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Social Security Disability Medical Determination

When a claimant submits their Social Security Disability application it is initially processed through a network of local Social Security Administration field offices. These agencies are also known as disability determination Services or DDS. The Federal government administers two separate Social Security Disability programs called Social Security Disability Insurance (SSDI) or Supplement Security Income (SSI).  Supplemental Security Income or Social Security Disability Insurance applications can be completed online, over the phone or through a personal interview at a local Social Security Administration field office.

Each Social Security Disability field office verifies all non-medical eligibility requirements which will vary for each of the federally administered disability programs. After non-medical eligibility is verified, Disability Determination examiners are responsible for obtaining medical evidence for each claimant from their medical sources. The DDS reviews the evidence and determines if it is sufficient to make a disability determination, if it is not, the Disability examiner will send the claimant to a Consultative Examiner or CE for an examination to gather additional medical information.

After all medical evidence is gathered for the claimant, the DDS examiner will make their decision for disability. After the disability decision is made the DDS examiner sends the Social Security Disability case back to the Social Security Administration field office for further processing. If a claim is approved, the Social Security Administration field office will calculate the benefit payment, send the Social Security Disability claimant notification of the date and amount of SSDI or SSI benefits and begin paying the Social Security Disability Insurance or Supplemental Security Income payment. Claimants who are denied benefits will receive a denial notice and they will have 60 days from the date of the denial letter to request a reconsideration of the disability decision. The reconsideration is the first step in the Social Security Administration’s appeal’s process. Social Security Disability claimants who are denied a second time can appeal their SSDI or SSI denial by filing for a Social Security Disability hearing.

Making the Disability Determination Decision

The DDS examiners make their disability determination using what the SSA refers to as the sequential evaluation process. The sequential evaluation process is as follows:

1.     Is the claimant engaged in substantial gainful activity? Work must be both substantial and gainful. Gainful is generally determined by a claimant’s earnings. If a Social Security Disability claimant is self-employed and working at a loss, the SSA may still consider their work gainful. Work is also considered without regard to legality.

2.     Is the claimant’s severe? This may not be difficult to prove, in fact, virtually any reduction in functional capacity may meet this requirement. The combined effect of multiple conditions can also be considered. Conditions must also be expected to last for at least 12 months or result in death.

3.     Does the claimant’s mental or physical condition meet the Social Security Administration’s List of Impairments? If it does the SSA does not consider a claimant’s functional ability to work.

4.     Can the claimant perform past relevant work? The Social Security Administration will review the claimant’s past 15 years of relevant work and determine if the claimant can perform the job with the lightest exertion level. Claimants who can perform any past job will be denied SSDI or SSI benefits. The Social Security Administration will evaluate all jobs as they are ordinarily done even if the claimant’s past job required a greater level of exertion and the claimant could not do their own particular job.

5.     Can the Claimant perform other work? If a claimant can perform another job which exists in significant numbers in the national economy given their residual mental or physical work capacity, age, education or work history, they will be considered not disabled.

If you have a mental or physical health condition and you are not able to work, you may be determined disabled if you have a medical impairment which meets a listing on the SSA List of Impairments. If your condition is not on the Social Security Administration’s List of impairments you may still be awarded Social Security Disability benefits if you do not have sufficient mental or physical residual functional capacity to perform work.