What is DDS? Disability Determination Services’ Role in Claim Reviews 

Navigating the path to financial stability while living with a disability is often overwhelming Especially when you depend on government programs. Disability Determination Services plays a vital role in this journey, acting as a state-level agency responsible for reviewing your medical evidence and making the initial decision regarding your disability claim. Whether you are preparing to submit your first benefits claim, gathering further evidence, or going through Continuing Disability Reviews (CDR), it is important to know how the DDS operates within these processes. Are you in need of help during your disability claims process? Learn more to find out how you can successfully gain benefits for your disability.

Understanding Disability Determination Services: Key Takeaways 

• Defining Disability Determination Services (DDS): State agencies funded by the Social Security Administration (SSA) that evaluate medical evidence to decide initial disability or blindness claims. 
• How the DDS and SSA work together: The SSA manages overall benefits and guidelines, while state-level DDS officers process medical evaluations and make eligibility decisions. 
• Evaluating your disability application: DDS examiners review your medical history, work background, and functional capacity against strict federal guidelines. 
• Appealing your decision: If you are unhappy with the decision the DDS and SSA made on your disability claim, you can appeal your decision by submitting a request for a non-medical or disability reconsideration within 60 days. 
• Hiring representation: Having a professional disability attorney can help you with all aspects of your case and triple your odds of receiving disability benefits. 

What Is DDS (Disability Determination Services)?  

Disability Determination Services (DDS) is a state agency tasked with developing medical evidence and making the initial decision on whether an individual is disabled or blind. With this, they also assess continued eligibility for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). They consider all the facts in your case and will use medical evidence from your doctors, hospitals, and other medical facilities that treat your condition. Examiners analyze these documents to measure how your condition limits your daily routine and prevents you from maintaining Substantial Gainful Activity (SGA).

What Does Disability Determination Services Do for the Social Security Administration (SSA)? 

The Disability Determination Services and the Social Security Administration work very closely together as a federal and state partnership to process disability claims. DDS offices are state agencies that the SSA funds and administers to make disability determinations. Conversely, the SSA manages the two programs that provide monthly assistance to those with severe or long-term disabilities.  

The process of determining a disability starts with filing an application for SSDI or SSI benefits . Next, if the SSA accepts that application, they forward it to the DDS in the state where the claimant lives for evaluation. The DDS either approves or denies the claim based on a medical evaluation of the applicant’s health condition(s). The DDS claims examiner then returns that claim to the original SSA office for final review.

Gathering and Reviewing Medical Records for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) Claims 

Gathering and reviewing medical records is one of the most important steps for anyone who wishes to receive SSDI and SSI benefits. The SSA relies on these records to prove the severity of your condition and what factors stop you from working. You are responsible for providing your own medical evidence that shows you have an impairment and shows the severity of your disability. But with your permission, the SSA can help you gather evidence or copies of documents from any medical sources who evaluate, treat, or examine your impairment. If you provide timely, accurate, and complete information and evidence, it can accelerate the processing of your claim.

Scheduling a Medical Examination to Confirm You Have a Medically Determinable Physical or Mental Impairment 

After you apply for disability benefits, you may need to have a special medical examination before the SSA and DDS can decide whether you are eligible to receive benefits. The employee from DDS that reviewed your claim likely determined there is more information they need from you in order to decide if you have a disability under Social Security laws. In this case, the SSA will pay for the exam and any related travel expenses. It is your responsibility to appear at your exam and cooperate with the doctor that is examining you. If you are unable to keep your appointment, you must notify your state agency to reschedule. If you don’t notify the agency or show up to your examination, it results in an automatic denial of your disability claim.

Evaluating Your Previous Work Experience, Job Skills, and Current Ability to Do Work-Related Activities 

The DDS evaluates your work history and skills during steps 4 and 5 of the SSA’s five-step evaluation process. This review determines your Residual Functional Capacity (RFC). RFC determines what you can do despite your impairment and compares your skills to required tasks from your prior jobs and other work within the national economy. 

• Step 4 – Ability to do previous work: The SSA decides if your medical condition prevents you from performing any relevant past work. This work must be considered Substantial Gainful Activity (SGA). 
• Step 5 – Ability to do other work: If you cannot do any relevant past work, the SSA will determine if you are able to adjust to any other types of work. This work must also be under SGA guidelines. 

Reviewing Your Educational Background, Age, and Eligibility for Faster Claim Approval 

Even though processing your application can take a lot of time, the DDS tries to expedite many applications based on certain factors. These factors can include: 

• Age: If you are at least 50 years old, it can qualify you for favorable evaluation standards since it’s harder for older workers to adapt to new types of employment. 
• Educational background: The SSA will look at your education level to see if your literacy and skills allow you to perform alternative work. 
• Qualification for faster approval: Age and education do not always speed up processing times, but there are expedited programs that can fast-track your application if you meet specific criteria. 

