Help! Decision Writing Advice

[willowby]

Hi, I have been a decision writer for two years. I have definitely increased my drafting pace but I still have a very difficult time with case that have over 400 or so pages of medical records (and I realize that most cases have over that amount). I do not take notes. I draft as I go through the records. I have tried a few times to take notes and then summarize in my drafts instead of going through appointments but I can only do that for files with a limited amount of medical evidence. I would greatly appreciate advice on how to increase my speed in cases with a lot of medical evidence. Do you recommend taking notes? If so, how do you take notes? Do you use excel? Do you use some sort of table? Do you just do it freehand on the computer or paper? On the other hand, would you discourage taking notes because it is a sure way to slow myself down? I struggle to meet the 95% rate every month. I don't break for lunch. I work straight through the day except for bathroom breaks and grabbing stuff to eat from the kitchen. Every month, I seem to get cases that take me a lot more time that we are allotted to do certain cases and then I end up with some cases that take me less time so I can make up the difference (is this the same with other writers?) but, usually, only by the skin of my teeth. I have searched Sharepoint looking for some advice on this issue (getting through cases with lots of medical evidence) and have found very little. Does anyone know of any helpful SSA document on this issue? Thank you.

[lurkerbelow]

Willowby, I'm sorry to hear about the troubles. I certainly sympathise. I'm a DW and yeah, it's not an easy job. But once you learn it, it will be fine.

With the standards as they are, you have to play smart, not accurate. I have a set of steps that I review for every single case before I make a draft: procedural history (not an issue until it is one, then whoo boy), SGA, RFC/Other Work, FA disapproval that sort of thing. Anything that will be a pain in the butt to change later.

Beyond that, instructions require that I vary my approach. Some ALJs instruct exactly what they want, time after time. I am appreciate and utilize this shamelessly. Do the same.

As to notes: I personally do not take notes. Instead, I take stock of the medical records, their dates, and then glean what occured based on various other records. Decision Writer Search (ask another DW for the link at work) is absolutely invaluable. Use it, as it helps you find those little things.

Find shortcuts. Find more shortcuts. Find some more from that. Keep finding them.

And please share tips. I could use them too!

This should be a general thread on the subject, since there are a number of us on this board.  Maybe we can help some newbies.

Feel free to PM me with any more specific concerns.

[jimmy224]

Unless I am doing prehearing reviews for the ALJ, I don’t take notes (my ALJ’s instructions have notes usually). Definitely use DWS tool—it cuts down finding things in the file tremendously (e.g., you can type up mri in search, and dws tool can highlight mri report in file with pin cite. Or you can type in keyword like hospital course to count up number of hospital stays, outcomes, etc)(plus dws puts the file in one pdf, so you can scroll the whole case file without having to navigate multiple PDFs-I find it a timesaver

As for speed, goes without saying to know law for speed (really know the Hallex poms ssrs etc.—once you know the law hallex poms ssrs etc really well, then you know what needs to be articulated and what does not in decision, and then it is just a matter of typing it up. I been doing the job for years, so I have had a chance to really review the regs poms etc, which helps with speed (know what to look for in file, eg to see if claimant meets listing, etc

[lspst888]

I’ve been a AA/SAA for almost 12 years and am typically a high producer. I personally take notes on 90% of the cases I write. I use a blank Word document and put everything in chronological order, summarizing the medical findings in just a line or two per note. I put opinions in a separate note section so I don’t forget to address them all in the decision. I focus on specialist notes, surgeries, imaging, psych med checks, and IP discharge summaries. I never read chiro notes, mainly just note the dates of PT, skim therapy notes and PCP notes, especially if the claimant is seeing any specialists. Even with cases of 1500 pages, my notes are rarely more than 4 pages so I’m not putting a ton of detail, just enough for a good summary and argument.

When drafting, I typically address each category of impairment separately ortho problems together, mental problems together, heart problems, etc. Then I address the opinions. Once I’ve taken notes, writing usually only takes me 60-90 minutes. If you PM me, I’m happy to send you examples of my notes or offer any other advice.

[shoocat]

There is also a B criteria generator out there which you can ask other decision writers about. 

