Why is Disability Determination Services (DDS) Deciding My Claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) Benefits

 

The Social Security Administration (SSA) Relies on this State Agency to Make Medical Determinations of Disability at the Initial and Reconsideration Levels

 

Although the Social Security Administration manages the federal disability programs, it rarely decides whether to approve or deny initial applications for SSDI or SSI.

 

Instead, state agencies called Disability Determination Services (DDS) review your adult function report and medical evidence to decide whether you qualify for benefits at the first two levels of the disability appeal process: the initial and request for reconsideration stages.

 

This article explains the role that Disability Determination Services has in your case.

 

If you have more questions about how to win the appeal a disability denial or if you want to hire one of Virginia’s best Social Security disability attorneys, complete this form or call (804) 251-1620 or (757) 810-5614.

 

What is Disability Determination Services?

 

DDS is part of the Virginia Department for Aging and Rehabilitation. It decides whether to allow or deny initial claims for Social Security disability benefits and reconsideration requests after reviewing the medical, educational, and vocational evidence.

 

It also reviews and adjudicates Medicare appeals.

 

Your state likely has a similar setup. All DDS offices nationwide must follow specific federal laws and regulations.

 

Where Does Disability Determination Services Get Its Power?

 

The United States Code – 42 USC Section 421 – gives states the power to decide if you are under a disability, the day such disability began, and whether your disability has ended.

 

To use this power, a State must tell the Commissioner of Social Security in writing that it wants to make such disability determinations.

 

Once notified, the Commissioner of Social Security will “promulgate regulations specifying, in such detail as the Commissioner deems appropriate, performance standards and administrative requirements and procedures to be followed in performing the disability determination function” to “assure effective and uniform administration of the disability insurance program throughout the United States.” For example, these regulations may specify the physical location of the State agency’s staff, performance criteria, and requirements for submitting reports and data.

 

Does the Social Security Administration Retain Power Over Disability Determination Services?

 

Yes.

 

Despite delegating this power and adopting DDS’s decisions at the initial and reconsideration stages, the Commissioner of Social Security retains the power to review disability determinations by state agencies. Indeed, anyone displeased with a DDS determination may request an administrative law judge (ALJ) hearing with the SSA.

 

Who Funds DDS?

 

The federal government advances or reimburses Disability Determination Services from the Social Security Trust Funds.

 

What Happens When Disability Determination Services Receives My Application from the Social Security Administration?

 

After receiving your claim file from the local SSA field office, DDS will assign your case to a disability examiner (DE). This person is not a medical doctor.

 

The DDS disability examiner’s responsibilities include the following:

 

    • Identify the period to consider evidence, such as your date last insured (DLI) and the time when you worked and earned above the substantial gainful activity (SGA) level.

 

    • Obtain evidence from you, your medical sources (office visit notes, diagnostic imaging, etc.), and nonmedical sources such as family members or friends who can testify about your daily living activities.

 

    • Contact you or your attorney and ask for more information if needed. For example, the DDS examiner may see a reference to a permanent impairment rating from a workers compensation case or an MRI in your medical records and call your attorney for a copy of these documents.

 

 

    • Identify and classify your past relevant work under the Dictionary of Occupational Titles (DOT) and whether you gained any transferable job skills in those positions.

 

    • Determine your highest level of education and ability to read or write.

 

    • Request school records if you allege an intellectual disability.

 

 

    • Follow up with CE doctors to obtain reports.

 

    • Prepare your case file for review by a medical consultant (MC), psychological consultant (PC), or medical advisor (MA).

 

    • Ensure that a qualified physician reviews your evidence if you allege a physical impairment and a psychiatrist or a licensed clinical psychologist reviews your medical reports if you allege a mental impairment

 

 

    • Evaluate the vocational parts of your case, including whether you can do any past relevant work or adjust to other work in the national economy given your RFC

 

DDS claims examiners must evaluate your application according to the Program Operations Manual System (POMS).

 

Will the DDS Disability Examiner Decide if I Meet the Medical Requirements for Social Security Benefits?

No.

 

The DDS claim examiner assigned to your case does not have the qualifications to determine if you have a severe medical impairment or how your impairments affect you. Indeed, Social Security’s regulations do not allow disability examiners to make medical determinations in most cases.

 

Instead, the DDS disability examiner should rely on the findings of the medical consultants.

 

What Does the 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. They will probably not even call you.

 

Generally, the medical consultant has these responsibilities regardless of the types of impairments alleged:

 

    • Determine whether the evidence is sufficient to complete the medical portion of the claim review or whether you need further testing.

