How Social Security Decides Whether You Are DisabledUpdated April 13, 2022 Social Security Disability
Who decides if I am disabled? If both my doctor and the Social Security disability doctors say I am unable to work, will I be approved?
Claims examiners in consultation with a physician decide whether you are disabled according to Social Security Disability rules. These employees of the Disability Determining Services called DDS for short, make the disability decision because they are trained in Social Security law and regulations including Social Security’s specific definition of disability. Neither your own doctors nor a doctor you might see in a consultative examination (whom some people call “Social Security disability doctors”) make the decision. If your claim has progressed to a hearing appeal, the administrative law judge (ALJ) who hears your case makes the decision.
What About Your Doctor’s Opinion?
The claims examiner and DDS doctor consider all the information from your attending physicians. However, to be accepted as valid evidence for your claim, your doctor’s assessments must be supported by clinical observations, test results, or other supporting medical evidence. In other words, your doctor has to explain how he arrived at his diagnosis and his assessment of your capabilities and limitations.
Consultative Examiner’s Opinion
When Social Security hires a doctor to examine you, the claims examiner instructs the doctor to evaluate whether you have the illness or injury that you claim and to identify any limitations and restrictions you may have. The doctor is not asked to make a disability decision and when the consulting doctor’s report is received, the DDS examiner reviews the report to be sure that the conclusions the doctor has drawn from the examination are supported by clinical observations or testing cited in the report.
5-Step Disability Evaluation Under Social Security
The Social Security Administration uses a basic 5-step process to determine eligibility for disability benefits:
Step 1: Are you working?
If your disability allows you to work, and you’re able to earn more than a certain amount per month then (usually) the SSA does not consider you to be disabled. The earnings limit in 2020 for non-blind persons is $1,260/month; for the blind, $2,100. This amount is adjusted each year. Your countable earnings for evaluating your work activity as related to whether or not you are disabled can be reduced by Impairment-Related Work Expenses (IRWE’s) including but not limited to medications that you take.
Step 2: Is your disability severe?
If your average earned income per month does not exceed the limit, then the SSA passes your application along to the Disability Determination Services (DDS) office in your state. For the DDS medical examiners to determine that, indeed, you are disabled; your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting, and remembering—for at least one year. If your disability is not that severe, they will decide that you are not eligible for SSD benefits. But if it is that severe, the DDS goes on to…
Step 3: Is your medical condition on the List of Impairments (LOI)?
The DDS refers to the LOI to see if your condition is listed. If it is, then it automatically means that you are disabled as defined by law. If it isn’t, then the DDS looks to see if your condition is as severe as a condition that is on the list. If it is, then they will consider you to be disabled. If it isn’t, they go on to…
Step 4: Can you do the work you did before?
The DDS decides if your medical condition prevents you from being able to do the work you did before. (Or something similar.) If you can still do it, they will decide that you are not disabled. But if your disability does prevent you from doing that kind of work, the DDS goes on to…
Step 5: Can you do any other type of work?
The DDS looks to see if you could do some other type of work, despite your disability. It evaluates your age, education, medical condition (physical or mental), work experience, and any skills you may have that could be used to do some other work. If you cannot, they will determine that you are disabled. But if you can do other work (even if you don’t care to), then you are deemed not disabled and, therefore, ineligible for SSD benefits.
Important Information for You to Submit for Your Claim
If you have a very severe illness or injury listed in the Social Security’s Listings and you submit records to document your diagnosis and the severity of your condition, you may be approved at Step Four of the disability evaluation process. If you don’t meet the Listings, you have another opportunity to be approved for benefits. At that point, Step Five in the evaluation, information about your work history and education become very important.
You are more likely to be successful with your Social Security claim if you know how the Social Security Administration evaluates for disability. With that knowledge, you will recognize the information you need to provide to support your claim.