Public Health Law Map - Beta 5 - Medical and Public Health Law Site

the medical problems have affected their functioning.
The initial application is made to the State Disability Determination Services (DDS)
in the state where the claimant resides. The DDS investigates the claim by obtaining
copies of medical records and by verifying work history and FICA payments. If the
claimant does not have a doctor or if there is not an adequate evaluation in the
records, then DDS must arrange for a medical exam at DDS expense. Usually, the
DDS has a group of physicians in various specialties who know the requirements of
the program and who regularly do consultative exams for the program.
Once the medical evidence (records) is received, it is given to a physician to
evaluate. This physician is an employee or contractor of the DDS who only sees the
records. If the physician knows the claimant or has cared for him or her in the past,
then this physician does not process the case.
c) Listing of Impairments
The Social Security Administration has a Listing of Impairments that is used to
judge the severity of the disability. This can be found in SSA Publication No. 64-
039, Disability Evaluation Under Social Security. This booklet should be in the
office of every physician who does disability evaluations of any kind. The system
is not complicated, but it is nit- picking. Leaving one finding out of a report can
cost a patient his or her benefits. The “Listing of Impairments” is divided into
fourteen body systems or groups of disorders. Within each group, there are specific
diseases or disabilities. For each disability there are specific problems that must be
present for the claimant to “meet listing.”
An example of a commonly used disability listing is 1.05 Disorders of the Spine:
1.05C. Other vertebrogenic disorders (e.g., herniated nucleus pulposus,
spinal stenosis) with the following persisting for at least 3 months despite
prescribed therapy and expected to last 12 months. With both 1 and 2:
1. Pain, muscle spasm, and significant limitation of motion in the spine; and
2. Appropriate radicular distribution of significant motor loss with muscle
weakness and sensory and reflex loss.
Notice that all the sentences use “and.” In order to meet the listing, and
automatically get disability, the records must show that the claimant has all the
problems described. Most doctors who have documented the nerve damage
described in number 2 don’t bother to note muscle spasm in the records. But
without that notation, the patient has more difficulty getting benefits.
d) Residual Functional Capacity
If the claim does not meet listing, then the DDS doctor determines whether there
are multiple conditions that will “equal” a listing. This is most common in claims
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