The Role of an Adjudicator in the SSA Disability Determination Process

An adjudicator at the Disability Determination Services (DDS) plays a pivotal role in the disability claim process for the Social Security Administration (SSA). When someone files a claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) due to a disability, it's the DDS and specifically the adjudicator's role to make the initial determination regarding the claimant's medical eligibility.

Here's what an adjudicator typically does at DDS in regard to SSA disability determinations:

1. Review the Application: The adjudicator starts by examining the disability claim to ensure it's complete and that all required documentation, including medical and work history, is present.

2. Gather Medical Evidence: The adjudicator collects medical records from the sources the claimant provided. This includes hospital records, doctors' notes, lab results, and other relevant medical evidence that can shed light on the claimant's medical condition and its severity.

3. Consultation with Medical and Vocational Experts: If the available medical evidence is insufficient to make a determination, the adjudicator might request further medical examinations or tests, often referred to as "consultative exams." These are conducted by doctors or specialists contracted by DDS. Additionally, vocational experts may be consulted to understand how the claimant's condition affects their ability to work.

4. Assess Severity and Duration: The adjudicator evaluates whether the disability is severe enough to significantly limit the claimant's ability to perform basic work-related activities. Moreover, the disability should be expected to last at least 12 months or result in death.

5. Compare with the Listing of Impairments: The SSA maintains a "Listing of Impairments" that details conditions considered severe enough to prevent an adult from performing any gainful activity, regardless of age, education, or work experience. The adjudicator checks whether the claimant's condition matches or equals a listed impairment.

6. Determine Residual Functional Capacity (RFC): If the condition doesn't meet a listing, the adjudicator assesses the claimant's RFC. This is an evaluation of the most a person can still do despite their limitations. It considers both physical and mental capacities.

7. Evaluate Past Work and Skills: The adjudicator looks into the claimant's work history to see if they can still perform any of their past jobs with their current condition. If they can't, the adjudicator evaluates if there are other jobs in the national economy the claimant could perform, given their age, education, work experience, and RFC.

8. Make a Determination: After all these steps, the adjudicator arrives at a decision. The claimant will then be notified if their claim has been approved or denied. If approved, benefits will start as determined by the SSA's guidelines. If denied, the claimant has the right to appeal.

In Conclusion

The role of an adjudicator at DDS is both critical and comprehensive. They must objectively evaluate a vast amount of information and follow SSA guidelines to determine if a claimant qualifies for disability benefits. The ultimate goal is to ensure that individuals truly in need receive the assistance they deserve while maintaining the integrity of the SSA's disability programs.

Under normal circumstances, this is how the process should work. However, based on my experience, determinations do not always go according to plan, despite everyone's best efforts. To keep you updated on your treatment and condition, I make regular inquiries with the adjudicator. Unfortunately, until an adjudicator is assigned to your case, your disability file remains in limbo and is not processed. Due to the high volume of cases at DDS, it can take up to 7-9 months for a case to be assigned to an adjudicator.

For help with your case, feel free to reach out to me by text or by calling (407) 738-38718.