Understanding the Medical Decision Notice

When Social Security sends you a notice saying "a medical decision has been made," it means a doctor or psychologist hired by Social Security has reviewed your medical records and formed an opinion about whether your condition meets their definition of disability. This is not a final decision on your whole claim — it is one piece of the process. The notice will tell you what the doctor concluded and give you the right to disagree.

The medical decision itself is written by a state Disability information Services (DDS) doctor, not your own physician. Social Security sends your medical records to this doctor, who writes a report called a Residual Functional Capacity (RFC) assessment. The RFC describes what physical or mental tasks the doctor believes you can still do — how long you can sit, whether you can lift objects, whether you can concentrate on a task for eight hours. This assessment becomes the foundation for whether Social Security says you are disabled.

You will receive this notice in the mail. It will include the doctor's findings, the medical evidence they reviewed, and instructions on what to do next if you disagree. Keep this notice — you will need it if you move forward with an appeal.

Key Takeaways

  • A medical decision notice means a state doctor has reviewed your records and formed an opinion about your functional capacity, but this is not the final word on your claim.
  • The notice will describe what tasks the doctor believes you can perform and will explain which medical records were reviewed and which were not.
  • You have the right to submit new medical evidence or a written disagreement within 10 days of receiving the notice, and this can change the outcome.
  • If you disagree with the medical decision, you can request reconsideration, which sends your case to a different doctor at the same DDS office.

What the Medical Decision Notice Contains

The notice will have several sections. At the top, it states the date the decision was made and the name of the doctor or psychologist who made it. Below that is a summary of your medical condition as the doctor understands it — this is based only on the records Social Security obtained, not on a physical exam or conversation with you.

The middle section lists the specific medical evidence the doctor reviewed: hospital discharge summaries, doctor's notes, test results, imaging reports. It will also list what evidence was not available — for example, "no mental health treatment records received" or "no recent imaging on file." This matters because if your doctor has written important records that are not on this list, you can send them in and ask for the decision to be reconsidered.

The final section describes the doctor's conclusion about your Residual Functional Capacity. This will say things like "can sit for six hours in an eight-hour workday" or "can perform straightforward, repetitive tasks but not complex problem-solving." This is the medical opinion that Social Security will use to decide whether you meet their rules for disability.

The Difference Between a Medical Decision and a Claim Decision

A medical decision is not the same as a decision on your whole claim. After the state doctor writes the RFC, a claims examiner at Social Security uses that RFC to decide whether you are disabled under Social Security rules. The examiner compares your RFC to the jobs that exist in the economy. If the examiner decides you cannot do your past work and cannot do any other work, they approve your claim. If they decide you can do other work, they deny it.

This means you can disagree with the medical decision without waiting for the final claim decision. If you think the doctor got your condition wrong, you can send in new medical evidence or request that a different doctor review your case. This can happen before the claims examiner makes their final decision, which may speed up the process.

How to Respond to a Medical Decision You Disagree With

You have options if the medical decision does not match what your own doctor says or what you know about your condition. The fastest option is to send new medical evidence directly to Social Security within 10 days of receiving the notice. This evidence goes back to the state doctor, who may revise their opinion based on the new information.

New medical evidence means records from your own doctors — recent office visit notes, test results, specialist reports, or a letter from your treating physician explaining why the state doctor's assessment is wrong. Do not send opinion letters from friends or family. Social Security will only consider records from licensed medical providers. Send these records to the address listed on your notice, and include a cover letter saying you are submitting them in response to the medical decision dated [date].

If you do not have new medical evidence, or if you want a second medical opinion from Social Security, you can request reconsideration. This sends your entire case to a different doctor at the same state DDS office. The new doctor will review all the original records plus any new evidence you submit, and will write a new RFC. Reconsideration takes 10 to 30 days. You do not pay for this — it is part of the SSDI process.

When the Medical Decision Leads to Approval or Denial

After the medical decision is made and any new evidence is considered, the claims examiner decides your whole claim. If the examiner approves you, you will receive a notice saying you are may have access to to SSDI benefits, the date your benefits begin, and the amount of your monthly payment. This notice will also explain Medicare may be able to access and when your coverage starts.

If the examiner denies your claim, the notice will explain the reason. Common reasons include: the RFC shows you can do your past work; the RFC shows you can do other work that exists in the economy; or your condition does not meet Social Security's medical rules for a specific impairment. The denial notice will tell you how to appeal and what your important date is — usually 60 days from the date you receive the notice.

A denial is not final. You can request reconsideration, and if that is denied, you can request a hearing before an Administrative Law Judge. Many people are approved at the hearing stage even after two denials, because you can present new evidence and testify about your condition in person.

What to Do If Medical Records Are Missing

If the medical decision notice lists medical records that should exist but are not checked off as received, you can obtain those records yourself and send them to Social Security. For example, if you saw a specialist but the notice says "no specialist records received," contact that specialist's office and request copies of your visit notes and any test results. Ask them to send the records directly to Social Security, or send them yourself with a cover letter.

Include the Social Security claim number on all records you send. Write a short letter explaining which records you are submitting and why they are important to your case — for example, "These records show that I have been unable to work since [date] due to [condition]." Keep a copy for your own records.

You can also ask your own doctor to write a statement about your functional capacity. This is different from a medical record — it is a letter from your treating physician saying what they believe you can and cannot do. Some doctors will write this for free; others charge a fee. This letter can be powerful evidence because it comes from someone who knows you and has treated you over time, unlike the state doctor who has only reviewed paperwork.

Timeline and What Happens Next

After you receive the medical decision notice, the timeline depends on what you do. If you do nothing, the claims examiner will make a decision on your whole claim within 30 to 60 days. If you submit new medical evidence within 10 days, the state doctor will review it and may issue a new RFC within 10 to 15 days. If you request reconsideration, a new doctor will review your case within 10 to 30 days.

Once the medical decision is final (either the original or a revised one after reconsideration), the claims examiner will use it to make the final decision on your claim. You will receive a notice in the mail. If you are approved, your benefits will begin the month after your established onset date of disability. If you are denied, you will have 60 days to request a hearing.

The entire process from medical decision to final claim decision usually takes 30 to 90 days, but this varies depending on how busy the DDS office is and whether you submit new evidence or request reconsideration.

Frequently Asked Questions

Does a medical decision mean my claim was approved?

No. A medical decision is the doctor's opinion about what you can do physically or mentally. The claims examiner then uses that opinion to decide whether you meet Social Security's rules for disability. You can have a medical decision that says you cannot work, but still be denied if the examiner decides you can do other work.

Can I talk to the doctor who made the medical decision?

No. The state doctor does not speak directly to applicants. If you disagree with their assessment, you submit new medical evidence or request that a different doctor review your case. You cannot request a specific doctor or ask questions directly.

What if my condition got worse after the medical decision was made?

You can submit new medical evidence showing the worsening. Send records from your doctor dated after the medical decision was made. Include a letter explaining how your condition has changed. This evidence will be reviewed by the claims examiner and may change the outcome of your claim.

How long do I have to disagree with the medical decision?

You have 10 days from the date you receive the notice to submit new medical evidence that will be reviewed by the state doctor. You can request reconsideration at any time before a final decision is made on your claim. After your claim is denied, you have 60 days to appeal.

Will requesting reconsideration delay my claim?

Reconsideration adds 10 to 30 days to the process, but it may be worth it if you believe the first doctor's assessment was wrong. Many people are approved on reconsideration. If you do not request reconsideration and are denied, you can still appeal, which takes longer — usually three to six months for a hearing.