[jimmy224]

On another note—the backlog is just about gone, so I am not sure how they are going to continue to have dwpi with lack of cases🤔. My judge ran out of cases, and I worked on CEOs calling claimants rather than write decisions.

[pepsifan]

I'm sorry you're having a hard time. I'm still burning that they increased DWPI from 80% to 95% that quickly. I have been in a job where I felt insecure in my performance and it was a horrible experience.

I don't know how carefully you read the medical consultants review of the file, but you might want to review that for your cases before you start writing them. They'll tell you what the important stuff is through the date of your decision.

I'm very concise in my writing. "The claimant attended physical therapy in June, July and August 2018 for his shoulder pain." That sentence could easily cover a 50-page PT record. I'll go through the PT record and mostly look at what the claimant was telling the therapist. Did he say he was sore from playing basketball? I'll put that in a separate sentence as I'm writing-it'll ultimately become the paragraph is the RFC/unfavorable analysis.

Similarly, mental health therapy notes can work the same way for me, because I use the mental health auto text combined with DWS. The claimant attended therapy approximately monthly throughout 2019. Then in the paragraph b criteria, I'll DWS things like memory...'Numerous treatment notes indicated that the claimant's memory was intact." (See, e.g., Exh. Y, pp. 1, 6, 44; Exh. Z, p. 4.) Or that her attention span was normal. Or that times he was described as pleasant. I do look for strong evidence one day or another, though: if a clinic banned the claimant for abusive behavior, I'd mention that. Or if someone who said they were scared of crowds went to a concert, I'd also mention that.

I just kind of assumed that all of the DW used the shorter cases to offset the longer cases that take forever to get through. 

My DWPI is fine. But I am looking to jump ship. I think it is only going to get worse, not better, for the DW as we run out cases. Especially since they played with the DWPI numbers even with COVID going on. I would not be surprised if we have furloughs or even an RIF in the next year or so. I have been a fed for a while and I have never been so uncomfortable with the job security inherent in my position. I would suggest that you start looking for other jobs as well.

[willowby]

I have also been assigned lists of CEO file review and calls to make. I'm wondering what will happen if the backlog disappears. Wouldn't the SSA have known when the backlog would disappear by doing a calculation of what each decision writer is supposed to produce, multiply it by the number of decision writers in the nation, and then calculate when the backlog would be eliminated? 

[jimmy224]

Oct 18, 2020 21:13:31 GMT -5 willowby said:

I have also been assigned lists of CEO file review and calls to make. I'm wondering what will happen if the backlog disappears. Wouldn't the SSA have known when the backlog would disappear by doing a calculation of what each decision writer is supposed to produce, multiply it by the number of decision writers in the nation, and then calculate when the backlog would be eliminated? 

I think the new position description says something vague like other duties as needed. What that means I don’t know. We probably will do something other than draft decisions-maybe CEOs, maybe start doing more CDRs, etc.  my judge flat out told there were no decisions available to write , so I worked on CEOs and inputted my time on the worksheet.  They will need to account for the downtime somehow I.e., no decisions to write, so you are sitting in your house not doing anything on the clock getting paid-that could count against your dwpi, need to find some other work or something to account for time not writing decisions

[jimmy224]

Keep in mind too, you do not need to cite all the evidence www.ssa.gov/OP_Home/hallex/I-03/I-3-3-4.html
When determining whether to recommend to the AC that an ALJ's decision is supported by substantial evidence, an Office of Appellate Operations analyst will consider the ALJ's action, findings, and conclusions as well as any evidence the ALJ cited in the decision. Additionally, the analyst will evaluate the entire record, including the evidence the ALJ did not cite in the decision.
www.casemine.com/judgement/us/5be3c1d0342cca4ce4b51c14
The commissioner's reliance on evidence of record not cited by an ALJ in support of the ALJ's stated rationale is not improper. "Evidence not cited by an [ALJ] may be relied upon as substantial evidence in support of his or her decision." Paquin v. Colvin, No. 1:13-cv-360-JDL, 2014 WL 6679123, at *4 n.5 (D. Me. Nov. 25, 2014) (citations omitted).

