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Social Security Disability, SSI Disability - Terms, Definitions, Concepts
What is DDS, or Disability Determination Services ?
How to prove you are disabled
and win disability benefits
When you file a claim for disability benefits with SSA, your application will be taken by a CR, or Social Security claims representative if you go to your local Social Security office, or if you file your disability application with a local office by phone. The claims representative will take information about your disabling condition or conditions, medical treatment, and work history in order to get your disability file ready for a medical determination. However, the claims representative at the local Social Security office does not process your disability determination. Instead, it goes to a state agency.
The Role of Disability Determination Services a.k.a. DDS
The Social Security Administration uses state disability agencies to process medical determinations. Each state has at least one disability agency (and some have more than one agency) which is responsible for making Social Security disability and SSI decisions. In some states, the state agency is known as Disability Determination Services and in other states the agency that makes medical decisions on claims is known as the Bureau of Disability Determination, or the Disability Determination Division. However, regardless of the name used in a particular state, all such state agencies perform the same function.
And that function is this: after the claim is sent to DDS, it is assigned to a disability examiner who functions similarly to an insurance claims manager. The disability examiner is a specialist who has been trained to interpret medical records and vocational data (involving jobs and work histories).
The examiner has also been trained with regard to the various qualifications for disability, such as the criteria used in the Social Security Administration's guidebook titled "Disability Evaluation under Social Security" which is typically referred to as the Social Security Disability List of Impairments, or simply the listings.
Listings, of course, are one way by which claimants may qualify for disability. However, as most claimants will not satisfy the criteria of a listing (which can be very specific), examiners are also trained to determine if claimants are eligible for disability benefits via a medical-vocational allowance. A medical vocational allowance is awarded when a case has satisfactorily passed through a five step sequential evaluation process that is used by all disability examiners.
Information gathered by the Disability Examiner
To facilitate their work, the disability examiner who has been assigned to a case will gather the medical records from the medical treatment sources supplied by the claimant at the time of their disability interview. The wait for these records will typically require some time and will constitute the greatest portion of processing time for a disability claim.
While the examiner waits to receive the requested medical records (from each hospital and doctor listed by the claimant), they may also gather additional evidence such as information regarding the claimant's relevant work history--meaning potentially all jobs that were performed within the last 15 years. Also, the disability examiner will ordinarily attempt to obtain information regarding the claimant's ADLs, or activities of daily living. This type of information is obtained so that the examiner can discern in what ways the claimant is physically or mentally limited and, thus, restricted in their ability to work.
Medical exams ordered by DDS
Once the disability examiner examines the medical sources and treatment information that have been gathered and placed in the disability claim file, they have to decide if there is enough current medical treatment (treatment that occurred within ninety days of filing for disability) to make a disability determination. If not, they will schedule consultative examinations to provide the necessary medical status information.
The consultative exam, or social security medical exam, of course, serves in most cases simply to provide a small amount of recently dated medical information so that a case decision can be made. And this why most consultative examinations that claimants are sent to by Disability Determination Services are little more than short physical exams. However, in cases involving mental conditions, a CE will often entail much more such as psychological IQ testing, or a full psychiatric evaluation.
Once a CE has been performed by an independent physician or psychologist, the report of the CE findings are sent to the examiner who scheduled the exam.
Decisions made by DDS
After the examiner has determined that they do have enough medical information, the claim can be decided. In a sense, the examiner renders the decision autonomously. However, in actuality, the examiner works in a team that involves a medical consultant (an M.D. physician) and a psycholgical consultant (a Ph.D. psychologist), as well as a case consultant (basically, the assistant supervisor in the examiner's case processing unit).
The decision that is made by the examiner will be based on the medical evidence and vocational information (work history). In the case of children filing for disability, vocational information is not used and the examiner will rely on school records, questionaires from the child's teacher or teachers, and reports of academic and IQ testing.
For adults, the primary consideration is whether or not the individual will be able to return to work activity, either their past work or some type of other work. For children who are filing for disability, the primary consideration is whether or not the child can engage in age-appropriate activities.
Once the evaluation is completed, of course, the disability claim will be approved or denied by the disability examiner. If the disability claim is denied, a decisional notice is automatically generated and mailed to the disability claimant.
However, if the disability claim is approved, allowing the claimant to qualify for disability benefits, the file is sent back to the disability claimant’s local Social Security office for adjudication. Once all issues have been addressed, Social Security will send the disability claimant a formal disability award letter.
To keep in mind when filing for disability
When you apply for Social Security disability or SSI disability, your disability application will typically be taken at a Social Security office, although you are able to file your Social Security disability or SSI disability claim by phone as well.
It is worth noting Social Security does have an online disability application process but this process does not actually allow an SSI disability claim to be formally taken and given a protected filing date. Protected filing dates are very important, of course, since SSI back pay is determined from the date of the application.
For this reason, even though SSA often encourages claimants to file for disability online, it is something of a hollow recommendation. Many claims will be concurrent, meaning that they will involve applications taken in both the title 16 SSI program as well as in the title 2 Social Security Disability program.
Additionally, filing online does not allow a claimant to directly ask questions and receive answers from a Social Security Administration CR, or claims representative; whereas, filing in person at a local Social Security office or even doing a disability application through a phone interview can easily facilitate this and ensure that the claim is started in a way that does not disadvantage the claimant's case.
Individual Questions and Answers
SSD and SSI are Federal Programs
The title II Social Security Disability and title 16 SSI Disability programs operate under federal guidelines and, therefore, the program requirements--medical and non-medical--apply to all states:
Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Recent approval and denial statistics for various states can be viewed here:
Social Security Disability, SSI Approval and Denial Statistics by state
Special Section: Disability Lawyers and unnecessary claim denials