Social Security Disability:

If you can no longer work because of a physical or mental condition, you should see your family doctor or a specialist without delay. A doctor can examine you, order tests and ultimately diagnose your condition. This diagnosis will be important for your future care and treatment. It also will be important for your SSD benefits claim.

Your next step is to make an initial determination of your eligibility. Generally speaking, you may qualify for SSD benefits if you:

• Are age 65 or younger
• Have worked five out of the previous 10 years or earned 20 work credits
• Suffer from a condition that meets the Social Security Administration’s narrow definition of a “disability.”

Work credits are based on your earnings. If you do not meet the SSA’s work credits requirements, you may still be eligible for a different form of benefits called Supplemental Security Income (SSI).

A “disability,” according to the SSA, is a physical or mental impairment that:

• Can be medically determined (this is why your doctor’s diagnosis is important)
• Prevents you from engaging in “substantial gainful activity”
• Has lasted or is expected to last for at least 12 consecutive months or likely result in death.

If you believe you meet the SSA’s non-medical and medical requirements, you should go forward with preparing your application. Be careful and be thorough. Many SSD applications are denied due to technical errors. Go to the SSA website to see a checklist of information and documents you will need to provide.

When you are ready to submit your application, you can submit it by:

• Calling Marks & Harrison
• SSA website
• Going to your nearest SSA field office (you can find the office nearest to you by using the SSA field office locator)
• By phone and by mailing in your documents after your phone interview (call 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday).

Hold on to your confirmation number. You can use that number to check on the status of your application after you submit it.

After you submit your application, the SSA will determine your eligibility. The process basically involves two steps:

• Non-medical eligibility – The SSA field office will determine if you have the required number of work credits or meet the eligibility requirements for SSI.
• Medical eligibility – If you meet the SSA’s work credit requirement, the SSA will forward your application to Virginia Disability Determination Services. DDS will determine whether you have a qualifying disability.

A two-person team from DDS typically will review your application: A staff doctor or clinical psychologist and a claims analyst, or examiner. Sometimes, it will be only a single decision-maker. DDS will go through a five-step sequential evaluation process. The five steps are:

1. Are you engaged in substantial gainful activity?
   In other words, do you earn more than $1,130 per month (or $1,820 if you meet the SSA’s statutory definition of blindness)? Note that these limits change each year.
   • No — Your review goes to Step 2
   • Yes — Your application will be denied
2. Do you suffer from a “severe” condition?
   Your condition must be diagnosed by medically acceptable clinical or diagnostic techniques. The DDS team will take a close look at the symptoms of your physical or mental impairment. A written statement from your doctor will be helpful to DDS.
   • Yes — Your review goes to Step 3
   • No — Your application will be denied
3. Does your condition match or is it equal in severity to a condition listed in the Blue Book?
   DDS will determine if your symptoms match or are equal in severity to an impairment listed in the Blue Book, which lists impairments in 14 different categories.
   • Yes — If you meet all non-medical requirements, your application should be approved
   • No — Your review goes to Steps 4 and 5 for an assessment of your residual functional capacity (RFC)
4. Can you return to your previous work?
   The DDS team will look at the physical and mental tasks that your previous work required you to do and will determine whether you can do those tasks after the onset of your impairment.
   • Yes — Your application will be denied
   • No — Your review goes to Step 5
5. Can you do any other work?
   If you cannot do the work you did before, DDS will determine whether you can do any other work based on your age, education, training and work history and based on whether you have any skills that can be transferred to another line of work.
   • Yes — Your application will be denied
   • No — If you meet all non-medical requirements, your application should be approved

To determine your medical eligibility, DDS must have the most current information about your condition. If any changes occur in your condition, you should follow up by sending your new medical records to the DDS team that is reviewing your case.

When your case is sent to DDS for review, you should receive a notice that contains the name of your claims examiner and the address to use when sending in your new medical records.

Additionally, if DDS believes it needs more information, it may request for you to submit more medical evidence or ask you to undergo a consultative medical examination. This examination will be conducted by an independent physician and not the physician who is reviewing your application.

You must submit any record DDS requests and go to any consultative examination DDS requires. If you fail to cooperate with DDS, your application could be denied.

If you meet both non-medical and medical eligibility requirements, your SSD benefits application should be approved. You will receive a Notice of Approval letter. The letter will provide the following information:

• Your onset of disability date
• Date of eligibility to receive benefits (generally, onset of disability date plus six months)
• Amount you are entitled to receive in back pay
• Amount you will receive in monthly benefits
• Date when your first continuing disability review (CDR) will be conducted.

As of January 2016, the average monthly amount paid to disabled workers receiving SSD benefits was $1,165.76. Please see our Benefits Calculator for an estimate of the amount you could receive in monthly payments. The amount you receive is subject to cost of living adjustments (COLA). This adjustment is based on economic data from the previous year.

If medical improvement is expected in your case, a CDR may be conducted as soon as the first year after you begin receiving benefits.

If a CDR results in a determination that you are no longer disabled, your benefits will be terminated. Otherwise, you should continue to receive benefits as before.

To learn more about returning to work while still receiving SSD benefits, please check out information about the SSA’s Ticket to Work program.

If your application is denied, you will receive a Notice of Denial letter. The letter will state the date when your claim was denied and provide a detailed explanation of the reasons for the denial.

If you wish to appeal the decision, you can submit a Request for Reconsideration in writing. You must submit the request within 60 days of the denial date. At this stage, a new DDS team will review your claim.

If your application is denied again, you will have 60 days from that denial date to request a hearing before an administrative law judge. Your hearing would be held at the nearest Office of Disability Adjudication and Review (ODAR). In Virginia, those offices are located in Richmond, Roanoke, Charlottesville, Falls Church and Norfolk. Satellite offices are located in other areas.

While roughly 40 percent of initially denied claims are approved at the hearing stage, you may have to wait more than 16 months before your hearing is even held.

As a result, you should explore options to speed up a decision on your application. These options include:

• Dire need letter – A statement that you are currently facing an “immediate threat” to your safety due to your inability to afford food, housing or medical care, which may reslt in a decision to expedite your application.
• On-the-record review – A request to have your case decided without the need for a hearing because the record in your case contains ample evidence and there is no need for testimony at a hearing from a medical or vocational expert.

If a hearing does not result in approval of your application, you may pursue an appeal with the Appeals Council based in Falls Church, Virginia. If your claim is not approved during the administrative appeals process, the next step would be to file a lawsuit in the nearest federal court: The U.S. District Court for the Eastern District of Virginia or the U.S. District Court for the Western District of Virginia.