Tuesday, April 16, 2024

What Does It Mean Disability Determination Decision Under Review

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What Is A Medically Determinable Impairment

what is the department of disability determination services?

A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings — not only by the individual’s statement of symptoms.

Contact The Team At Joel Thrift Law Today

Are you interested in learning more about how to file a Social Security Disability claim? Or have you already received a denial at the initial determination stage of the process? With so many different stages to navigate and strict rules that must be followed from the SSA, its easy to feel lost without the guidance of an experienced lawyer by your side. At Joel Thrift Law, weve got the knowledge and skills necessary to help you through every step of the appeals process and to make sure you understand what new terms mean for your claim. Give us a call at 618-4816 or contact us today for more information and to schedule an initial consultation.

Strategy For Developing An Ssa Disability Research Program

Prior to developing a program of research, identifying issues for research, and specifying research mechanisms and methodologies, a strategy for establishing priorities needs to be created. At present, compelling research questions are vying for attention. The IOM committee may wish to consider establishing a working group to draft an outline of work that addresses the following three issues preliminary to creating priorities for research:


Using SSA information, identify weak points in the existing adjudication process and identify strong points that can be built on or generalized across claims based on physical and mental disorders:

  • Develop a plan for fixing the sequential process. For example, if the first two steps work well, keep them. Then go to the third step to look at problem areas .
  • Acknowledging that there will always be inherently difficult claims, develop a way of preselecting them and creating a process for handling them .

Review the ICF, ICF Checklist, WHO DAS II, and WHO DAS II screening questions to identify which components can: be used to create a standard form for the submission of medical evidence can be used as a screen of slight and very severe claims and can provide the basis for a fuller, more detailed version of the functional limitation criteria for both physical and mental conditions, and conduct a thorough investigation of the scale points and ratings as they calibrate to disability decisions for both physical and mental conditions.

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American Psychiatric Association Evaluation Study

In 1984, prior to the publication of the 1985 Listings of Mental Impairments, the SSA, under the direction of the then-Assistant Commissioner for Disability Patricia Owens, contracted with the APA to design an evaluation of the soon-to-be-released standards and guidelines for the evaluation of mental impairments. The evaluation would include the Listings, the operational definitions for their implementation, and the forms that would be used in practice. The designed evaluation was accepted, and in 1985 the SSA awarded a contract to the APA to conduct the two-year evaluation. The following description is a summary of the study.

Why The Ssa Reviews Dds Decisions

disability determination decision under review meaning

Because DDS claims examiners are not employees of the Social Security Administration or under the SSA’s direct supervision, the Social Security Administration conducts “Quality Assurance” reviews to make sure each DDS agency is making disability determinations that are in line with federal policies and standards. This ensures that there is consistency in applying those standards to all Social Security disability applications, regardless of where the applicant lives.

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What Does This Mean

Your benefit application is currently under review for processing accuracy. Once the review is complete, we will continue processing your benefit application.

This is what I found on my social security disability information site today

Amy do I understand correctly that before you were told you were approved for SSDI you read this Disability Determination Decision Under Review

Your benefit application is currently under review for processing accuracy. Once the review is complete, we will continue processing your benefit application.

Mine says this today.

Update: my initial case worker called me today to inform me of my APPROVAL and that I have been approved to receive back pay starting from June of 2016! Also that my Medicare will go into affect in June of 2018. Whew I’m so happy and relieved!

Wendy I received that message before I was approved. It is not 100& sure that you will be approved but from my retired SSDI Counselor he told me that 90% claims that are sent to admin review are approved.

Awesome congratulations but I thought and was told they couldn’t tell you over the phone? But I am so happy for you I have a question have you ever done office work?

Ok, so today it was updated to a medical determination has been made. That if they needed more information a social security worker would contact me…. I’m beyond confused

The Disability Determination Process

After you file for Disability benefits, the Social Security office will send your completed application to be processed by the Disability Determination Division in your jurisdiction. The process of determining eligibility may include sending requests to your doctors for medical records and asking you to complete questionnaires about your daily activities and the jobs you have held in the past. If more medical information is needed, you may be scheduled for an examination with a local physician or psychologist at our expense.

Once all the necessary information has been compiled, a team including a trained disability examiner, physician and psychologist will review the evidence and come to a decision. Once a decision has been reached, the claim is returned to the Social Security office who will notify you by letter regarding the determination.

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What Does Appeal Under Review Mean For Ssdi

Gina Ramsey – November 13, 2020

If youve applied for Social Security Disability Insurance from the Social Security Administration , there is a possibility your application could be denied. Should this happen, youll have the opportunity to file a claim, and appeal that denial. Once youve filed an appeal, you might receive a letter stating that you have an appeal under review.