So, knowing that you don’t need to cite to all the evidence, you can use that to cut down on what you write and get faster at drafting decisions (the key is knowing what needs to be articulated in the decision, what is relevant and needs to be discussed, etc—and you get an understanding of that from reading hallex Poms ssrs etc

[redsox1]

I use bookmarks for notes both as an ALJ and DW. Find it very helpful.

[odarwinian]

There is a wealth of information on World Of Writers as well, including a great word document with tons of autotext and one that has links to just about any reference you might need. It is a little outdated, but easy to bring up to par. Long ago, there was a wonderful document on decision writing compiled by a former writer turned ALJ, but I will have to seach for it...it is the one that references Cheech and Chong if anyone else has it handy. Hang in there!!

[monopoly]

My best advice is to let go of some quality. The Agency has AC agree rate goals that are much lower than productivity goals. I've never heard of anybody getting in trouble for not meeting an AC agree rate goal, but there is a fast smack down if you don't meet productivity standards. That makes the Agency priorities VERY clear. I'm not saying to turn out totally trashy product, but as decision writers we aren't turning out fancy gourmet meals, more like fast food special #4 with no pickles. For a fully fav especially, you can glean a lot just from ALJ notes, rep briefs, hospital discharge summaries, and even summary of evidence in the DDE opinions. I never read chiropractic records and might look at PT records just to get the dates of treatment and body part treated. Don't feel pressured to read every page of every exhibit for every case, just focus on the absolute necessary stuff that lets you be legally sufficient.

[nappyloxs]

A few tips:

Visit world or writer. Hopefully it still exists.
Learn to use autocorrect/autotext/building blocks. Use autocorrect for commonly used terms, dot codes, etc. Use the x or # to create multiple shortcuts for same language.
Remember every decision does not need to be written from scratch. Many parts of the decision can utilize canned language updated to facts
Make his/her language (as well as t2,t16,concurrent)
Yes take notes, even if it is with decision. It really depends on case whether to take notes or draft on the go.
Control+B to bookmark page. Bookmarks can be used instead of notes. Start bookmark with month/year and then quick note.
Draft Para B language last.
Now and days it is best to start with most recent records. With Hitmer and other electronic records, sometimes the entire history or records are in the last few exhibits. The latest treatment note may summarize all the history even if just with that provider. You still have to review the actual notes, but you have the entire history and pertinent info all in the laid out for you.

Here is one that will get most scrutiny. Listen to hearing first and focus attention on what the claimant testified about. About 30 minutes to 1.5 hours to listen and type out testimony. You will also get correct rfc, prw, and dot. Then focus your review of records on claimant’s allegations at the hearing. Claimant doesn’t complain of knee pain at the hearing. No need to go to in depth on it because judge finds it djd of knee severe. Claimant testifies to excruciating back pain, focus time on that instead. You still want to review and cover everything in record. Between instructions and testimony that gives you plenty of info to focus on specific issues before you begin your file review.

Also, it will help identify any possible issues earlier rather than later, such as claimant testified to impairments not mentioned in instructions or ve issues.

2 years is nothing. I tweaked my style for years in an attempt to find my balance of quality and quantity.

[WallyGator]

I found writing while reviewing (multitasking) always felt faster, but in the end took longer. I would finish reviewing, my time would almost be up, and I would have pages and pages written, but only just figured out what the decision needed to say. I’d rush to finish. I would be frustrated that my productivity was slipping down more and that I was not happy with the draft that felt rushed. My productivity was always better when I reviewed the record first and then drafted from my outlined notes.

When they first came out, I tried bookmarks, but eventually let them go. It works alright if you develop a system. I think someone suggested starting with the date and that can help, but then the best you can sort is chronological. You can start the bookmark with impairment and then the date to try to sort by impairment. Ultimately I found that I generally organized my notes by impairment and it’s not easy to do with bookmarks. HACPS does allow you to create notes not tied to exhibits that work better for this, but I don’t think the writer can access that feature once instructions are completed.

