Processing of your Initial Social Security Disability Claim

The Social Security definition of disability mandates that you must have a medically determinable mental or physical impairment and that the impairment has prevented you from performing work activity that earned SGA-level income for the past twelve months, or can be expected to prevent SGA for twelve months.

After each claim is initiated and a disability interview has been conducted, claims representatives at social security offices gather the medical and work information for your disability claim and then send the claim to a state disability agency (DDS, or disability determination services) for a medical determination.

Once your disability file is received at the state disability agency, or DDS, it is assigned to a disability examiner, who then sends for your medical records. Ordinarily, the wait for your medical records will constitute the bulk of the time that it takes to process your case. In some instances, your records will be gathered within a couple of weeks. Very often, however, it can take months if the medical provider is very slow in responding to the medical record requests.

Once the medical records have been received, the disability examiner will review them to look for signs of physical and mental functional limitations that would A) prevent the individual from going back to one of their past jobs and B) prevent the individual from doing some type of other work.

In many cases, the claimant will not have been treated for one of the conditions that has been listed on the disability application, or will not have received medical treatment recently (within the last 90 days). In such cases, it may be necessary for the disability examiner to schedule one or more consultative examinations, if needed.

Once your disability case has been assigned to a disability examiner (examiners make decisions on cases at the disability application and reconsideration appeal levels, but not at the disability hearing levels), you may be asked to either provide additional information or attend an examination appointment.

Social Security uses consultative examinations to provide clarification of the information found in your medical treatment notes, or to get a current status on your medical condition if you have not had medical treatment in the past ninety days. Disability examiners must have current medical treatment information to make their disability decision.

If you get a letter stating that you must go to an examination, this will be something known as a CE, or consultative examination. A CE is conducted by a psychologist or physician to either--

A) Provide the social security administration with information that your own records may be lacking. For example, you may have indicated on your disability application that you have depression but have never been treated for this.

OR

B) To provide recent medical records (SSA defines "recent" as within the last 90 days) that your case file is missing. Note: to be considered disabled, the social security administration must have proof that your state of disability exists as of the time that your claim is being considered. This means that the disability examiner or the disability judge must have access to current records.

Most consultative exams are short physical exams and they basically add nothing to the case credentials. They simply allow the disability examiner to make a decision on the case since the examiner is required to have recent evidence. However, sometimes a CE will be scheduled only to have an xray done, or to have either a psychiatric exam, or a memory evaluation, or even mental IQ testing conducted.

Once the disability examiner has enough medical information from your treating medical sources and/or consultative examination reports, they will make their medical determination. They consider the limitations imposed upon you by your disabling condition.

The Disability Determination Services (DDS) evaluation process can take six months (sometimes longer) to reach a decision. If DDS denies your claim, don’t give up—this happens to most people the first time, especially those who file on their own. Reasons include: technicalities, inadequate medical documentation, not knowing how to describe your disability and other mistakes.

If you need helping applying for Social Security Disability or SSI, please contact me at joshben99@gmail.com. I have over 20 years experience with Social Security Disability cases.