Writing the Medical Summary Report: How Hard Can It Be?

As a member of the SSI/SSDI Outreach, Access, and Recovery (SOAR) Technical Assistance (TA) Center team for 9 years, my role has primarily been behind the scenes. Give me a website page to create, an issue brief to edit, or a SOAR Online Course trainee who needs technical assistance, and I am perfectly happy!

However, to round out my knowledge, Kristin Lupfer, SOAR TA Center Project Director, asked that I complete a Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI) application for an individual from Interfaith Partnership for the Homeless (IPH). While this was outside of my usual role, (and, quite frankly, my comfort zone), I was excited to take on this challenge and gain experience. I looked forward to putting all I had learned about SSI/SSDI and SOAR into practice. While I knew it would take a lot of time and effort, I figured, “how hard can it be?”

Don’t misunderstand me—I have the utmost respect for the front-line SOAR caseworkers who are out there every day changing lives. It is emotionally, psychologically, and physically trying work. I am a Social Worker (at least by education) and have at least some experience with direct service—notice I didn’t choose that path.

I had a number of things going for me that I thought would make this task “easier” than I suspected it was for those out in the field.  I was extremely familiar with the SSI/SSDI application forms and process—after all, I work at the SOAR TA Center; it’s what we do! I have written and edited website pages, documents, handouts, and other resources that explain SSI/SSDI and the SOAR model. I have completed the SOAR Online Course and reviewed hundreds of sample application packets from other trainees. What else did I need?

Even further, one of the greatest challenges for SOAR caseworkers is gathering all the necessary information from an individual who is experiencing homelessness; that information not always easy to find. The applicant I would be assisting worked part-time at IPH, and we would have weekly meetings.  (There’s a myth busted for you…you can work and apply for/receive SSI/SSDI!). Plus, I wouldn’t be doing it alone.  My co-worker, Abby Kirkman, who has submitted several SSI/SSDI applications, would be with me every step of the way.

So, off we went to meet our applicant, Evan*. He was easy to talk to, very open and honest about his struggles and was eager to get started. Over the course of several weeks, we learned more about his life, health conditions, the trauma he had experienced, and more. With every visit, I became more comfortable with the process, as did he. We were building rapport and mutual trust, and Abby and I were able to gather all the information we needed. The paperwork was tedious, but not too challenging. When his medical providers were slow to respond or send his records, it was certainly frustrating. Fitting this process into my regular workload took some additional time management skills. But all in all, it was going well. Then, it came time to write the Medical Summary Report (MSR).

It was the hardest thing I have ever done.

The Medical Summary Report (MSR) is SOAR’s signature tool and the key to a successful application. It provides a succinct, comprehensive summary of the applicant’s personal and treatment history and its impact on his or her life. It also clearly describes the factors affecting functioning and ability to work. It is a letter written by the case manager and submitted as part of the SOAR application packet. Learn more on the SOARWorks website!

The MSR is a bear, and the description above doesn’t quite do it justice. It is your one shot to provide a unique perspective of the applicant based on your observations and the details of their life that they, and those who know them, have shared with you. Much of this information won’t be found in the medical records that are submitted as part of the application packet, particularly regarding the applicant’s ability to function (e.g., follow instructions, maintain concentration, get along with others, and manage oneself physically and emotionally) both in the community and the workplace. This is all crucial information needed for a decision to be made about whether this person qualifies for SSA disability benefits.

Evan was a real person who was counting on attaining these benefits to improve his quality of life. This wasn’t “Collette Rose” or “Michael Byrnes,” the fictional applicants from the SOAR Online Course: Adult Curriculum. I came to realize that knowing how to complete forms and reading sample MSRs means nothing when you have the details of someone’s life laid out in front of you and it is your responsibility to tell their story.

I spent hours poring through interview notes and medical records, pulling out the relevant details and quotes, and organizing all of the information. I spent many more hours writing and re-writing to get it just right. When all was said and done, I ended up telling Evan’s story in 9 pages. In many respects, it was more challenging than any paper I had written in college or graduate school, although those were often twice the length and entailed more research. None of those would affect someone’s life.

We knew going in that this was an “iffy” case, as Evan’s physical and mental health diagnoses and symptoms weren’t quite at the level required for an approval. However, it didn’t make it any less heartbreaking when we received the denial letter from SSA. All that hard work, for…what? Evan’s willingness to share the details of his life with strangers, all for naught. It was frustrating and disappointing, to say the least. On the positive side, he continues to do well with his part-time job, and he has a (subsidized housing) roof over his head. I at least know that he is not sleeping outside without access to basic necessities, like so many of those experiencing homelessness do.

So, to all you SOAR caseworkers out there—keep fighting the good fight. My respect and admiration for the work you do is immeasurable. I could not do what you do day in and day out. But if you call the SOAR TA Center in need of a document, worksheet, or resource that can make your job easier, I’ll be here.

*Name changed to protect applicant anonymity.

Benefits, SOAR    

The views expressed by the blog post author are their own and do not necessarily represent the official views of Policy Research Associates, Inc.

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