When you apply for Social Security Disability benefits, your case is referred to a claims examiner who works for Disability Determination Services (DDS). DDS is the state agency responsible for making a decision on your application.

This article explains DDS, what it does, and what tools it uses to make a decision on your Social Security claim. Call or e-mail Corey Pollard, one of the best Social Security Disability lawyers in Richmond, if you have a question about your claim or need help proving you’re disabled under Social Security’s rules and regulations.

What is DDS?

The Virginia Disability Determination Services is a division of the Virginia Department for Aging and Rehabilitation Services. DDS works with the Social Security Administration (SSA)to make decisions on claims for all types of Social Security Disability benefits – Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Medicaid programs.

Though DDS is run differently from state to state, all DDS offices must follow certain federal laws and regulations. DDS is charged with making accurate and prompt decisions on claims for Social Security based on medical, vocational, and educational evidence. This creates uniformity in the Social Security system.

What Claims does DDS Handle?

DDS handles several types of disability claims, including:

  • Initial applications for disability benefits. This is the first step in the Social Security process.
  • Requests for reconsideration. When your initial application for disability benefits is denied, you should file a request for reconsideration. DDS reviews these appeals also.
  • Subsequent initial applications for disability benefits. If you go through the Social Security process and are denied, you may file a new application for benefits. DDS will evaluate and decide this application also.
  • Continuing disability reviews (CDRs). Sometimes DDS will review cases where the applicant has been approved for benefits. The purpose of a CDR is to make sure the person receiving benefits remains disabled.
  • Claims for Medicaid based on Social Security Disability status. Medicaid is a health insurance program for low-income people. It is funded by both the federal and state government.

How Do I Contact DDS?

Are There Times Where DDS Will Put My Claim on Hold?

Yes. Sometimes DDS will wait to make a decision on a claim and put the claim on hold. Usually this happens when you have suffered a severe injury or have a serious illness, but DDS is unsure of whether you will recover fully with appropriate treatment.

For example, you may have suffered a traumatic brain injury in an auto accident or multiple fractures in a work accident. Or maybe you are a firefighter who was diagnosed with heart disease. These are injuries that may resolve within a few months – or may take much longer. DDS may put your claim on hold to see what happens.

DDS Claims Examiners in Your Social Security Claim

Upon receipt of your file from the local Social Security Field Office, DDS will assign your case to a disability claims examiner. There are four types of claims examiners: those who handle initial applications for benefits; those who handle requests for reconsideration; those who supervise other claims examiners; and, those who help with continuing disability reviews (CDRs).

Claims examiners are responsible for the nonmedical aspects of Social Security Disability claims. Their responsibilities include:

  • Determining your age
  • Determining your past relevant work and whether you gained any transferable job skills
  • Determining your highest level of education
  • Obtaining school records if your claim is based on intellectual disability or other mental disorders
  • Scheduling you for consultative examinations if necessary
  • Requesting and obtaining medical records from your treating health care providers
  • Speaking with DDS medical consultants about your medical impairments and whether additional medical evidence is needed
  • Speaking with DDS vocational analysts for clarification on your past work and transferable skills

DDS claims examiners are supposed to conduct their evaluations as directed by the Program Operations Manual System (POMS).

Is the DDS claims examiner supposed to make a medical decision in my case?

No, the claims examiner is not qualified to make a decision on the severity of your medical impairments. Social Security’s regulations do not allow claims examiners to make medical determinations in most cases. The examiner must rely on the medical consultant’s findings.

Unfortunately some claims examiners may try to make medical decisions in your case. They may think that after reviewing hundreds or thousands of claims, they are qualified to make those decisions. But they are not permitted to do so. Your disability attorney will be able to review the file and determine if an improper determination was made.

State Agency Medical Consultants in Your SSDI or SSI Claim

Your DDS claims examiner will work with a medical consultant to evaluate your claim. Medical consultants are the people who review your medical records and make a decision on the severity of your impairments and how they impact your activities of daily living.

A DDS medical consultant must be a licensed medical doctor, osteopathic doctor, or psychologist with a Ph.D. Many DDS doctors are retired physicians.

If you apply for disability based on a mental disorder, a licensed clinical psychologist or psychiatrist will review your claim. If you apply for benefits based on a physical disability, a licensed medical doctor or osteopath will evaluate your claim. If your claim for benefits is based on both mental and physical impairments, then multiple state agency medical doctors may evaluate your claim.

What does a DDS medical consultant do?

Usually the DDS medical consultant receives your claim after the disability examiner has obtained your medical records, talked with you by phone about your medical treatment and activities, and reviewed your work history. The medical consultant will not examine you in person. In fact, he or she will probably not even call you.

The medical consultant will do the following after receiving your file:

  • Evaluate your medical records and reports and compare the findings to Social Security’s Listing of Impairments
  • Determine which of your conditions are severe medical impairments
  • Tell your claims examiner what other evidence would be helpful to making a medical determination in your claim
  • Tell your claims examiner what type of consultative examination(s) should be requested
  • Sign disability assessment forms

The medical consultant should not one of the doctors who examines you at a consultative examination or who treats you in a private practice or local clinic. Such a relationship is disqualifying. Bring it to your disability attorney’s attention immediately.

What happens after the claims examiner and medical consultant at DDS review my case?

So the claims examiner makes a decision on the nonmedical aspects of your SSDI or SSI claim and the medical consultant evaluates the medical portion of your claim. If the DDS medical consultant finds you disabled and the claims examiner finds you meet the nonmedical requirements for disability, then both individuals will sign a determination form. The form is sent to your local SSA Field Office, which will contact you to process the award of benefits.

The SSA must notify you of the approval. Approval should be mailed within two weeks of the DDS decision. Sometimes, however, it takes longer to receive the decision depending on how busy – or motivated – the local SSA Field Office employees are.

If your claim is denied you should receive a copy of the Form SSA-831 Disability Determination and Transmittal. This will provide insight into why your claim was denied. And it will help your Richmond disability attorney build your case.

Frequently Asked Questions about DDS and Social Security Claims

You should stay involved in your SSD claim at every level. If you think your claim is being handled incorrectly, you can do the following:

  • Call your claims examiner and discuss the problem.
  • If you’re not getting anywhere with the claims examiner, ask to speak with his or supervisor
  • Call the DDS director for the regional office handling your claim. We provide contact information above.
  • Write to your legislators and ask for help. CC the DDS director on your letter to the legislator

Question about DDS and Your Social Security Disability Claim