INSIDE A SOCIAL SECURITY DISABILITY DECISION
You have filed an application for Social Security disability benefits. You've been told it will be 90 to 120 days before a decision is reached. Let's go inside Social Security for a closer, partial look at what is happening with your application.
After the local Social Security field office has gathered all the forms and papers associated with your initial claim, the file will be sent to the Disability Determination Service (DDS) in Birmingham. The DDS is a state agency that will investigate your claim and decide whether you meet the rules to get disability payments. Your application will probably spend 3 to 4 months at DDS being processed.
DDS will assign a case worker, called a "disability specialist" to herd your application through the process. This person will probably call you early on to introduce himself/herself and briefly explain the process to you.
DDS will now order medical records from each doctor, hospital or other provider that you listed in your application. They get raw medical records. DDS does not ask the doctors whether or not you are disabled. They will look at doctor's notes from each office visit, each ER visit or hospitalization. X-ray, MRI, EKG and CT scan reports will be analyzed.
If your medical records are incomplete, not recent, or fail to clearly show how severe your medical conditions are, the disability examiner may order you to report to a doctor of their choice for a consultative examination. They can ask for a physical examination by a medical doctor or psychological consultation by a licensed psychologist.
Note: You have a right to have YOUR DOCTOR perform a consultative exam, providing your doctor is qualified (CFR 404.1527). He must agree to accept the payment that DDS offers for this exam. Many doctors charge more than DDS pays.
DDS cannot force you to attend a consultative examination; however, it is usually in your best interest to do so. They will pay for the exam.
The disability specialist at DDS will analyze your past jobs and determine the required skill level required for each job and determine an exertion level for each job.
The specialist, perhaps in consultation with a vocational rehabilitation counselor and or a staff medical doctor will determine the "residual functional capacity" (RFC) at which you are capable of working. The 5 RFCs are: sedentary, light, medium, heavy and very heavy work. Sedentary is the most restrictive and very heavy is the least restrictive. Assigning the RFC is the heart of the case. If they get this wrong, your denial will be erroneous and unfair. This is primarily what will be challenged at the hearing/appeal.
Note: If the disability examiner at DDS does not use a medical professional in forming an opinion about your medical limitations and your ability to perform work related tasks, she is called a "Single Decision Maker" or SDM and her conclusions are NOT entitled to be considered as medical opinion evidence in any subsequent hearing or appeal.
If you are age 50 or over, DDS must determine whether you are physically and mentally capable of performing any of your "past relevant work" (full-time jobs you have held during the past 15 year period just before your application). If you are judged capable of performing past relevant work, you will be found not disabled, not eligible for benefits.
The only factors that can be considered in determining whether you can perform past work are: age, education, past work experience and residual functional capacity.
If you are under age 50, DDS must determine whether you are physically and mentally capable of performing any other job which exists in the US economy. They will again use only age, education, past work experience and residual functional capacity to make this determination. If you are found capable to performing any work which exists in significant numbers in the US economy, you will be denied. For example, if they find you are capable of being an egg washer, silverware wrapper, parking garage attendant or house cleaner, they will deny benefits--even if you have a college education and once had a highly skilled job.
After the local Social Security field office has gathered all the forms and papers associated with your initial claim, the file will be sent to the Disability Determination Service (DDS) in Birmingham. The DDS is a state agency that will investigate your claim and decide whether you meet the rules to get disability payments. Your application will probably spend 3 to 4 months at DDS being processed.
DDS will assign a case worker, called a "disability specialist" to herd your application through the process. This person will probably call you early on to introduce himself/herself and briefly explain the process to you.
DDS will now order medical records from each doctor, hospital or other provider that you listed in your application. They get raw medical records. DDS does not ask the doctors whether or not you are disabled. They will look at doctor's notes from each office visit, each ER visit or hospitalization. X-ray, MRI, EKG and CT scan reports will be analyzed.
If your medical records are incomplete, not recent, or fail to clearly show how severe your medical conditions are, the disability examiner may order you to report to a doctor of their choice for a consultative examination. They can ask for a physical examination by a medical doctor or psychological consultation by a licensed psychologist.
Note: You have a right to have YOUR DOCTOR perform a consultative exam, providing your doctor is qualified (CFR 404.1527). He must agree to accept the payment that DDS offers for this exam. Many doctors charge more than DDS pays.
DDS cannot force you to attend a consultative examination; however, it is usually in your best interest to do so. They will pay for the exam.
The disability specialist at DDS will analyze your past jobs and determine the required skill level required for each job and determine an exertion level for each job.
The specialist, perhaps in consultation with a vocational rehabilitation counselor and or a staff medical doctor will determine the "residual functional capacity" (RFC) at which you are capable of working. The 5 RFCs are: sedentary, light, medium, heavy and very heavy work. Sedentary is the most restrictive and very heavy is the least restrictive. Assigning the RFC is the heart of the case. If they get this wrong, your denial will be erroneous and unfair. This is primarily what will be challenged at the hearing/appeal.
Note: If the disability examiner at DDS does not use a medical professional in forming an opinion about your medical limitations and your ability to perform work related tasks, she is called a "Single Decision Maker" or SDM and her conclusions are NOT entitled to be considered as medical opinion evidence in any subsequent hearing or appeal.
If you are age 50 or over, DDS must determine whether you are physically and mentally capable of performing any of your "past relevant work" (full-time jobs you have held during the past 15 year period just before your application). If you are judged capable of performing past relevant work, you will be found not disabled, not eligible for benefits.
The only factors that can be considered in determining whether you can perform past work are: age, education, past work experience and residual functional capacity.
If you are under age 50, DDS must determine whether you are physically and mentally capable of performing any other job which exists in the US economy. They will again use only age, education, past work experience and residual functional capacity to make this determination. If you are found capable to performing any work which exists in significant numbers in the US economy, you will be denied. For example, if they find you are capable of being an egg washer, silverware wrapper, parking garage attendant or house cleaner, they will deny benefits--even if you have a college education and once had a highly skilled job.
"Assigning the wrong RFC is the very heart of the case; this is what will be challenged at the hearing or appeal. If the RFC is wrong, then the denial is wrong."
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