After waiting months for a decision, you finally get a letter from Disability Determination Services (DDS), but like 75% of all applicants, you were denied. Your first thought was probably not G-rated. But if your second thought was “what in the world does this letter even mean?” you’re not alone.
When DDS denies a claim, it sends out the same template letter to every applicant, and includes canned language that usually doesn’t make much sense. However, there is a way to de-code these letters and determine what you should do next.
Usually on the first page of the letter, there will be a paragraph that says:
In reviewing your case, we requested records from the following providers:
- ABC Primary Care (received 1/1/2017)
- Smith & Jones Neurology
- General Hospital (received 2/3/2017)
There are a few helpful lessons you can glean from this section if you decide to file an appeal:
- If all of your medical providers are not included in this list, DDS did not request all of the records they were supposed to. On appeal, make sure DDS gets records from all of your doctors.
- The notation “(received [date]),” means that DDS received records from that doctor on the date noted. On appeal, make sure DDS gets any records from visits you’ve made to these doctors after that date.
- Notice there is no notation next to Smith & Jones Neurology. This means that DDS did not receive those records from that provider. On appeal, make sure DDS gets the records from this provider.
Near the end of the letter, there will be a section with the reason for your denial. It will include language similar to the following:
- You are currently engaging in substantial gainful activity (SGA).
- Explanation: DDS found evidence that you were earning money from work that was over the SGA limit. This limit changes annually, but it is currently $1,180/month.
- You do not have a severe impairment.
- Explanation: DDS found that your medical condition was non-severe, meaning it does not limit you very much. Ex: You have asthma, but only have to use an inhaler occasionally, and can participate in daily activities.
- Your impairment did not last or is not expected to last 12 months, or result in death.
- Explanation: Even if you had a severe medical condition, your condition resolved or is expected to resolve within 12 months. DDS looks at your medical records and any evidence of recovery, and doctors’ notes regarding your anticipated recovery.
- Though you have a severe impairment, you can return to your prior job as a ______.
- Explanation: DDS found that you did not meet or equal a listing (Step 3), so they prepared a Residual Functional Capacity (RFC) evaluation. After comparing your RFC to the description of your old jobs, they found that you were able to perform at least one of your old jobs. See this post for more information on this evaluation.
- Though you cannot return to your work as a ______, you can return to other types of work. DDS then lists three jobs that you can perform.
- Explanation: They compared your RFC to your old jobs, found that you could not perform your old jobs, and then found three other jobs in the national economy that you could do with your RFC. Again, see this post.
There are other reasons a person could be denied, and other ways in which DDS can phrase it, but this is generally what you see most often.
Important: If you receive a denial letter, make sure you keep it! It contains valuable information that could help you get approved on appeal, and it gives you important information on deadlines for appealing.
If you received a denial letter from DDS recently and are thinking about appealing, be sure to do so within 60 days. If you have any questions, it can always be helpful to talk to a disability attorney first.