When the evidence is unavailable or insufficient to make a determination, the DDS may arrange a consultative examination (CE) to obtain additional evidence. Usually, the DDS obtains evidence from the claimant's own medical sources first. These State agencies are fully funded by the Federal Government. The DDSs are State agencies responsible for developing medical evidence and making the initial determination about whether the claimant is or is not disabled or blind under the law. The field office sends the case to a DDS for disability evaluation. For SSI eligibility, the field office verifies income, resources, and living arrangement information. The field office is responsible for verifying nonmedical eligibility requirements, which may include age, employment, marital status, citizenship and residency, and Social Security coverage information. (The "claimant" is the person who is requesting disability benefits.) The completed application and related forms provide information about the claimant's impairment(s) names, addresses, and telephone numbers of medical sources and other information that relates to the alleged disability. When an individual applies for disability benefits, whether online, in person, by telephone, or by mail, the application is initially processed at an SSA field office. Subsequent appeals of unfavorable determinations may be decided in the DDSs or by administrative law judges in SSA's Office of Hearing Operations (OHO). Most disability claims are initially processed through a network of local Social Security field offices and State agencies (usually called Disability Determination Services, or DDSs). The medical evidence must establish that an individual has a physical or mental impairment a statement about the individual's symptoms is not enough. What is a "Medically Determinable Impairment"?Ī medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Under title XVI, a child under age 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months. The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. The Act and SSA's implementing regulations prescribe rules for deciding if an individual is "disabled." SSA's criteria for deciding disability may differ from the criteria applied in other government and private disability programs.įor all individuals applying for disability benefits under title II, and for adults applying under title XVI, the definition of disability is the same. Title XVI provides SSI payments to disabled individuals (including children under age 18) who have limited income and resources. Title II provides for payment of disability benefits to disabled individuals who are "insured" under the Act by virtue of their contributions to the Social Security trust fund through the Social Security tax on their earnings, as well as to certain disabled dependents of insured individuals. The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security disability insurance program (title II of the Social Security Act (Act)) and the Supplemental Security Income (SSI) program (title XVI of the Act). Revisions to Rules Regarding the Evaluation of Medical Evidence Disability Evaluation Under Social
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