What Is the Job of a Social Security Disability Examiner?

To receive Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits, you must qualify medically (and nonmedically). The Social Security disability claims examiner is the person who makes the initial determination on an applicant's medical eligibility for disability benefits.

Where Do Disability Examiners Work?

Most disability claims examiners work at state agencies rather than at a Social Security Administration (SSA) office. The state agencies are often called Disability Determination Services (DDS) but might also be called something like the Disability Determination Bureau or Bureau of Disability Adjudication.

Each state has at least one DDS facility, and larger states with decentralized systems have several DDS offices. The typical DDS office has several hundred disability examiners.

Here's what a DDS or Social Security disability claims examiner does.

Disability Claims Examiners Gather Medical Evidence

The primary role of the Social Security disability examiner is to decide if your medical condition (whether physical or mental) is severe enough to prevent you from working in any type of job. The disability examiner is also responsible for maintaining contact with you.

To decide your claim, the examiner must first gather all your medical records and any additional information needed. For instance, the examiner might call you or send you a questionnaire asking you to fill out more information about your work history or education.

What Kind of Medical Information Does the DDS Examiner Collect?

The claims examiner will want to see medical records covering the entire time you've been disabled, including information about all the medical treatments and therapies you've had. You'll need to sign a release and provide contact information for all the doctors and clinics you've visited.

The examiner might contact both medical and non-medical sources to gather information about your ability to work, including:

• your doctor
• your employer
• you lawyer, if you have one, or
• other appropriate parties.

Doctor Statements Can Help the Disability Examiner Decide

Getting support from your treating doctor or psychologist can reinforce your claim. A statement from your doctor that details how and why each of your impairments prevents you from working can be especially helpful, but only if it's backed up with medical evidence like:

• lab tests (like blood panels)
• imaging texts (like X-rays or CT scans)
• surgical reports (including biopsies)
• physical or occupational therapy reports, and
• treatment notes (including information about any side effects you suffered).

The Examiner Might Send You to a Consultative Exam

The disability examiner might schedule you for a consultative examination (CE) with a doctor or psychologist paid for by Social Security if the examiner determines that either:

• you haven't seen any doctors (called "medical treating sources") within the past three months, or
• the doctors listed in your disability claims file haven't provided enough medical information to make a medical determination about your disability.

Social Security will often schedule your CE with a doctor or psychologist already treating you. But that's not always the case.

Putting Together Your Medical and Vocational Information

The disability examiner then gathers together your medical and vocational information, including the following:

• your medical records and relevant treatment notes
• consultative examination results
• your relevant past work history (all the jobs you've had in the 15 years before the onset of your disability)
• information on your educational background, and
• any other pertinent information.

How the Examiner Makes the Disability Determination

The disability examiner will use this evidence in a five-step evaluation process to determine disability. In each step, the examiner will evaluate the information in your file to answer the following questions:

1. Are you working or earning enough income for your work to be considered substantial gainful activity (SGA)? (If you're doing SGA, you won't qualify for disability.)
2. Is your medical condition severe? (Does it limit your daily activities enough to keep you from doing SGA?)
3. Does your medical condition meet or equal a listing in Social Security's Blue Book (which lists the criteria needed to qualify for disability benefits automatically)?
4. Can you do the work you did before your impairment began? (If you can, the DDS examiner will find you're not disabled.)
5. Can you be expected to do any other type of work?

To answer the last question, the claims examiner will consider your:

• medical condition and remaining abilities
• age
• education
• past work experience, and
• transferable job skills.

Because of special medical-vocational rules for applicants over 50, it's generally easier for older disability applicants to win Social Security disability claims.

The Examiner Works With a Doctor or Psychologist

The disability examiner uses all the gathered information to make a disability determination with the help of a "medical consultant" (a doctor or psychologist who works for Social Security). The disability examiner and medical consultant must decide if, given the evidence in your file, you qualify as disabled as defined by law (20 C.F.R. § 404.1505(a)).

For you to meet this definition, all of the following must be true:

• You have at least one medically determinable physical or mental impairment.
• Your impairment has lasted or is expected to last at least 12 months (or be expected to result in your death).
• Your impairment keeps you from working enough to earn more than the SGA limit.

(Social Security uses slightly different criteria in defining disability in children.)

What the Medical Consultant Is Supposed to Do

The medical consultant, or state disability unit psychologist, is supposed to develop your RFC, but this doesn't always happen. The disability examiner should at least consult the doctor on the nature and severity of your medical impairments and the kind of additional medical evidence needed to decide your claim.

The DDS examiner can't decide medical eligibility without consulting the doctor on these points, except in quick disability determination (QDD) cases.

What Medical Consultants Often Do Instead

In most cases, the disability examiner will complete a medical decisional write-up and ask the medical consultant to review it and sign it.

In writing up the medical decision, the examiner will discuss whether your impairment meets the requirements of a disability listing, and if not, whether your residual functional capacity (RFC)—how much you can be expected to do given your medical impairment(s)—is enough to allow you to work at some type of job.

If the claims examiner initially denies your claim, it doesn't mean you can't get SSDI or SSI benefits. The initial denial is often just the beginning of the Social Security disability claims process. Learn what happens next if the disability examiner denies your claim.

_{Updated September 7, 2023}