Former Social Security Disability Examiner Gives Insight on How Disability Cases are Evaluated
I worked for ten years adjudicating disability claims for a Florida Social Security Disability Determinations Services (DDS) office before becoming a Freedom Disability Advocate. I know how the disability approval system works.
DDS examiners follow medical and vocational guidelines established by the Social Security Administration (SSA) to rationalize their decisions. These are universally followed at every state DDS office. When your disability case is reviewed at DDS, the examiner will:
- Compare your medical condition against impairments listed in SSA’s publication, “Disability Evaluation under Social Security,” commonly known as SSA’s “Blue Book”
- Analyze supportive evidence from medical professionals about your condition
- Evaluate your work and medical history, age, skills and your functional capacity
- Conclude if all these factors put together will support why you can’t work to earn income
The critical scenario is that you need your doctors to put your case in a favorable position for getting approved, and their opinions must be in writing. If DDS needs more medical proof, they may require that you go for a Consultative Exam (CE) with one of SSA’s contracted medical professionals.
Even after a CE, if there isn’t enough medical evidence to support your case, you can expect DDS to order additional testing, further delaying the process until the SSA guidelines are met.
The thing is, and perhaps unfortunately, time is a factor in getting approved. If you started off with inadequate medical documentation, more medical evidence will inevitably be added over time. Months later, when your case moves through the appeal process, you could stand a better chance of getting approved.
As a former DDS examiner I can tell you that the process for getting disability benefits for many cases is challenging. If your case is denied at the initial level, or at the reconsideration level, it is understandable to feel upset or angry, but you should have realistic expectations. Without quality medical evidence to prove disability, you face long delays before getting approved. This is how it works at DDS.
You may face major hurdles in getting through the DDS adjudication process. As Freedom Disability Advocates we facilitate the process between you and SSA informing you on what to expect from DDS. We know the guidelines and how to build strong disability cases. To be effective for our customers, we have to know what we’re doing.
why is it that you work all of your life to have things,like home; credit ; a good life; not a rich like but a good one; things that you have always wanted as a child; money put back for emergencies such as deaths and hospitals stay. You work your entire life paying in disability and social security. So that when you get unable to work it will be there for you. But instead you have to have a lawyer; you have to file no telling how many times; you have to get an appeal no telling how many times; you worked for this you paid in this money for when you need it. But You have to go through the act of congress to get what is yours to begin with. There are people out there that has never worked a day in their life and they get social security ; disability; food stamps any kind of government help that is out there. But for the ones that has worked all their life has to be nearly on their death bed and almost living under a shade tree. People having kids every 9 months to a year apart just so they can get in to low income housing and food stamps. Grandparents raising their grand kids so they can get money and food stamps; and their teen age girls still having one baby after another. No one cares about that. And you know why because the tax payers are paying the bills. The money that the tax payers are paying or going toward those that has never worked. Yes I am trying to get on disability and have been for a year and a half. But because my name was on my husbands company and all I did was just sit here and fixed his meals I couldn’t get my disability I have my Lawyer here in Jackson, MS. But the thing is I had to have my name taken off of the company completely a company that while I was able to work I help build. I don’t have any thing any more not even to my respect, I am ashamed to go any place that my old friends might be. I am so used to working ;holding my head up high and be proud of who and what I was I was a mom; grand mother, an asst. manager of a department store and proud of it, I could call the bank up and ask for a loan over the phone and they would have it ready by the time I would get off from work. Now Mr. Former Disability Officer can you tell me the answer to this. you have my e-mail address and you can email me the answer if you like .
Hello, I have carpal tunnel syn. in both my hands caused from working at an industry Victaulic of America. I’ve undergone surgery on my left hand and I learned now that I have permenant work restrictions. I am now awaiting the surgery date for my right hand. How do I proceed with appling for disability with my condition?
Mary,
A Freedom Disability Advocate can help you apply. First you need to talk to one of our Eligibility Consultants. Please call 866-347-2910 for more guidance on what to do.
my son was denied ssi and ssd. I found and attorney before I saw your commercial. I have not heard from him in 2 months and have tryed calling. My son has Asthma and had ssi as a child. he is now 31 and has worked in the past, but now its getting worst and he left texas and came home, to california. my question is, can I change attorneys and what are his chances the second time around? thank you
Angela,
Social Security is very strict about the approval process. Because your son is so young, it will be hard to prove to SSA that he is unable to work at any job. His condition would have to be severe enough to meet SSA’s definition of disability. You will need to have strong support from his doctors to prove that his condition so so severe it will prevent him from working for 12 months or longer or cause death.
I was wondering the max amount a person can get on SSI? I am disabled, and gotten SSI but its not that much per month. I guess its from my not so good work history. That why I also don’t qualify for SSDI.
Just want some in site, Thanks
Patsy,
The SSI amount you receive is based on your income and resources. Please read our article “What is Supplemental Security Income.” It explains how SSA calculates your monthly benefit.
