Even if successfully retrieved and assembled, existing documentation may not provide the information needed. Basic problems include:
Doctors do not know what information SSA needs to see in order to make a determination of disability and approve an application.
Doctors do not habitually focus on the impact of a patients condition(s) on functioning, but this is important for establishing disability for some conditions.
What doctors write in their notes following routine health care interactions often does not have anything to do with documenting impairment levels for SSA. Their notes may be difficult to interpret with respect to functioning, and that can make it less likely that SSA will approve the applicant for SSI.
A doctor in Bostons Health Care for the Homeless Program (BHCHP) offered us an example from his own experience: When I see a patient with end-stage renal failure and the person is holding her own, I will probably write doing well in the case notes. What I really mean is, doing as well as can be expected, considering shes dying and hasnt the energy to leave her house for anything but dialysis, but thats not what I write down. If the first comment is what the SSA reviewers see, they are likely to deny the claim unless they also see the test results that accompany the doctors notes. If the doctor instead says what he really means as noted above, the claim is more likely to be approved. People interviewed in several of the communities visited for this project are making special efforts to help doctors understand what they need to write in medical charts to help patients with these severe disabilities qualify for SSI.