I would recommend drafting the discussion of the claimant’s allegations before looking at the medical evidence. Also review the DDEs along with the instructions to try to get an idea of what you will find in the file. Next review the opinions and the consultative examinations. These set up some snapshots to use and compare to the other evidence. Have a strategy when reviewing the medical evidence and don’t go by exhibit number. Try to group together evidence related to each impairment and review all records from one source before moving on to another source to help weed out duplicates and get the full picture from that source. Try to start with what might be the most important evidence such as specialty treatment before looking at evidence likely to be less important such as physical therapy records. I think someone else mentioned this, but draft the listings after the support for the residual functional capacity. At that point you will have a good idea of what evidence supports the step three finding and in particular the B criteria.

I disagree with the recommendations of auto text. There is already a lot of template language. It should be used sparingly and for things not covered by the templates. I’m not sure how adding auto text saves time. To use it well it should be tied to evidence in the file. In many cases it simply adds pages without adding much value to the decision.

I think my favorite resource is no longer on there, but there are some resources regarding this on the decision writer share point site - the one used for new decision writer training. Maybe it’s changed, but I don’t remember WOW being very active. However, I do access the training share points with some degree of regularity as the modules can be great for finding information such as citations in the regulations or which SSR might apply. I think there is something on the training share point now about how to write less and say more.

Best of luck. I hope you can find what works for you. I think it’s easy to experience burn out and feel isolated as a writer, but there are a lot of positives about the job. If you can find a routine that maintains your numbers with the quality level you want there can be a sense of accomplishment while also maintaining a good work life balance. The work life balance and having more control over the quality of my work product are things I miss about being a decision writer.

[nappyloxs]

Oct 19, 2020 19:35:28 GMT -5 WallyGator said:

I found writing while reviewing (multitasking) always felt faster, but in the end took longer. I would finish reviewing, my time would almost be up, and I would have pages and pages written, but only just figured out what the decision needed to say. I’d rush to finish. I would be frustrated that my productivity was slipping down more and that I was not happy with the draft that felt rushed. My productivity was always better when I reviewed the record first and then drafted from my outlined notes.

When they first came out, I tried bookmarks, but eventually let them go. It works alright if you develop a system. I think someone suggested starting with the date and that can help, but then the best you can sort is chronological. You can start the bookmark with impairment and then the date to try to sort by impairment. Ultimately I found that I generally organized my notes by impairment and it’s not easy to do with bookmarks. HACPS does allow you to create notes not tied to exhibits that work better for this, but I don’t think the writer can access that feature once instructions are completed.

I would recommend drafting the discussion of the claimant’s allegations before looking at the medical evidence. Also review the DDEs along with the instructions to try to get an idea of what you will find in the file. Next review the opinions and the consultative examinations. These set up some snapshots to use and compare to the other evidence. Have a strategy when reviewing the medical evidence and don’t go by exhibit number. Try to group together evidence related to each impairment and review all records from one source before moving on to another source to help weed out duplicates and get the full picture from that source. Try to start with what might be the most important evidence such as specialty treatment before looking at evidence likely to be less important such as physical therapy records. I think someone else mentioned this, but draft the listings after the support for the residual functional capacity. At that point you will have a good idea of what evidence supports the step three finding and in particular the B criteria.

I disagree with the recommendations of auto text. There is already a lot of template language. It should be used sparingly and for things not covered by the templates. I’m not sure how adding auto text saves time. To use it well it should be tied to evidence in the file. In many cases it simply adds pages without adding much value to the decision.

I think my favorite resource is no longer on there, but there are some resources regarding this on the decision writer share point site - the one used for new decision writer training. Maybe it’s changed, but I don’t remember WOW being very active. However, I do access the training share points with some degree of regularity as the modules can be great for finding information such as citations in the regulations or which SSR might apply. I think there is something on the training share point now about how to write less and say more.

Best of luck. I hope you can find what works for you. I think it’s easy to experience burn out and feel isolated as a writer, but there are a lot of positives about the job. If you can find a routine that maintains your numbers with the quality level you want there can be a sense of accomplishment while also maintaining a good work life balance. The work life balance and having more control over the quality of my work product are things I miss about being a decision writer.