How The Dqb Reviews A Case

How long does Social Security take to make a Disability Decision?

If your case is selected, the DQB reviews your case to ensure that the DDS claims examiner who made a decision on your application did their job properly. This includes making sure that the medical evidence in your file supports the examiner’s decision and that all documentation that is required is in the file. The DQB will also consider whether the examiner considered your medical evidence appropriately and in its entirety, whether the vocational rules were applied properly, and whether you were given the correct RFC .

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What Kind Of Social Security Disability Benefits Are Available To Louisiana Citizens Who Can Get Disability Benefits Under The Social Security Administration

The Social Security Act provides benefits to disabled individuals under Title II and Title XVI .

Under Title II there are three basic categories of individuals who can qualify for benefits on the basis of disability:

  • A disabled insured worker under 65.
  • A person disabled since childhood who is a dependent of a deceased insured parent or parent entitled to Title II disability or retirement benefits.
  • A disabled widow or widower age 50-60 if the deceased spouse was insured under Social Security.

Under Title XVI there are two basic categories under which a financially needy person with limited income and resources can get payments on the basis of disability:

  • An adult age 18 or over who is disabled.
  • A child under 18 who is disabled.

World Health Organization Disablement Assessment Schedule Ii

In a separate but related activity in the revision of ICIDH and the creation of the ICF Checklist, the WHO and three institutes of the National Institutes of Health joined in a cooperative agreement to develop disability assessment instruments for use in clinical settings and in epidemiological surveys. The WHO Disability Assessment Schedule II was designed for use in assessing disability irrespective of health-related etiology. It is calibrated for use to assess disabilities associated with mental as well as physical conditions.

The WHO DAS II is conceptually based on the ICF and queries six domains:


life activities and


participation in society.

The WHO DAS II has undergone testing of its psychometric properties, notably reliability, validity, and sensitivity to change. It underwent testing in approximately 28 centers in more than 18 geographically and culturally diverse countries. Three versions are the product of this endeavor: the full 36-item instrument a 12-item screener and a 5-item short form.

Because the WHO DAS II is designed to be used either in conjunction with a diagnostic assessment instrument or as a stand-alone instrument, the rating of the domains of disabilities is preceded by two sections. The first section collects demographic and other background information.

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How Long Does Social Security Disability Approval Process Take

The Disability Determination Services evaluation process can take six months to reach a decision. If DDS denies your claim, dont give upthis happens to most people the first time, especially those who file on their own. Reasons include: technicalities, inadequate medical documentation, not knowing how to describe your disability and other mistakes.

Does Applicant Have A Severe Impairment

What Does Fully Favorable Mean In A Disability Case ...


  • Case managers can help by clearly and accurately presenting information about the persons functioning.
  • DDS considers physical activities involved in work, such as standing, walking, lifting, carrying, seeing, hearing, and speaking.
  • They consider mental activities such as understanding, remembering, and carrying out simple instructions, judgment, responding to supervision, dealing with changes.
  • If the impairment is considered severe the application moves to Step 3
  • If the impairment is not severe the application is denied
NOTE: Serious illness is NOTequivalent to severe impairment. For example, a person diagnosed with bipolar disorder may be able to manage his or her illness, complete activities of daily living, have healthy ongoing relationships, and complete cognitive tasks. Clearly bipolar disorder is a serious illness, and there may be times when it is difficult to manage. However, many people with this disorder function very well and are capable of work. If a person does not have a severe impairment the application will be denied.

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Statutory Definition Of Disability

The foundation of the SSA’s two disability programs is the statutory definition of disability in the Social Security Act. The same definition applies to both the SSDI and the SSI programs and is the standard that the SSA puts into operation for the determination of claims for disability benefits. The definition can be changed only by an act of Congress. According to the Social Security Act, the definition of disability is Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period on not less than 12 months ).

The term substantial gainful activity means work that is remunerated at a rate specified by regulations. As of January 1, 2001, the rate is $740 per month. In other words, an individual may not be earning more than $740 per month in order to be eligible for disability benefits. The statute further states that the physical or mental impairments must be so severe that the claimant cannot do any work in the national economy that exists in substantial numbers. It does not matter whether or not jobs are available in the local region or whether or not the person would actually be hired if a job existed. If a type of job exists in substantial numbers somewhere in the country that the claimant could do, then she or he is not given disability benefits.