I HAVE WORKED SINCE I WAS 16 YRS OLD. I HAVE A LOT OF HEALTH PROBLEMS.I HAVE HAD CARPEL TUNNEL SURGERY,SHOULDER SURGERY.NOW I HAVE CARPEL TUNNEL AGAIN IN MY LEFT HAND,MY MIDDLE FINGER WILL NOT BEND,I HAVE BONE SPURS IN MY LEFT FOOT,ON PAIN MEDICINE BECAUSE OF ALL THE PROBLEMS I HAVE. I AM 60 YRS OLD AND HAVE PAID MY DUES BUT CAN’T AFFORD TO GO OFF WORK TO APPLY SO CAN YOU APPLY WHILE YOU ARE STILL WOKING? I THINK 40 SOMETHING YEARS IS ENOUGH AND ITS TIME FOR THE PEOPLE THAT HAVE WORKED ALL THEIR LIFE TO BE ABLE TO GET THEIR SSD WHEN THEY HAVE PUT IN THAT MANY YEARS.I AM NOW HAVING BREATHING PROBLEMS WHEN IT IS HOT OR REALLY COLD.
Bonnie,
There are very specific and strict eligiblity rules for getting Social Security benefits based on disability. One is that your medical condition is so severe it is expected to prevent you from working for 12 months or longer at any job you are qualified to do or could retrain to do, or your medical condition is so severe it could result in death. Another criteria is that your substantial gainful activity from your current work is no more than $1,000 a month. Please read our article on Social Security Disability Eligibility to better understand this criteria. If you choose to apply for disability you must prove why you can’t work due to your medical problems. That process is very difficult and can sometimes take as long as two years to get a final decision, often at an appeals hearing. There is a wealth of articles on this site that explains the application process. One thing to think about is that the longer you can work the more you will get in retirement benefits once you reach retirement age.
I was denied twice for Disabilities. I have Ankolosing Spondylitis and it’s a debilitating disease. I stopped working after I had my girls in 2007 and was trying to find work but was steady getting worse and worse. My neck and bones finally fused together and after I realised the medication couldn’t help, I filed for disability in 2011. I was asked the question when did I last work and told them 2007 and all the Doctors I’ve had since then and they are basting and judging my case from 2007 and saying my Doctors said I am not disabled so deny my. How do I get it across that across, How can I only be judged from 2011 when is the time I claim disability.
Arlene,
At this time it does not sound as though you are insured for SSDI since you have stopped working more than 5 years ago. I recomment you make 100% sure you are eligible for SSDI and if you are, your next step to ensure you have enough recent medical records and treatment to provide as proof of your disability. Please keep in mind SSA will only look within a 24 month window from when you file, so SSA will not going back to 2007 unless you haven’t had any other medical treatment since then. Good Luck.
I am waiting for the results of my SSDI mental disability case. The wait alone gives me severe anxiety as a lot rides of the outcome including becoming homeless because I am so depressed that I can’t get out of bed most days. I keep bouncing back and forth on web sites reading about my condition and wondering if I will win. My case is not cut and dry so I have had no luck in finding a lawyer. I have come to the conclusion that most disability lawyers either have enough cases to pick through that they will only take the easy cases that they are positive they will win… this is because they only get paid if they win.
My case early on involved alcohol but I have been sober for six months. I have been depressed my whole life but due to some circumstances in 2011 I became deeply depressed and suicidal. I have consistently had a GAF score of 35 through all phases of my case including my Mental Status Exam, MMPI-2 test a year ago, and my most recent stay at a psychiatric hospital two months ago. All three have stated that I suffer from Major Depression Syndrome with Psychotic fearures because I have frequently heard voices. How ever, during my MSE, I passed the RFC tests regarding concentration memory and IQ. I am an educated person, that has not change because I am depressed. So I am wondering if because I passed those tests despite my GAF score and diagnosis if they will find that I am not disabled. My MSE also stated that I am high risk for suicide and my prognosis is poor. Also to note, I have been inpatient hospitalized 9 times in a year and a half, eight times at the local psychiatric hospital, one serious suicide attempt a year ago and have several attempts as well. My suicidal thoughts continue to this day. The voices have been diminished because of the anti-psychotic medication I am on that make me extremely tired during the day. I can’t imagine what is going to happen if I lose my case as I can’t support myself anymore.
Also I am wondering whar is the difference of the GAF score and the RFC test?
Kevin,
It is hard to determine based on the information as the GAF scores help SSA make their determination. Concentration and memory are areas of assessment but it depends on results of all the other areas they assess.
GAF – Global Assessment of Function is how mental health professionals use to rate subjectively the social, occupational, and psychological functioning of adults.
RFC – Residual Functional Capacity is what SSA uses determine the remaining functional capacity of an individual.