Autotext can save tons of time and helps with quality of decision. I agree with you though, it should be used effectively not just to add language. You can use it for DOT codes. Even helps to catch errors in DOT numbers. Dot# generates your job sentence with dot #, exertion, svp. DDD changes to degenerative disc disease. Light# generates .... TC = the claimant. YCE psychological consultative examination. Building blocks is a little trickier. These tools were specifically created to speed up and save time writing. It takes time to build a library (and make sure to back it up), but once you get use to adding to library and using the tools, it saves time writing, saves time proofreading, and hopefully lowers the odds of CTS.

As to quality, it helps with reducing grammar errors, helps spell out words and/or acronyms instead of using acronyms, quickly adds those extra sentence or two to a paragraph or finding that makes it more persuasive. You can’t draft the entire decision with autotext, but it can help draft a more persuasive legally sufficient decision quicker.

Tip: Set up 1st tab of toolbar with options to quickly add to autocorrect or building blocks. Even better, move the quick access toolbar below the regular toolbar and add the options there also. I learned this trick from a legal writing CLE.

[WallyGator]

Those types of auto text can be time savers when used carefully. Also things such as common phrases in residual functional capacities like “able to understand, remember, and carry out simple instructions.” I guess I took the earlier comment of looking for auto text on WOW to mean something different. I agree that using auto text to reduce typing common phrases is a time saver. I think that used to be an autocorrect function in a previous version of Word. When I read auto text, pages of listing criteria and explanations of what obesity is came to mind. I understand now and I do agree with you that it can save time.

Oct 19, 2020 20:44:39 GMT -5 nappyloxs said:

Oct 19, 2020 19:35:28 GMT -5 WallyGator said:

I found writing while reviewing (multitasking) always felt faster, but in the end took longer. I would finish reviewing, my time would almost be up, and I would have pages and pages written, but only just figured out what the decision needed to say. I’d rush to finish. I would be frustrated that my productivity was slipping down more and that I was not happy with the draft that felt rushed. My productivity was always better when I reviewed the record first and then drafted from my outlined notes.

When they first came out, I tried bookmarks, but eventually let them go. It works alright if you develop a system. I think someone suggested starting with the date and that can help, but then the best you can sort is chronological. You can start the bookmark with impairment and then the date to try to sort by impairment. Ultimately I found that I generally organized my notes by impairment and it’s not easy to do with bookmarks. HACPS does allow you to create notes not tied to exhibits that work better for this, but I don’t think the writer can access that feature once instructions are completed.

I would recommend drafting the discussion of the claimant’s allegations before looking at the medical evidence. Also review the DDEs along with the instructions to try to get an idea of what you will find in the file. Next review the opinions and the consultative examinations. These set up some snapshots to use and compare to the other evidence. Have a strategy when reviewing the medical evidence and don’t go by exhibit number. Try to group together evidence related to each impairment and review all records from one source before moving on to another source to help weed out duplicates and get the full picture from that source. Try to start with what might be the most important evidence such as specialty treatment before looking at evidence likely to be less important such as physical therapy records. I think someone else mentioned this, but draft the listings after the support for the residual functional capacity. At that point you will have a good idea of what evidence supports the step three finding and in particular the B criteria.

I disagree with the recommendations of auto text. There is already a lot of template language. It should be used sparingly and for things not covered by the templates. I’m not sure how adding auto text saves time. To use it well it should be tied to evidence in the file. In many cases it simply adds pages without adding much value to the decision.

I think my favorite resource is no longer on there, but there are some resources regarding this on the decision writer share point site - the one used for new decision writer training. Maybe it’s changed, but I don’t remember WOW being very active. However, I do access the training share points with some degree of regularity as the modules can be great for finding information such as citations in the regulations or which SSR might apply. I think there is something on the training share point now about how to write less and say more.

Best of luck. I hope you can find what works for you. I think it’s easy to experience burn out and feel isolated as a writer, but there are a lot of positives about the job. If you can find a routine that maintains your numbers with the quality level you want there can be a sense of accomplishment while also maintaining a good work life balance. The work life balance and having more control over the quality of my work product are things I miss about being a decision writer.

