Disability Determination Services
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Disability Determination Services, commonly called DDS, are state agencies, funded by the United States Federal Government. Their purpose is to make disability findings for the Social Security Administration.
If the application is accepted it is sent to the DDS in the state where the applicant lives to have a person's claim of disability assessed.
The claim is either approved or denied at the DDS for disability qualification. The claim is then returned to the originating SSA office to finish processing.
The following methods are used in determining a disability:
Applicant's own statement
The applicant is requested to provide his/her own information on his/her disability. During the application process, it is requested that the applicant list all conditions that contribute to his/her disability, and how they prevent him/her from working.
In addition to this information being requested during the application process, the applicant is mailed a questionnaire. The questionnaire contains questions pertaining to the applicant's activity before and after s/he became disabled, including what his/her daily activities are, and how the disability has affected his/her ability to perform them. Such activities include activities like dressing, bathing, grooming, food shopping, meal preparation, housekeeping, laundry, and transportation.
Approval is based on how the applicant's medical conditions impact his or her ability to earn an income. While an applicant's own words alone are usually not sufficient to qualify him/her for approval, they can play an important role.
Personal statements can be of questionable validity. If the applicant has expertise in the system, or can obtain help from an expert, they may be able to influence the decision by the use of particular words and phrases.
The applicant's medical records are obtained from physicians involved in the current treatment of the applicant. The physician(s) provide information on the condition(s) for which the applicant is being treated, and how they impede the applicant's ability to work.
In many cases, DDS will send the applicant to one or more physicians for a medical examination, paid by DDS. This most often occurs in the absence of a physician with an existing treating relationship with the applicant who can verify an impairment alleged by the applicant. The examination will be used to verify the information provided by other sources, and to provide a more up-to-date record in making a determination.
Study of applicant's life
Staff of the DDS will often contact the applicant or other people who know the applicant in order to obtain descriptions of "Activities of Daily Living" (ADLs). These ADLs can be combined with the objective medical opinion and the opinions of medical sources to build an assessment of what the applicant can or can not do in a typical day.
Rarely, and in only a limited number of locations, an external investigation can be conducted by a DDS referally to a "Cooperative Disability Investigations" (CDI) unit. Such a referral is made only when fraud is suspected. The purpose is to corroborate that the applicant's statements reflect his/her real life activities. For example, there are cases when one will file for disability, falsely claiming to be unable to engage in various forms of physical activity. The fraudulent applicant is then observed performing tasks outside of a work setting that require the same skills. Such information could be used to then deny benefits.
The examiner and his/her representatives may also call or otherwise obtain statements from those known to the applicant. These persons may include relatives, friends, acquaintances, neighbors, co-workers, and teachers. These questions will be asked in a manner in which evidence may be corroborated.
How the decision is made
The decision is made based on whether or not the applicant is able to perform work that s/he has done in the past or is trained to do, and is likely to be able to perform and find employment in given his/her disability. It is for this reason that two people with identical disabilities could have very differing outcomes in their applications.
The legal definition of a disability that qualifies an applicant for benefits is: “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” For adult applicants, Social Security Administration regulations specify a five-step process for making the decision. A modified process is used in the case of children for whom Supplemental Security Income benefits are being claimed (as children are not expected to work).
For adults, part of the disability-determination process involves assessing the applicant’s “residual functional capacity”; that is, what the applicant can do in spite of his or her disability. Factors that may be considered in determining one’s “residual functional capacity” may include:
- Known limitations caused by diagnosed medical conditions. These limitations must be documented by a physician. Many medical conditions can be debilitating in one person but not another. Almost all applications lacking a physician's documentation of a known condition are rejected.
- Symptoms of undiagnosed medical conditions documented by a physician. Like with diagnosed medical conditions, a physician must document how these are actually debilitating.
- Side effects and other limitations caused by treatment received due to medical condition(s). The need to spend a significant amount of time in one's life to continually receive care in lieu of employment can be a qualifying factor.
Contrary to what many think, simply "being disabled" by any definition does not alone qualify one to automatically be approved. While one who is able to walk, talk, and manage one's own life may be considered disabled if there is no suitable employment given his/her abilities, one with diminished mobility or mental capacity may not qualify if there is plentiful employment available to him/her with his/her abilities.
One or more diagnosed medical conditions may not automatically qualify an applicant, and the lack of one or more may not disqualify the applicant. In some cases, an applicant may qualify based on symptoms alone.
In determining a physical disability, common factors are the ability to sit, stand, lift, bend, and stoop. Mental disabilities are determined based on the ability to communicate with others, understand oral and/or written instructions from others, and to get along with others. One who is able to sit for prolonged periods of time but not stand, lift, bend, or stoop may be disqualified if s/he is able to perform some type of desk work, whereas one may qualify if s/he lacks such an ability given his/her intellectual capacity, education level, or previous work experience. Likewise, a person with limited mental capacity who has the ability to perform physical labor may not qualify as "disabled."
These skills are also used for applicants who have never worked and for whom the claim is they can never work.
- 42 U.S.C. § 423(d).
- 20 C.F.R. § 404.1520 Archived June 12, 2011, at the Wayback Machine.; 20 C.F.R. § 416.920 Archived June 12, 2011, at the Wayback Machine..
- See 20 C.F.R. § 416.924. Archived June 12, 2011, at the Wayback Machine.
- 20 C.F.R. 404.1545 Archived June 12, 2011, at the Wayback Machine.; 20 C.F.R. 416.945 Archived June 12, 2011, at the Wayback Machine..