Disability Evaluation Under Social Security
Disability Evaluation Under Social Security has been specially prepared to provide physicians and other health professionals with an understanding of the disability programs administered by the Social Security Administration. It explains how each program works, and the kinds of information a health professional can furnish to help ensure sound and prompt determinations and decisions on disability claims.
The Listing of Impairments, which includes listings for both adults and children, appear in the Code of Federal Regulations (CFR) in appendix 1 to subpart P of part 404 . We also provide them here. The listings are just part of how we decide if someone is disabled. For adults, we also consider past work experience, severity of medical conditions, age, education, and work skills.
We no longer publish Disability Evaluation Under Social Security in hardcopy because we publish updated versions of the Listing of Impairments electronically.
Our Disability Determination Process
Most Social Security disability claims are initially processed through a network of local Social Security Administration (SSA) field offices and State agencies (usually called Disability Determination Services or DDSs). Subsequent appeals of unfavorable determinations may be decided in a DDS or by an administrative law judge in SSAs Office of Disability Adjudication and Review.
Social Security representatives in the field offices usually obtain applications for disability benefits in person, by telephone, by mail, or by filing online. The application and related forms ask for a description of the claimants impairment (s), treatment sources, and other information that relates to the alleged disability. (The "claimant" is the person who is requesting disability benefits.)
The field office is responsible for verifying non-medical eligibility requirements, which may include age, employment, marital status, or Social Security coverage information. The field office then sends the case to a DDS for evaluation of disability.
The DDSs, which are fully funded by the Federal Government, are State agencies responsible for developing medical evidence and rendering the initial determination on whether or not a claimant is disabled or blind under the law.
Usually, the DDS tries to obtain evidence from the claimant's own medical sources first. If that evidence is unavailable or insufficient to make a determination, the DDS will arrange for a consultative examination (CE) to obtain the additional information needed. The claimant's treating source is the preferred source for the CE, but the DDS may obtain the CE from an independent source. After completing its development of the evidence, trained staff at the DDS makes the initial disability determination.
Then, the DDS returns the case to the field office
for appropriate action. If the DDS found that the claimant is disabled,
SSA completes any outstanding non-disability development, computes the
benefit amount, and begins paying benefits. If the claimant was found
not to be disabled, the file is kept in the field office in case the claimant
decides to appeal the determination.