If your disability is extreme enough for the DDS, they will bypass these factors to fast-track your approval. They perform this through initiatives like Quick Disability Determinations (QDD) or Compassionate Allowances (CAL), which allow the DDS to identify claimants with severe disabilities and expedite the approval process.

Sending the SSA a Disability Decision Recommendation on Your SSDI or SSI Claim 

Submitting a recommendation from your medical source or treating physician can help support your SSI and SSDI claim by providing direct evidence of your functional limitations. This evidence can therefore speed up your decision process and can be helpful along the way when dealing with other steps of your claim decision. 

These steps can include: 

• Clarifying your medical severity: Providing recommendations on your claim can show just how severe your impairments are and if they prevent you from doing substantial work. 
• Reducing requests for extra exams: Well-documented recommendations prevent the need for the DDS to request for any extra medical exams. 
• Appealing your denial decision: Submitting recommendations from medical sources or physicians can strengthen your disability appeal if they need more information from you. 

How Long Does It Take DDS to Make a Disability Claim Decision? 

When you first submit your claim to receive benefits for your disability, it can take the DDS some time to process it. It usually takes about 6-8 months to release their initial decision. This may take longer, depending on the severity of your case. Many factors go into making their decision, including: 

• The nature of your disability 
• When the SSA gets medical evidence from your doctor or other medical providers 
• Whether they need you to undergo a medical exam 
• Whether they need to review your application for quality purposes 

How to Appeal a DDS Disability Decision You Disagree With 

If the DDS makes your final disability decision and you don’t agree with it, you can request a reconsideration to appeal. There are four ways to appeal your DDS decision, including: 

• Requesting reconsideration: Once you receive your disability decision, you can request a disability or non-medical reconsideration within 60 days.  
• Hearing with a judge: After you submit your request for reconsideration, you may have an online, in person, or phone-based hearing. With this, a judge will review your evidence, ask you any questions about your condition, or call for more evidence and medical witnesses to prove your claim. 
• Review of hearing decision: If you don’t agree with the judge’s decision from your hearing, you can ask the Appeals Council to review it. Once you get the decision from your hearing, you will then have 60 days to submit a request for review. If the Appeals Council agrees with the judge’s decision, they will reject your request. But if they choose to review your case, they will turn it over to a judge for further review or decide to review it themselves. 
• File federal district court action: You will have 60 days to file a civil suit. You can file it with your closest district court. You will then use certified/registered mail to send copies of your complaint and court summons to the SSA’s Office of the General Counsel (OGC). 

What Is DDS Doing for People Who Already Get SSDI or SSI Benefits?  

You may wonder “what does the DDS do for me if I already have benefits?” Part of the DDS’s duties include evaluating current SSI and SSDI beneficiaries through Continuous Disability Reviews (CDR). The DDS is also in charge of completing the following tasks for the SSA: 

• Periodic health evaluations: Tracking changes in your medical condition over time through regular check-ins. 
• Requesting new information: Obtaining updated treatment notes from your primary care physicians. 
• Scheduling independent exams: Ordering examinations when your current medical files lack necessary details. 
• Re-evaluating work capacity: Assessing whether your earnings or physical abilities now allow you to return to the workforce.

Continuing Disability Reviews (CDRs) 

Even though you already received approval for your disability from the DDS, they are required to periodically check if you still have the disability. They call this process a Continuing Disability Review (CDR). CDRs normally occur once every three years. There are some exceptions if you have a medical condition that is not expected to improve. In this case, they will review your case every 5-7 years. During this process, the DDS will also conduct a periodic review called Redetermination where they will review your income, resources, and living arrangements to make sure that you continue to meet non-medical program requirements.

Help the OIG Investigate Suspected Disability Fraud  

With such a helpful disability benefits program, some people may try to take advantage. There are many ways someone can commit fraudulent acts against the Social Security Administration. This can include: 

Fraud, such as: 

• Misusing Social Security benefits or a Social Security number. 
• Providing false or misleading information to receive or continue receiving benefits. 
• Hiding benefits ineligibility factors, such as living arrangements, disability status, work ability, and earnings. 
• Representative payees acting in a fraudulent manner or misusing benefits. 

Scams, such as: 

• Pretending to be from the SSA or Office of Inspector General. 
• Saying there is a problem with your Social Security number, account, or promising to increase your benefits in exchange for payment. 
• Pressuring you to act immediately. 
• Telling you to pay in a specific way. 

To report someone whom you suspect of committing fraud, waste, or abuse against the SSA, contact the Office of Inspector General.

How an Attorney Can Help You Get DDS Claim Approval the First Time

Getting your disability claim approved is not always an easy task. The process can be long and tumultuous, depending on several factors. A disability lawyer can help you out with all factors of your case, such as managing your paperwork, gathering your medical records, and representing you during your hearing. It is even proven that claimants who hired representation were three times more likely to secure benefits than those without representatives. Don’t wait to hire help. Visit DisabilityApprovalGuide to get a free evaluation from a certified disability lawyer today.

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