Step 4: The Social Security Administration Reviews Your Medical Evidence

After you submit your SSDI process, the Social Security Administration (SSA) does not make the decision itself. Instead, your process goes to your state's Disability information Services (DDS) office, which is a state agency that contracts with Social Security to review medical evidence and decide whether you meet the definition of disability under federal law.

The DDS examiner assigned to your case will request your medical records from the doctors, hospitals, and clinics you listed on your process. They will also order a Consultative Examination (CE) if your records do not contain enough recent medical evidence to make a decision. This is a one-time medical appointment, usually with a doctor chosen by DDS, not your own physician. You do not pay for it.

The examiner compares your medical evidence against the SSA's Blue Book — the official list of conditions that automatically meet the disability standard if your medical records show you have that condition at the severity level described. If your condition is not in the Blue Book, or your records do not match the Blue Book criteria exactly, the examiner uses a five-step process to decide whether your condition prevents you from doing any work.

Key Takeaways

  • Your state's Disability information Services office, not Social Security directly, reviews your medical records and decides whether you meet the disability definition.
  • DDS will request medical records from all the doctors and facilities you listed, and may order a free Consultative Examination if your records lack recent evidence.
  • The decision process typically takes three to six months, though it can take longer if DDS needs to obtain additional records or schedule an examination.
  • You will receive a written decision in the mail that explains whether you were found disabled and, if not, which step of the five-step process you did not meet.
  • If you disagree with the decision, you have 60 days to file a Request for Reconsideration, which sends your case to a different examiner at DDS.

What DDS Does With Your Medical Records

The DDS examiner will contact every doctor, hospital, clinic, and mental health provider you listed on your process. They request all treatment notes, test results, imaging reports, and medication records from the date your condition began until the date you submitted your process. This process can take several weeks because medical offices sometimes respond slowly.

While waiting for records, the examiner also reviews what you wrote on your process about your daily activities, work history, and symptoms. They look for inconsistencies — for example, if you reported that you cannot walk more than 50 feet but your medical records show you were hiking last month, the examiner will note that discrepancy.

If your records show treatment only once or twice a year, or if the most recent record is more than three months old, DDS will order a Consultative Examination. The SSA pays for this appointment and schedules it for you. You will receive a notice in the mail telling you the date, time, and location. The doctor who performs the CE is not your treating physician — it is a physician DDS contracts with — but the examination is free to you.

How DDS Decides if You Are Disabled

The SSA's definition of disability is strict: you must have a condition that prevents you from doing any substantial work for at least 12 months or results in death. DDS uses a five-step evaluation to determine this.

Step 1 asks whether you are currently working and earning more than $1,550 per month (as of 2024; this amount changes yearly). If you are, DDS will usually deny your process at this step, because earning above this amount suggests you can do substantial work.

Step 2 asks whether your condition is severe — meaning it causes more than minimal functional limitation. Almost all applicants pass this step if they have ongoing medical treatment.

Step 3 compares your condition to the Blue Book. If your medical records show you have one of the listed conditions at the severity level described, you are found disabled and the process stops. If not, DDS moves to Step 4.

Step 4 asks whether you can do your past work. DDS looks at the physical and mental demands of the jobs you held in the 15 years before you applied. If your condition prevents you from doing that work, DDS moves to Step 5.

Step 5 asks whether you can do any other work that exists in the national economy, given your age, education, work history, and functional limitations. If DDS concludes you cannot, you are found disabled. If they conclude you can do other work, your process is denied.

Timeline and What to Expect During Review

The review process typically takes three to six months from the date you submit your process. If DDS is waiting for medical records from a provider who responds slowly, or if they need to schedule a Consultative Examination, the timeline can stretch to nine months or longer.

You will not hear from DDS during the review unless they need something from you. If they need additional information — for example, a more recent medical record, or clarification about a job you held — they will send you a letter asking you to provide it within 10 days. If you do not respond, DDS may deny your process based on the records they have.

Some applicants receive a letter asking them to attend a Consultative Examination. This is not a sign that your process is being denied. It straightforward means DDS needs more recent medical evidence. Attend the appointment; missing it can result in denial.

When DDS reaches a decision, they will mail you a written notice. The notice will state whether you were found disabled or not disabled, and it will explain which step of the five-step process led to that decision. If you were denied, the notice will tell you why — for example, "Your condition does not meet the Blue Book criteria" or "You can perform other work available in the national economy."

If Your process Is Denied

A denial at Step 4 does not mean your process is final. You have the right to challenge the decision. Within 60 days of receiving the denial notice, you can file a Request for Reconsideration. This sends your case to a different examiner at DDS who will review all the evidence again from the beginning.

You can submit new medical records with your reconsideration request — for example, if you have had additional treatment or testing since you first applied. New evidence often changes the outcome, especially if it shows your condition has worsened or that you have received a diagnosis that was not documented in your original process.

If DDS denies your reconsideration request, you can file an appeal with an Administrative Law Judge (ALJ) within 60 days. An ALJ is an independent decision-maker who holds a hearing where you can present evidence and testimony. Many applicants who were denied at the DDS level are approved at the ALJ hearing stage.

What Happens if You Are Approved

If DDS finds you disabled, they will send you an approval notice that states your Established Onset Date (EOD) — the date your disability began according to your medical records. Your first SSDI payment is based on this date. If your EOD is in the past, you may receive back pay covering the months between your EOD and the month you applied.

After approval, you will also become may be able to access for Medicare after you have been on SSDI for 24 months. During the first 24 months, you may be able to stay on Medicaid if you were already receiving it, depending on your state's rules.

Your approval notice will also explain your work incentives — programs that allow you to work part-time or test your ability to work without when ready losing your benefits. The most common work incentive is the Trial Work Period (TWP), which allows you to work and earn any amount for nine months without affecting your SSDI payment.

Frequently Asked Questions

Can I work while DDS is reviewing my process?

Yes. Working while your process is pending does not affect the review process. However, if you earn more than $1,550 per month (2024 amount), DDS may deny your process at Step 1 because the earnings suggest you can do substantial work. Keep records of any work you do and any income you earn.

What if I disagree with the Consultative Examination doctor's findings?

You can submit a statement disagreeing with the CE findings when you file your reconsideration request, and you can submit records from your own treating doctor that contradict the CE report. The reconsideration examiner will weigh all the evidence, including both the CE report and your treating physician's records.

How long do I have to file a reconsideration after I receive a denial?

You have 60 days from the date on the denial notice. If you miss this important date, you lose the right to reconsideration and must instead file an appeal with an Administrative Law Judge, which requires a different form and process.

Will I receive back pay if I am approved?

You may receive back pay if your Established Onset Date is before the month you applied. Back pay covers the months from your EOD to the month before your process month. The exact amount depends on your Established Onset Date and your Primary Insurance Amount (PIA).

What if DDS loses my medical records?

Contact your DDS office when ready and ask them to re-request the records from your provider. You can also submit copies of your own records directly to DDS. Keep copies of everything you send and request written confirmation that DDS received them.