The Decision on Social Security Disability or SSI is based on evidence of functional limitations
For a Social Security Disability or SSI claim that is being determined at DDS, or disability determination services, the decision is based on evidence of functional limitations.
Functional limitations are extrapolated from the information contained in the claimant's medical records. What does the social security administration consider to be limitations? Specific limitations might refer to how long a person can sit, stand, or walk during the course of a normal work day. Or how much they can lift. Or whether or not they can tolerate heights and hazards, or see or hear or smell sufficiently.
There are mental limitations as well, and these can include a reduced ability to concentrate and pay attention, maintain a work pace, learn new information, remember previously learned information, avoid job hazards, and interact appropriately with other individuals such as work colleagues and managers, as well as an impaired ability to adapt to changes in the work environment, or
Functional limitations that are noted by the disability examiner will be used to determine whether or not the claim is approved or denied. However, the disability examiner does not make the decision entirely by himself. Before the case can be decided, the examiner will consult with one or more consultants that are part of the examiner's case processing unit.
If the claim is based on just one or more physical conditions, the examiner will consult with a medical consultant (very often, right down the hall from the examiner's cubicle or office) who is an M.D. physician. If the disability claim is based on a mental condition, the examiner will consult with PH.D. - level psychologist who is also part of the examiner's unit. Very often, as many cases involve both physical and mental conditions, the disability examiner will need to consult with, and obtain the approval of, both unit consultants before a final decision can be made.
Once the decision on the case is made, the claimant's file is transferred back to the social security office where it was originally taken.
Can a claimant contact disability determination services and speak to the disability examiner about their case? Yes, and it may even be possible to meet with the examiner to ask about the progress and status of the claim. However, in a large percentage of cases, the examiner will actually contact the claimant to inquire about their work history, medical history, or their daily activities.
Note: Information about ADLs, or activities of daily living, can give the disability examiner additional insights into what ways the claimant might be functionally limited. Or the reverse, indicating how capable they are actually are with regard to day-to-day tasks.
The disability examiner, however, cannot release any information to the claimant regarding what the decision on the case might be, or what the decision actually is (assuming that a decision has been reached). This is because formal notification must be made by the social security administration and also because some cases are randomly selected for quality control checks which, in a small percentage of cases, can actually change the outcome of a disability case.
How? If the quality control division, known as DQB--disability quality branch--finds that the disability examiner did not evaluate the medical evidence properly, or did not apply a regulation or rule properly, an approval can become a denial.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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