How Does DDS Determine Whether A Person Is Disabled?
After Social Security determines you have the necessary work credits to qualify for Social Security Disability Insurance, a state agency determines whether your medical conditions qualifies. The agency is generally known as Disability Determination Service (DDS). Following are the 5 questions that DDS asks, followed by a description of the determinaton process.
The Five Questions that are asked, in the order DDS asks them, are:
Question 1: Are you working?
- The first question is whether you are working at all.
- If you are working, the question is whether you are working. Social Security reframes this question to be: Are you earning enough a month to be engaged in what Social Security refers to as "Substantial Gainful Activity" (SGA). SGA is determined by the amount you make per month (or hours you put in if you are self employed.) In 2016, the question is whether you are earning less than $1,130 a month or $1,820 if you are statutorily blind (these numbers vary from year to year). If you are working and earning more than this amount, your claim will be denied. If not, the evaluator moves on to the next question.
Question 2: Is there a medical problem that impacts your ability to work to any degree?
- You must have a medical condition, either physical or mental, that interferes with your basic work-related activities. If you don't, the claim will be denied. If you do, the evaluator will go to the next step.
Question 3: Is your condition found in the list of disabling impairments or is it equal to a listing?
- Social Security has a list of conditions for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is on the list, you will be determined to be disabled. The list of impairments can be found at http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm
- A diagnosis alone doesn't meet the guidelines of the Listing just because it has the same name as a listed impairment. To be considered a listed impairment, it must have the symptoms, clinical signs, and laboratory findings which are specified in the Listing.
- If your condition is not on the list, the evaluator has to decide if your condition is equal to a listed impairment. For example, you may think that a diagnosis of cancer is serious enough to qualify as a disabling impairment. However, there are many degrees and levels of severity to cancer. The listings under "Neoplastic Diseases -- Malignant" take up several pages to describe the specific types and severity of different cancers that automatically qualify someone for disability benefits.
- The listing level impairment must be demonstrated to have lasted, or be expected to last, for at least the minimum durational requirement for a listing to be met or equaled. Your age, education or past work experience is not relevant to this step.
- If your condition is as severe as a condition on the list, the evaluator will approve your application.
- If your condition is not as severe as a condition on the list, the evaluator will move on to the next question.
Question 4: Can you do the work you did previously?
Since the answer to Question 3 determined that your condition was not as severe as a listed impairment, the next step is to match your condition to your ability to work.
This question first looks at whether you can return to your past relevant work, both on and off the books. The answer depends on knowing the functional demands (both physical and mental) of all your past relevant jobs, and what you can still do at work -- what Social Security calls this your "Residual Functional Capacity" (RFC). For example, if Barry worked as a construction worker that required him to lift 100 pounds, and now he has a bad back, he is not capable of returning to his previous relevant work.
It doesn't matter whether you would be hired to do a job, or whether the job you used to do exists any more (such as being an elevator operator.)
If you can work according to Social Security standards, your claim will be denied. If you can't, the evaluator goes to the next, and last, question.
Question 5: Is there another type of work that you can do?
Technically, at this step, the burden shifts to Social Security.
If you cannot do the work you did in the past, the evaluator looks to see if you are able to adjust to other work that can provide an income at least equal to the amount defined as Substantial Gainful Activity ($830 in 2005). The evaluator checks what Social Security calls a "vocational grid" which helps determine the level of work, if any, that you can sustain both physically and mentally. The grid considers:
- Your medical condition
- Your age, education, past work experience, transferable skills.
- Your "Residual Functional Capacity" (RFC), and
- Whether there is work in the national economy that you can do, given your vocational factors, RFC and your specifics. For example, if you have breathing problems, jobs with exposure to bad air won't be considered for you. If you can't travel to work, a job requiring travel is not considered.
When looking at your past work, and whether you're able to do future work, Social Security recognizes the exertion required in different work levels, such as sitting versus heavy lifting, as well as various skill levels. For more, see Exertion Levels and Skills Level.
The other work DDS looks at doesn't have to be work you like doing: it's any job in the national economy for which you may be qualified.
The amount of your old salary versus what you could make also doesn't matter.
The Social Security Grid: For an example of a grid to get an idea of what Social Security looks for in your situation, click on: http://policy.Social Security.gov/poms.nsf/Inx/0425025005 .
You can obtain the complete Social Security grid from NOSSCR.org for a fee. Click on www.nosscr.org .
If you have tests that are not on Social Security's list, such as because the machine is newer than the ones used by Social Security -- don't worry. Social Security will use the newer tests and results.
If it is determined that you can adjust to another kind of work, your claim will be denied.
If it is determined that you cannot adjust to another kind of work (keeping in mind your age, education and the work you've done), your claim will be approved.
The Process At DDS
When your case is turned over to DDS:
- Your case is assigned to a disability claims examiner.
- The examiner looks to see what medical evidence you have supplied.
- The claims examiner contacts all medical sources to obtain any medical evidence which is missing, if any. You may be contacted to supply additional information. You may be asked to visit another doctor at no cost to you if there is not enough medical information.
- When all the medical information has been received, your status is determined by a two person team consisting of a medical or psychological consultant and the disability examiner.
- The team asks a series of five questions in a pre-set order to determine if you are disabled as defined by the law. The process stops as soon as Social Security can make a determination or decision as to whether or not you are "disabled". [Blindness has its own set of rules. (See: Blindness)].