resources, the attorney or advocate will usually represent a 
claimant on a contingency basis.  Additionally, the SSA requires that 
any fees charged by an attorney to a successful claimant be 
submitted to the SSA for approval, along with information detailing 
the amount of time they spent working on the case.  This system of 
review assures that fees will truly reflect the work performed and 
the level of difficulty!
 of the representation.
 
The sequential evaluation process suggests that medical evidence is 
crucially relevant in two areas:

 1. Determining whether the claimant廣 impairments are severe 
enough so as to comply with ("meet or equal") one of the various 
impairments described in the Social Security regulations, and 

2. Determining the claimants "residual functional capacity" (RFC).  
Ideally the medical report should contain an assessment of your 
patient廣 condition relative to both areas.
 
Since the treating chiropractor廣 report will be granted more weight 
than evidence from any other physician, your report will certainly be 
more important than any other single piece of evidence put forward 
by the claimant.

Ideally, your medical report will be a well written narrative 
containing the following information:

1. A comprehensive medical history. 

2. The patient廣 symptoms and subjective complaints.

3. Medications 

4. A description of any physical or mental examinations, along with 
clinical findings and results of such examinations. 

5. Laboratory findings. 

6. Diagnosis. 

7. Your treatment and treatment plan. 

8. Prognosis 

9. An assessment concerning the extent to which a patient廣 
impairments "meet or equal" applicable impairments described in 
the SSA regulations. 

10. A Residual Functional Capacity assessment.

11. Please seek and obtain the necessary skill sets to be able to 
present your patient廣 condition in the most appropriate and 
convincing light.

References

1. Disability Evaluation Under Social Security, Social Security 
Administration (SSA) 
Publication No.  64-039 January 1998     	

2. Demeter, S et al.  Disability Evaluation, American Medical 
Association, Mosby-Year Book Inc.  St.  Louis, MO 1996