Section H Engaging the Applicant; Medical Summary;

Mental Status Report; Medical Records; Medications; SSA # Codes;

Cheryl Folkes

1

Goal is to portray an individual’s history

Asking the applicant to share very personal information

Sensitivity, compassion, respect, empathy

Use open-ended questions to avoid yes/no answers and to obtain richer responses: ◦ How? What? Why? ◦ What is a good day like? What is a bad day like? ◦ Tell me about… ◦ Describe what happens…

2

Synopsis of the case and why the claimant should be found disabled

Add at the end of the Function Report as a detailed summary of the case

Use for ALJ hearings as a case summary and

to reference exhibits

Brief , descriptive and concise

3

Describe past work and exertional levels; concentration, pace & persistence

Describe problems at work: why the claimant

quit/was fired; describe if the work was “sheltered” List treatment, episodes of decompensation

(related incarcerations), & medications

Link the symptoms to the functional impairment Help the DDS examiner “see” the person

4

May be requested by DDS examiner to help decide certain cases

Completed by treating physician

Important in determining decision

Emphasis given to questions 12, 13, & 14 ◦ Prognosis ◦ Ability to relate to others & sustain work ◦ Ability to respond to changes/stress in work

settings

5

Medications treat the symptoms of mental health disorders; cannot cure the disorders but they help improve functioning

Medications work differently for different people; some get side effects; some don’t

Factors that affect how medications work: ◦ Age, sex, body size, genetics ◦ Physical illness; other medications ◦ Habits like smoking & drinking; diet ◦ Liver and kidney function ◦ Compliance

6

Medication side effects ◦ Rigidity, muscle spasm, tremors ◦ Drowsiness ◦ Dizziness ◦ Blurred vision ◦ Sensitivity to sun; skin rashes ◦ Agitation ◦ Restlessness ◦ Sexual dysfunction

Side effects can contribute non-compliance;

important to document!

7

Electronic Records Express: Contact DDS at 800-252-9627 to set up system; send electronic records or scanned records to the DDS examiner

Bar code identifies each individual’s record

Include the following: ◦ Diagnosis ◦ Medical history ◦ Clinical findings (physical or mental tests) ◦ Lab findings (kidney function, x-rays, etc) ◦ Treatment prescribed with response & prognosis ◦ Clinical summary prepared by CBO staff

8

A Primary claimant (wage earner) B Aged wife, age 62 or over B1 Aged husband, age 62 or over B2 Young wife, with a child in her care B3 Aged wife, age 62 or over, second

claimant B6 Divorced wife, age 62 or over BY Young husband, with a child in his care C1-9 Child - Includes minor, student or

disabled child

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D Aged Widow, age 60 or over D1 Aged widower, age 60 or over D2 Aged widow (2nd claimant) D3 Aged widower (2nd claimant) D6 Surviving Divorced Wife W Disabled Widow W1 Disabled Widower W6 Disabled Surviving Divorced Wife

10

1

June 27, 2014 Medical Summary Report Re: Mr. James DOB: 55.55.5555 SS no: 555.55.5555 Dear DDS Examiner: Introduction Mr. James is a 55-year-old divorced, chronically homeless male. He has been diagnosed with schizoaffective disorder bipolar type, myocardial infarction requiring stent, cataracts, and memory impairment. Mr. James is 5 feet 8 inches and 205 pounds. He presents with an extremely flat affect and makes minimal eye contact. Mr. James attempts to answers questions but has difficulty remembering past events. His answers are brief with latency in response and he offers no spontaneous information. Current Living Situation. Mr. James currently lives in the Transitional Housing shelter at Gulf Coast Center. He has experienced homelessness for the past 5 years, staying on the street and in shelters. Personal History/Relationships Mr. James has been married one time, from 1979 to 1995. He had three children by this marriage, but currently has no contact with either the children or his former wife. He has no significant relationships at this time. Educational History Mr. James completed a Bachelor Degree in 1982; Double Major in English and Psychology. Employment History “My boss always fires me.” Mr. James most recent employment was in 2013 as a “ride jock” for two carnivals; he was fired from these jobs because he was not able to remember the sequence of steps to take down and re-assemble the rides. Prior to that, he sold newspapers and also worked as a day laborer; he was unable to maintain these jobs as his cardiac problems limited his strength and stamina. In 2010 he worked as a plumber’s assistant. He has difficulty remembering much about specific employment prior to 2010 other than his earlier teaching career. Mr. James was a teacher from 1983-1989 but suffered a psychotic break in 1989 and after that was unable to resume full time teaching. He attempted to work as a substitute teacher in the 1990’s but he did not have adequate concentration for the teaching responsibilities and could not tolerate the stress. Physical Health History of myocardial infarction requiring a stent; his strength and stamina are extremely limited. Additionally, he has cataracts which limit his vision.

