The Disability Award Decision Process

by Tim Moore, Disability Representative in North Carolina

How Does the disability award process work?

Step one

The process that hopefully ends with you receiving a disability award begins with filing your claim. You can do this online, by calling the SSA toll free line, or by contacting a local Social Security office.

(Call if you live in North Carolina)

Speaking as a former disability examiner, I advise you to contact a local office when you file for disability benefits. This will allow you to ask questions and avoid mistakes. When you do your disability application interview with a local office, it can be done over the phone, or at the office, whichever is more convenient.

Step two

After you apply for disability benefits, your case is sent to Disability Determination Services, or DDS. Here it is assigned to a disability examiner who will evaluate the claim. This is where the disability award process really begins.

Step three

The disability examiner who gets your case will send requests for your medical records to the doctors you listed when you applied. After receiving the records, the examiner will evaluate them.

At this point, we should say that there are two different ways of being awarded disability.

The first way to get disability – if your condition is on “the list”

In working on your case, the examiner may check the Social Security impairment listing manual (known as the blue book) to evaluate your physical or mental condition.

If you have a medical condition on the list, you may get disability this way. However, the requirements of a listing (such as for depression) are very specific. Most people don’t win their benefits this way. And even being diagnosed with a listed condition will not mean an approval if the medical records don’t provide the right information.

The second way to get disability – when the evidence shows you can’t go back to work

This is how the vast majority of people receive a disability award.

If the examiner can’t give you a listing approval, they will look to see if they can make a “medical vocational allowance”. This means the examiner will use your medical records and work history information to 1. determine what your past work required, and 2. determine if you have the ability to still do your past work, or to switch to some type of other work.

If you can’t do either of these things, you may be approved for disability.

How does the examiner make a medical vocational approval?

The examiner will decide what your residual functional capacity is. RFC, or residual functional capacity is an assessment of what you can still do even with your condition. To measure it, Social Security looks at your medical records and decides what it is that you can’t do. Perhaps you have trouble bending at the waist, or reaching overhead, or sitting or standing more than a short amount of time. Maybe you have difficulty remembering, or learning new things, or being around other people. These things get measured on an RFC assessment. And this measurement allows a disability examiner to decide what kind of work you can, and cannot, do.

What if you can’t go back to your past work?

Your RFC assessment is compared to the requirements of your old jobs. If you can’t go back to your past work, the disability examiner will investigate the possibility of you switching to some type of other work (that you have never done before). This will be based on your work skills, as well as your age, education, and residual functional capacity.

If you cannot do your past work, or do some type of other work, you will be approved for disability benefits under SSD or SSI.

But, if you CAN do either your past work or some type of other work, you will be denied on your claim for disability benefits.

There, in a nutshell, is how the disability process works. And this is, for the most part, how a judge will also decide a case at a hearing.