How the Decision on a Disability Application or Appeal Under SSDI or SSI is MadeAll disability claims begin with the Social Security office. However, decisions on disability claims are not made at the Social Security office, but, instead, at a state agency that has been assigned this responsibility. It is for this reason that all new disability claims are transferred to DDS (disability determination services) and assigned to a case processing specialist known as a disability examiner. It is the responsibility of the disability examiner to do the following: A) Gather the claimant's medical records. B) Identify their past jobs as well as the skills and requirements of their jobs. C) Obtain information about their ADLs, or activities of daily living (this can be done by contacting directly or mailing a questionaire to either the claimant or a third-party contact, an individual who is knowledgeable about their condition). D) Assess, in consultation with a medical doctor or a psychologist, the claimant's remaining physical and/or mental functional capabilities, known as their residual functional capacity, or RFC for short. Processing the Disability Case Disability examiners, who make decisions on each disability application and reconsideration (the "request for reconsideration" is the first appeal) will generally send out medical record request letters to all the physicians and clinics listed by the claimant on the very first day that they have been assigned a disability case. In fact, this is usually the very first task that is performed on any case after it is received by an examiner. The wait for requested records can be lengthy and, ultimately, depends on how quickly each hospital or medical practice responds to a request. Not surprisingly, one of the chief reasons for how long a decision may take is the wait for medical records. Until the records have been received, the SSDI (Social Security Disability insurance) or SSI case will generally sit and wait with no development work being performed. But after the medical records have been received, the examiner's primary focus will be to read and evaluate the records, make notes regarding key information contained in the records, and compare this information to the Social Security Disability list of impairments (the blue book, or listing manual) to see if the claimant has a condition which satisfies the requirements of a listing. After all of this has been done, the examiner will take his or her writeup of the particulars of the case to either a medical consultant or a psychological consultant (or both if the claimant has filed on the basis of both mental and physical conditions) who is part of the examiner's case processing unit. This will be for the purpose of determining what restrictions and limitations the claimant may possess based on their condition, or conditions (as stated, this is the RFC, or residual functional capacity). This is basically the step of the disability evaluation process where the examiner is able to conclude two very important things: 1. Can the claimant return to their past work, meaning any of the "relevant" jobs that they have performed in the last 15 years (note: for a particular job to be relevant, it must also be one in which the claimant was able to earn a livable wage, defined as substantial gainful activity and it must be one for which the claimant was able to learn the required skills of the job). 2. Can the claimant, if they cannot go back to one of their former jobs, do some type of other work for which their skills and work experience might suit them, and which their age, education, and current limitations would not prevent them from doing? If the claimant can do neither of these (go back to a former job or perform some type of suitable other work), they will be approved for SSDI or approved for SSI, depending on which program their claim has been taken in. If the Disability Case is denied If the case is denied, of course, the claimant will need to consider whether or not they should file a disability appeal and whether or not they should consider finding representation in the form of a disability representative or a Social Security Disability lawyer to assist them with their claim. If the claim is denied at the disability application level, the appeal will be a request for reconsideration. At that appeal level, a proactive attorney or representative can certainly increase the chances of winning benefits, even though the odds are usually against any claimant, represented or not, for winning benefits (reconsideration appeals have an 87 percent denial rate). However, if the claim is denied at the reconsideration appeal level (as said, this usually occurs), then the next appeal will be to request a disability hearing. Hearings are conducted by federal administrative law judges who often bring in medical and vocational experts to provide hearing testimony. At the hearing level, a claimant is generally advised to seek representation well before the hearing takes place so that proper preparation can be done and so that the case can be presented in the most effective manner possible to the presiding judge. About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here. 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