2

Substance Use History of alcohol abuse and amphetamine abuse; full remission since 2012. Psychiatric History and Treatment Gulf Coast Center/Dr. Odom (Galveston, TX): 7/2/2012—Present; Medications: risperidone (psychosis), lithium (mood stabilization), & trazodone (insomnia). Hospitalizations St Joseph (Houston, TX): 2012 psychotic episode South Texas Medical Center (Harlingen, TX): 2011 cardiac surgery Brownsville Medical Center (Brownsville, TX): 1989 psychotic episode Social Functioning Mr. James has not had contact with any family members in many years. He tends to isolate and does not generally engage in social activities. Concentration, Persistence and Pace Mr. James has substantial memory impairments, resulting in inability to remember instructions. Due to the symptoms he experiences from his mental illness, Mr. James displays significant impairments in his ability to focus and concentrate. Conclusion Mr. James is a 55-year-old divorced, chronically homeless male. Mr. James has been diagnosed with schizoaffective disorder, bipolar type. Mr. James’ symptoms include auditory hallucinations, blunted affect, aggressive and irritable mood swings, isolation, social anxiety, and memory impairments resulting in difficulty with concentration and focus. These symptoms have had a direct affect on his ability to maintain stable employment and housing.

If you have any questions, please contact Cheryl Folkes at 111-111-1111. Sincerely, Cheryl Folkes, M.A. Gulf Coast Center

Sending the Medical Electronic Records (MERS)

When medical records are compiled and need to be mailed or scanned to the DDS examiner.

Contact DDS at 1-800-252-9627 ask for Mr. Tom Freeman – set up contact for electronically file medical records.

Following medical Records:

• Diagnosis • Medical History • Clinical findings (physical or mental tests) • Lab findings (blood pressure, X-Rays etc…) • Treatment prescribed with response and prognosis • Clinical Summary prepared by CBO Staff

*The Mental Status Exam (MSE) or Current Mental Status (CMS) is the most important of all the MERS documents.

Once you are set and medical records are scanned to DDS, you will receive a response with tracking number.

       

Sponsored with funds from the Center for Medicare and Medicaid Services (CMS) Medicaid Infrastructure Grant CFDA # 93.768)

Work  Incentives  Cheat  Sheet  &  Definitions  

Work  Incentive  Terminology  

SSI  or  SSDI?  

Details  

Substantial  Gainful  Activity  (SGA)  

SSDI   If  countable  income  is  consistently  above  the  applicable  SGA  level  (monthly  dollar  figure),  the  work  activity  will  be  considered  to  represent  SGA;  this  dollar  amount  is  set  every  year  by  SSA,  and  may  change.  

Trial  Work  Period  (TWP)  

SSDI   A  period  of  9  months  that  a  person  can  work  and  earn  money  without  any  impact  on  the  SSDI  check.  

Extended  Period  of  Eligibility  (EPE)  

SSDI   36  month  period  immediately  following  the  Trial  Work  Period.    Individual  receives  SSDI  check  when  earning  less  than  SGA.  

Grace  Period   SSDI   Starts  in  first  month  after  Trial  Work  Period  in  which  an  individual  has  countable  earnings  above  SGA.    For  3  consecutive  months,  SSDI  cash  benefits  continue  regardless  of  earnings.  

Subsidy  and  Special  Conditions  

SSDI   Support  received  on  the  job  that  may  result  in  the  worker  receiving  more  pay  than  the  actual  value  of  the  services  performed.    Support  could  be  provided  by  employer  or  by  someone  else.  

Blind  Work  Expense  (BWE)  

SSI   For  people  whose  primary  disability  is  a  visual  impairment,  cost  of  work-­‐related  expenses  can  be  deducted  from  countable  income  dollar  for  dollar.  

Student  Earned  Income  Exclusion  (SEIE)  

SSI   People  under  age  22  and  regularly  attending  school  can  exclude  up  to  a  certain  dollar  amount  of  earned  income  per  month,  with  a  maximum  yearly  exclusion  (may  vary  each  year).  

Plan  for  Achieving  Self-­‐Support  (PASS)  

SSI   Earned  income  can  be  set  aside  in  support  of  a  vocational  goal.  

Impairment  Related  Work  Expense  (IRWE)  

SSDI  &  SSI  

Costs  of  work-­‐related  expenses  can  be  deducted  from  a  person’s  earnings.    Expenses  must  be  disability-­‐related.  

Expedited  Reinstatement  (ExR)  

SSDI  &  SSI  

If  re-­‐apply  for  benefits  within  5  years  of  termination,  have  expedited  reinstatement.    Eligible  for  6  months  of  provisional  benefits  while  a  decision  is  pending.  

Social  Security  Administration  (SSA)  

SSDI  &  SSI  

SSA  is  the  federal  agency  that  administers  social  security  benefits,  through  disability  and  retirement  programs.  

 

What do the letters after a Social Security or Medicare number mean?

