The Social Security Secrets Series Episode 3: Getting Approved for Social Security – Who Makes the Decision and How?

In the last two episodes of The Social Security Secrets Series, we talked about the first two steps in the SSI/SSDI application process: financial eligibility and the basic application process. Now that you have submitted your application to the Social Security Administration (SSA), what happens?

SSA will forward your application to a state agency called Disability Determination Services, or DDS. (Any of you who are familiar with my background may remember that, in my pre-attorney days, I worked as a claims examiner at DDS). DDS claims examiners, in conjunction with a medical doctor or psychologist, make the final decision of whether or not you meet SSA’s definition of “disabled.” They request and review your medical records for your medical conditions, specific lab or test results, results of physical or mental status evaluations, medications you are prescribed, and progress notes. If DDS needs more medical evidence to determine whether you are disabled, they may schedule a medical examination for you, called a Consultative Examination.

DDS will also mail questionnaires to you and, in some situations, the third party contact you listed on your application. These questionnaires gather information on your ability to function on a daily basis.

These questionnaires may seem unimportant compared to the medical evidence, but this functional evidence is truly the key to getting approved. You must be 100% open and honest when answering these questionnaires if you want DDS to fairly evaluate your case.

The claims examiners and doctors on staff at DDS review all of your medical records and questionnaires to decide whether you are disabled under SSA’s criteria. In making this decision, DDS follows a process called sequential evaluation. Sequential evaluation is a five-step process that can get a bit complicated, so I will give you a condensed version here and provide more detail in later posts.

Step 1: Is the claimant (you, the applicant) working at or above SGA[1]?
  • Yes: Claim denied
  • No: Continue to Step 2
Step 2: Is the claimant diagnosed with a severe medical or psychological condition?
  • Yes: Continue to Step 3
  • No: Claim denied
Step 3: Does this condition meet or medically equal the listings[2]?
  • Yes: Claim approved
  • No: Continue to Step 4
Step 4: If no, can the claimant perform her past work?
  • Yes: Claim denied
  • No: Continue to Step 5
Step 5: If no, can the claimant perform any other work?
  • Yes: Claim denied
  • No: Claim approved

If you are approved, you will receive a letter in the mail with instructions on what to do next to get your benefits started. Depending on when DDS decided your disability began, you may receive a lump sum payment for back-benefits in addition to monthly payments moving forward.

If you are denied, you can appeal. If you appeal, your case will go back to DDS for a second review, called a Reconsideration.

The next several installments of Social Security Secrets will discuss the appeals process, so be sure to follow the blog (in the side bar) to learn what to do if you are denied.

[1] SGA is defined in a dollar amount that changes every year. In 2018, the SGA level is $1,180 per month. 

[2] The listings are a list of medical and psychological conditions, with specific symptoms or findings for each condition. If you “meet” or “medically equal” a listing, it means that your condition meets the criteria laid out in the listings. These are very severe impairments. Most people do not get approved at this step. For more information and a link to the listings:

Author: Kathryn L. Blevins, Esq.

Attorney. Small business owner. Military family. I am the owner and attorney at Blevins Law, LLC. My firm focuses on Social Security disability claims (SSI and SSDI), Veterans' Disability Compensation, Advance Medical Directives and medical and financial powers of attorney. I also assist veterans assessing other types of VA benefits they may be eligible for. I am licensed in Maryland and Washington, D.C., and am a VA Accredited Attorney. I am the proud wife of an Army veteran, and the proud mother of two amazing children and three rescued fur children.

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