How to Qualify for Disability (What Happens at DDS)
Claims examiners at the state disability determination agency decide whether you are medically eligible for Social Security disability or SSI.
To determine whether you are disabled, and thus qualify for Social Security disability benefits -- either SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) -- the Social Security Administration (SSA) will send your claim to a state agency that's often called Disability Determination Services (DDS). (To learn other common names for the agency, see our article on the state disability determination agency.)
DDS, rather than the Social Security Administration, assesses whether you are doing a certain minimal amount of work (in which case you aren't eligible for benefits) and whether you are medically disabled (physically or mentally unable to perform any job).
This is what happens at DDS: A disability claimant's file arrives from a Social Security office and is assigned to a disability claims examiner. The examiner begins immediately to order medical records from all the treatment sources indicated by the applicant on their application. Once those medical records begin to arrive, the examiner can begin to go about the task of deciding whether or not a person will qualify for disability. These are the questions the claims examiner will ask.
Are You Currently Working?
The first test the examiner will apply to your file has nothing to do with your condition, but whether you are working, and how much you're working. For both the SSDI program and the SSI program, a disability claimant cannot work and earn more than an amount equal to or greater than what is known as SGA, or substantial gainful activity. In 2016, the SGA amount is $1,820 for blind applicants and $1,130 for applicants with other disabilities. If you are currently working and are making this amount or more, DDS assumes you can't really be disabled. (There are specific rules for the self-employed, who may not bring home a set paycheck every month.) For more information, see our article on SGA.
Is Your Condition Severe?
As the second step of the evaluation process, the DDS will assess the severity of your condition and how it limits you. For instance, if you have moderate hearing loss, but with hearing aids you are able to hear 95% of what people are saying, the DDS is not likely to consider your condition severe, and your claim will not move on to the next level of the evaluation process.
Does Your Condition Meet a Disability Listing?
If your medical records indicate that you have a severe medical condition that matches the requirements of an official Social Security disability listing, you qualify for disability and the claims examiner will immediately put you on "benefit receipt" status. The examiner will forward your file back to the SSA for further processing.
For details on this part of the evaluation process, see our section on the medical disability listings.
Are You Able to Work Full-Time?
This test has to do with how your medical, psychological, or psychiatric condition limits your ability to work. If you have a medical impairment or disability that makes to impossible for you to work your prior job full time, or another type of work full time, you can get benefits. For the details on this part of the evaluation process, see our section on the medical-vocational assessment.