 

    • Review any consultative examination requests to decide if the exam is necessary.

 

    • Answer medical questions from the disability examiner.

 

    • Determine which conditions are severe medical impairments at step two of the sequential evaluation process and whether you meet or equal a listing at step three of that process.

 

    • Assess your RFC

 

    • Sign disability assessment forms.

 

Is DDS’s Medical Consultant a Healthcare Provider that I Have Seen Before?

 

Probably not.

 

Although the DDS medical consultant must be a licensed medical doctor, osteopathic doctor, or psychologist with a Ph.D., it is unlikely that you will have received treatment with DDS’s medical consultant assigned to your case. Indeed, many DDS doctors are retired physicians.

 

What Happens After DDS Determines My Initial Application?

 

DDS must notify you of its decision in writing.

 

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.

 

DDS sends the form to your local SSA field office so they can contact you to process benefits, including disability backpay.

 

If DDS denies your application, you should receive a Form SSA-831 Disability Determination and Transmittal. This paper will help you determine the reason for the denial.

 

Will the Same DDS Team Review My Claim if I Request Reconsideration of the Initial Denial?

 

No.

 

If you request reconsideration, a different DDS disability examiner and a new medical consultant will review your evidence.

 

However, the data shows that you will likely receive the same result.

 

The next step is to request a hearing before an ALJ, separate from DDS.

 

What Can I Do if I Have Concerns About How DDS Handles My Case?

 

I recommend staying involved in your Social Security case, even if you have hired an attorney.

 

If you have concerns about what DDS is doing, consider these steps:

 

    • Call your claims examiner and discuss the problem.

 

    • If you are not getting anywhere with the claims examiner, ask to speak with their supervisor.

 

    • Call the DDS director for the regional office handling your claim.

 

    • Write to your legislators and ask for help. CC the DDS director on your letter to the legislator

 

What are the Main Differences Between Decisions from Disability Determination Services and ALJ Opinions?

 

My view is that many DDS decisions are cold and mechanical. DDS claims examiners seem unwilling to look beyond the medical reports or give much weight to your reports of symptoms as found in the paperwork.

 

For example, I see claimants have much more success with disability claims at the ALJ level compared to the Disability Determination Services level when:

 

    • The medical reports fail to address all the criteria for Social Security’s listing for your impairment.

 

    • You are under age 50.

 

    • Under the Medical-Vocational Guidelines (the “Grid Rules”), you would be found disabled; however, DDS is unsure how you performed your past relevant work.

 

    • You seek benefits for a back injury, arthritis, diabetes, bipolar disorder, depression, PTSD, or fibromyalgia.

 

Therefore, you should expect to need the Social Security Administration to review the decisions from Disability Determination Services.

 

How Do I Contact DDS in Virginia?

 

Below is the contact information for DDS offices in Virginia:

 

ADMINISTRATIVE HEADQUARTERS

8004 Franklin Farms Dr.

Richmond, VA 23229-5019

Phone: (804) 662-7625

Toll Free: (800) 552-5019

Fax: (804) 662-9041 or (804) 662-7275

 

CENTRAL VIRGINIA OFFICE

9960 Mayland Dr., Suite 200

Richmond, VA 23233

Phone: (804) 367-4700

Toll Free: (800) 523-5007

Fax: (804) 527-4523

 

TIDEWATER OFFICE

5850 Lake Herbert Dr., Suite 200

Norfolk, VA 23502

Phone: (757) 466-4300

Toll Free: (800) 379-4403

Fax: (757) 455-3829

 

NORTHERN VIRGINIA OFFICE

11150 Fairfax Blvd., Suite 200

Fairfax, VA 22030-5066

Phone: (703) 934-7400

Toll Free: (800) 379-9548

Fax: (703) 934-7410

 

SOUTHWEST VIRGINIA OFFICE

612 S. Jefferson Street, Suite 300

Roanoke, VA 24011

Phone: (540) 857-7748

Toll Free: (800) 627-1288

Fax: (540) 857-7707

 

SOUTHWEST REGIONAL OFFICE – EXTENDED SERVICE TEAM (EST)

111 Franklin Road, S.E., Suite 250

Roanoke, VA 24011

Phone: (540) 512-1880

Toll Free: (877) 892-6871

Fax: (540) 512-1990

 

You can also contact your local Social Security field office to learn the status of your claim.

 

Questions About Disability Determination Services and Its Review of Your Disability Claim? We Have Answers.

 

You may feel discouraged by the time it takes for DDS to decide your case or denials at the initial or reconsideration level.

 

But do not give up.

 

We can help.

 

Contact us today.

 

Corey Pollard
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