Disability Determination

The Disability Determination Section, by agreement with the Social Security Administration, determines medical eligibility for Social Security Disability for West Virginians. These benefits include claims for Social Security Disability (SSDI) and Supplemental Security Income (SSI).

Administered in West Virginia by the state Division of Rehabilitation Services, DDS is federally regulated and funded entirely through the Social Security Administration. The volume of claims is substantial, yet DDS staff take pride in providing individualized, accurate services to all who apply for assistance. Their mission is to process SSDI and SSI disability claims in a manner that is accurate, timely, compassionate, and cost-effective.

Qualifying for benefits

There are two SSA programs of disability benefits:

  • Social Security Disability Insurance (SSDI) — This program pays benefits to you and certain family members if you worked long enough and paid Social Security taxes.
  • Supplemental Security Income (SSI) — This program pays benefits to disabled children and adults who have limited income and resources.

The Social Security Administration looks at medical and non-medical factors to determine if someone is eligible for benefits. While non-medical factors like personal income and resources are assessed differently for SSDI and SSI, the medical factors and the basic process are the same. To obtain benefits under either program, the applicant must be found unable to perform any type of work for at least 12 months due to physical, mental, or combined physical and mental impairment. For more information on qualifying for disability benefits, the Social Security Administration provides excellent resources.

The Disability Determination Process

The Social Security Administration requires each state to process its own disability applications, with some exceptions. West Virginia residents' disability applications generally will be processed in West Virginia. Each state processes claims independently, and all must follow the same rules and regulations set forth by Congress.

Getting Started

Whether filing for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), the process always begins by contacting the Social Security Administration in one of these ways:

Disability determination

When an application for disability benefits is received, a case is opened at the local office and forwarded to the Disability Determination Service to assess whether the medical requirements are met for disability.

Under the rules of Social Security, eligibility is determined when a person is found unable to perform any type of work for at least 12 months due to physical, mental, or combined physical and mental impairment. Under the Social Security Disability Program, an applicant cannot be found "25 percent" disabled, as may be the case under the rules for worker's compensation or veteran's benefits. The Social Security Administration uses a "Listing of Impairments" to guide disability assessment. These criteria provide general guidance for assessment based on common medical conditions.

When the case is received by the Disability Determination Service, it is assigned to a disability evaluation specialist. This person reviews the application and may contact the applicant, or claimant, for more information.

Medical assessment as needed

Some impairments are so severe that they already meet the requirements of the Listings, and further processing and assessment is not needed. Others require the disability evaluation specialist to assess the limitations of the impairment(s), vocational experience, age, and education to determine if the person is eligible for disability. The case also may be reviewed by a medical or psychological consultant, who is a licensed doctor contracted by our agency.

If necessary, the disability evaluation specialist then contacts relevant medical sources for documentation of the impairments. It also may be necessary to schedule consultative exams for claimants. These exams help determine what functional limitations may result from an individual's impairment(s); they are not for providing further medical treatment.

When sufficient medical evidence has been gathered, the disability evaluation specialist will use the "Listing of Impairments" as a guide to determine if the individual qualifies for disability benefits.

Informing the claimant of the decision

When a medical determination is made on the claim, claimants are advised in writing. If a claimant does not meet the requirements, a detailed explanation summarizes the reasons for that decision.

The right to appeal

If the disability evaluation specialist determines that an applicant is not eligible for benefits, an appeal or reconsideration can be requested. This must be done within 60 days of the date on the written notice of the decision. As with the initial application process, this begins by contacting the Social Security Administration:

Please note that an appeal cannot begin by contacting the Disability Determination Service. A summary of the appeals process and procedure can be found here: How Do I Appeal a Social Security Decision?

When the Social Security Administration receives an appeal request, an effort is made to update information and the claim is reviewed by a different disability evaluation specialist and medical/psychological consultant. If the claim is denied at this point, the applicant can file another appeal to have the case heard by an SSA administrative law judge, then continue the appeals process through the legal system if warranted.