Problems Already Identified By Research

The lack of sufficient medical evidence and the low quality of the medical evidence that is provided were identified as serious issues by participating psychiatrists in the APA study. This was their impression even though the claims had been through an SSA review for the quality of the evidence. In other words, they may have been better or more complete than average claims adjudicated in the DDSs. In addition to the APA’s recommendation that a standard form for medical evidence be designed and used nationally, other medical evidence collection procedures might be reviewed. For example, although SSA is seeking to streamline its process, something may be gained by collecting medical evidence in two stages: the first stage for slight and very severe decisions based on a modification to the first three B criteria, the second for more in-depth assessment of the remaining claims, notably those that are expected to be inherently difficult, near the border of able or unable to work. What is needed? Which items in ICF can guide the development of medical evidence forms? Have some states developed standard medical evidence forms, and if so, how are they working?

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Is The Applicant Working At A Substantial Gainful Level

What is Substantial Gainful Activity ?

  • Gainful work activity is work performed for pay or profit, or work intended for profit, even if profit is not realized.
  • Each year, SSA sets an amount of gross monthly earnings that are considered to be SGA.
  • The type and amount of supports an individual receives while at work is taken into consideration when determining SGA.

SSA will evaluate the applicant’s work activity

  • If the applicant is working and earning gross monthly wages equivalent to or exceeding SGA, the claim will be denied.
  • The applicant is potentially eligible if they are:
  • Not working or
  • Working, but not at SGA
SOAR Tip: If the applicant is currently working, SSA uses the SSA-821 Work Activity Report to document any work incentives that may apply before making a determination about Substantial Gainful Activity for initial decisions, appeals, and continuing disability reviews.

About The Quality Review Board

Social Security Disability and Favorable Decisions

Employees in the disability and supplemental security income branches of the SSA Office of Quality Review evaluate randomly selected benefits applications from each of the regional Disability Determination Services regional office. According to Disability Secrets, about one of every 100 applications accepted at each field office are chosen to undergo a review.

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The random selection takes place after the claims examiner finishes verifying and approving or rejecting an application, but before the application is forwarded to the SSA for final processing. If your application received an initial approval, benefits won’t begin until the quality review is complete. There is also no set time frame for an SSA examiner to complete a quality review and notify you of the board’s decision. Depending on what the review uncovers, the process can take a few weeks or months.

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Listings Of Mental Impairments

The Listings of Impairments are published by the SSA and updated periodically. Chapter 12 of the Listings is devoted to mental disorders, otherwise known as the Listings of Mental Impairments. Major revisions to the Listings of Mental Impairments, currently being applied to claims for disability benefits, were published in 1985 and have since undergone relatively minor modifications. The 1985 revision was intended to bring the Listings in line with then-current psychiatric practice to reflect the APA’s third edition of its Diagnostic and Statistical Manual of Mental Disorders . The process of this revision was unique in SSA’s history. It was the first time that the SSA had sought outside expertise to revise its Listings. The APA, the American Psychological Association, and other mental health experts participated with the SSA in the process.

There are currently nine Listings of Mental Impairment designed to reflect the major psychiatric diagnostic categories likely to cause disability for work. There are three sets of criteria within the Listings of Mental Impairments: A, B, and, for a subset of categories, C.

The purpose of the A criteria for mental disorders is to medically substantiate the presence of a mental disorder. The categories for adults follow:

  • Organic Mental Disorders
  • Schizophrenic, Paranoid and Other Psychotic Disorders
  • Affective Disorders
  • Substance Addiction Disorders and
  • Autistic Disorder and Other Pervasive Developmental Disorders.

Medical Evidence

What Is The Disability Determination Process

Most disability claims are initially processed through the network of local Social Security field offices and State agencies. In Louisiana, the state agency is called Disability Determination Services . Subsequent appeals of unfavorable determinations may be decided by Hearing Officers in the DDS’s Hearing Units or Administrative Law Judges in SSA’s Office of Hearings and Appeals.

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Disability Approval Letters And Other Indications Of Approval

The Social Security Administration will send you a letter telling you whether your application for Social Security Disability benefits has been approved or denied however, an approval letter may not be the first indication that you have been approved on initial claim or reconsideration appeal.

If you gave Social Security your banking information for direct deposit, you are likely to receive a deposit to your bank account before you receive a letter. So, if you think that its about time for you to get a decision, check your accounts every few days for a deposit from the U.S. Treasury. If you applied online, you can check the status of your claim by going to yourMy Social Security account.

If you get a payment before you receive a letter, you can either wait for the explanatory approval letter, which may come up to two weeks later, or you can call the Social Security Administration at 772-1213 for an explanation of the deposit and information about your ongoing benefits or back pay.

Another way you may find out about your approval is by a phone call from the Social Security Administration. If some additional information or documentation is needed to start disability payments. Also, if you have eligible dependents, Social Security may call you or your spouse to complete an application for the children, which, of course, is a sign your claim has been approved.

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