Code Identification

A Primary claimant (wage earner)

B Aged wife, age 62 or over

B1 Aged husband, age 62 or over

B2 Young wife, with a child in her care

B3Aged wife, age 62 or over, second claimant

B5Young wife, with a child in her care, second claimant

B6Divorced wife, age 62 or over

BYYoung husband, with a child in his care

C1-C9 Child - Includes minor, student or disabled child

D Aged Widow, age 60 or over

D1 Aged widower, age 60 or over

D2 Aged widow (2nd claimant)

D3 Aged widower (2nd claimant)

D6 Surviving Divorced Wife, age 60 or over

E Widowed Mother

E1 Surviving Divorced Mother

E4 Widowed Father

E5 Surviving Divorced Father

F1 Parent (Father)

F2 Parent (Mother)

F3 Stepfather

F4 Stepmother

F5 Adopting Father

F6 Adopting Mother

HA Disabled claimant (wage earner)

HB Aged wife of disabled claimant, age 62 or over

M Uninsured – Premium Health Insurance Benefits (Part A)

M1 Uninsured - Qualified for but refused Health Insurance Benefits (Part A)

T Uninsured - Entitled to HIB (Part A) under deemed or renal provisions; or Fully insured who have elected entitlement

only to HIB

TA Medicare Qualified Government Employment (MQGE)

TB MQGE aged spouse

W Disabled Widow

W1 Disabled Widower

W6 Disabled Surviving Divorced Wife

The Social Security number followed by one of these codes is often referred to as a claim number. We assign these codes once you apply for

benefits. These letter codes may appear on correspondence you receive from Social Security or on your Medicare card. They will never appear on a

Social Security card.

For example, if the wage earner applying for benefits and your number is 123-45-6789, then your claim number is 123-45-6789A. This number will also

be used as your Medicare claim number, once you are eligible for Medicare.

Meaning of the letters after a Social Security or Medicare number.

Fact SheetSOCIAL SECURITY

Social Security National Press Office Baltimore, MD

2018 SOCIAL SECURITY CHANGES

Cost-of-Living Adjustment (COLA):

Based on the increase in the Consumer Price Index (CPI-W) from the third quarter of 2016 through the third quarter of 2017, Social Security and Supplemental Security Income (SSI) beneficiaries will receive a 2.0 percent COLA for 2018. Other important 2018 Social Security information is as follows:

Tax Rate 2017 2018 Employee 7.65% 7.65%

Self-Employed 15.30% 15.30%

NOTE: The 7.65% tax rate is the combined rate for Social Security and Medicare. The Social Security portion (OASDI) is 6.20% on earnings up to the applicable taxable maximum amount (see below). The Medicare portion (HI) is 1.45% on all earnings. Also, as of January 2013, individuals with earned income of more than $200,000 ($250,000 for married couples filing jointly) pay an additional 0.9 percent in Medicare taxes. The tax rates shown above do not include the 0.9 percent.

2017 2018 Maximum Taxable Earnings

Social Security (OASDI only) $127,200 $128,4001 Medicare (HI only) No Limit

Quarter of Coverage $1,300 $1,320

Retirement Earnings Test Exempt Amounts

Under full retirement age $16,920/yr. ($1,410/mo.)

$17,040/yr. ($1,420/mo.)

NOTE: One dollar in benefits will be withheld for every $2 in earnings above the limit.

The year an individual reaches full retirement age

$44,880/yr. ($3,740/mo.)

$45,360/yr. ($3,780/mo.)

NOTE: Applies only to earnings for months prior to attaining full retirement age. One dollar in benefits will be withheld for every $3 in earnings above the limit.

Beginning the month an individual attains full retirement age None

2017 2018 Social Security Disability Thresholds

Substantial Gainful Activity (SGA) Non-Blind $1,170/mo. $1,180/mo.

Blind $1,950/mo. $1,970/mo. Trial Work Period (TWP) $ 840/mo. $ 850/mo.

Maximum Social Security Benefit: Worker Retiring at Full Retirement Age $2,687/mo. $2,788/mo.

SSI Federal Payment Standard

Individual $ 735/mo. $ 750/mo. Couple $1,103/mo. $1,125/mo.

SSI Resource Limits Individual $2,000 $2,000

Couple $3,000 $3,000 SSI Student Exclusion

Monthly limit $1,790 $1,820 Annual limit $7,200 $7,350

Estimated Average Monthly Social Security Benefits Payable in January 2018

Before 2.0% COLA

After 2.0% COLA

All Retired Workers $1,377 $1,404 Aged Couple, Both Receiving Benefits $2,294 $2,340

Widowed Mother and Two Children $2,717 $2,771 Aged Widow(er) Alone $1,310 $1,336

Disabled Worker, Spouse and One or More Children $2,011 $2,051

All Disabled Workers $1,173 $1,197

1This amount was updated per our November 27, 2017 press release titled, Updated 2018

Taxable Maximum Amount Announced.