Autotext can save tons of time and helps with quality of decision. I agree with you though, it should be used effectively not just to add language. You can use it for DOT codes. Even helps to catch errors in DOT numbers. Dot# generates your job sentence with dot #, exertion, svp. DDD changes to degenerative disc disease. Light# generates .... TC = the claimant. YCE psychological consultative examination. Building blocks is a little trickier. These tools were specifically created to speed up and save time writing. It takes time to build a library (and make sure to back it up), but once you get use to adding to library and using the tools, it saves time writing, saves time proofreading, and hopefully lowers the odds of CTS.

As to quality, it helps with reducing grammar errors, helps spell out words and/or acronyms instead of using acronyms, quickly adds those extra sentence or two to a paragraph or finding that makes it more persuasive. You can’t draft the entire decision with autotext, but it can help draft a more persuasive legally sufficient decision quicker.

Tip: Set up 1st tab of toolbar with options to quickly add to autocorrect or building blocks. Even better, move the quick access toolbar below the regular toolbar and add the options there also. I learned this trick from a legal writing CLE.

[maquereau]

It is almost never a good idea to open the file and start typing, unless you are certain that judges and reviewing bodies like stream of consciousness style.

See the forest. Then worry about the trees. Read the DDS analysis and do file review hitting the essentials of what the case is about. I sometimes see decisions where every single doctor visit is written out (usually poorly) and with notes about blood pressure, or claimant's height, or glomerular filtration rate in cases where none of that is an issue.

Consider starting your paragraphs with topic sentences that give some context to what will follow so that the material flows smoothly and reads easily to a reviewer. Wrap up the impairment definitively and then go to the next impairment. Let the reader know where we stand with respect to a claim about a particular impairment and then move on to the next.

If you can master Dragon, that may be a file review timesaver for you. The job of writer is certainly not for everyone. You need to be able to digest a lot of material quickly and then retain it while sorting out a rough outline for your draft. I have no idea why management has decided that the fewer pending cases we have the less time a writer is allowed to spend on any one of them. It is stupid beyond belief.

[Wynona Writer]

I did not read through all of the replies, so I apologize if someone has already said this. I tried taking notes for a while but found that it was far too time consuming. I now rely mostly on adding bookmarks to the file. As I skim through the records I will bookmark notable examination findings, imaging studies, reports by the claimant that are/are not consistent with the allegations. I will also bookmark a representative sample of BMI numbers if obesity is an issue. Having these easy to access bookmarks makes the drafting much faster. I also use the eview search function. It’s not as accurate as the DWS tool but much more convenient. I will do a search for key words like “lumbar” “gait” “memory” etc depending on what the impairments are. Hope this helps.

[Portulaca]

Oct 18, 2020 22:29:36 GMT -5 jimmy224 said:

Keep in mind too, you do not need to cite all the evidence www.ssa.gov/OP_Home/hallex/I-03/I-3-3-4.html
When determining whether to recommend to the AC that an ALJ's decision is supported by substantial evidence, an Office of Appellate Operations analyst will consider the ALJ's action, findings, and conclusions as well as any evidence the ALJ cited in the decision. Additionally, the analyst will evaluate the entire record, including the evidence the ALJ did not cite in the decision.
www.casemine.com/judgement/us/5be3c1d0342cca4ce4b51c14
The commissioner's reliance on evidence of record not cited by an ALJ in support of the ALJ's stated rationale is not improper. "Evidence not cited by an [ALJ] may be relied upon as substantial evidence in support of his or her decision." Paquin v. Colvin, No. 1:13-cv-360-JDL, 2014 WL 6679123, at *4 n.5 (D. Me. Nov. 25, 2014) (citations omitted).

So, knowing that you don’t need to cite to all the evidence, you can use that to cut down on what you write and get faster at drafting decisions (the key is knowing what needs to be articulated in the decision, what is relevant and needs to be discussed, etc—and you get an understanding of that from reading hallex Poms ssrs etc

Before relying on the bolded advice above, I would recommend looking at Chenery v. SEC, 318 U.S. 80 (1943), an old US Supreme Court case that did not buy the use of post hoc rationale that was not relied on by an ALJ. While the AC may be okay with looking at the record to see whether the ALJ's decision is supported by substantial evidence, including evidence not clearly relied on, federal courts cannot be expected to do so.  There is obviously some gray area here, but I think the evidence cited needs to provide substantial evidence in support of the ALJ's findings.