Social Security

A. Purpose

This emergency message (EM) provides the Disability Determination Services (DDS) and federal disability adjudicating components with disability case processing guidance for Disability Examiner Decisional Authority (DEDA). DEDA will temporarily allow qualifying disability examiners to make fully favorable disability determinations in adult cases based on physical impairments alone without medical review by medical consultants (MC), but with the flexibility to consult with an MC at the disability examiner’s discretion.

These temporary instructions apply to initial level claims, including initial-level claims pending at the DDS and federal disability case processing sites (DPB, DPU, etc.).

The Social Security Administration (SSA) faces unprecedented initial disability claims backlogs surpassing the 1.12 million case mark, resulting in high average processing times and claimant wait times. A contributing factor to the increase in average processing time is the general requirement that qualified physicians, psychiatrists, and psychologists (referred to in our policy as medical consultants (MC) and psychological consultants (PC)) complete the medical review of all initial level disability determinations combined with an insufficient number of MCs and PCs. See Section 221(h) of the Social Security Act).

The agency approved the temporary implementation of the DEDA. The DEDA initiative allows disability examiners deemed qualified by their respective DDS or federal disability case processing site to make fully favorable disability determinations in initial, adult cases based on physical impairments alone without medical review by MCs, but with the flexibility to consult with an MC at the disability examiner’s discretion.

The statute requires the agency to make “every reasonable effort” to obtain the services of MCs to perform the medical portion of case reviews for cases involving physical impairments. Thus, to leverage DEDA each adjudicating site would be required to:


· Document the steps taken by the state which demonstrates the state has met SSA’s ‘every reasonable effort’ standard for MC recruitment (see Section D of this EM).

In addition, to ensure the integrity of the DEDA process, each state DDS would be required to:

· Assess the experience level of each disability examiner, to ensure individuals granted the authority, meets SSA’s minimum qualifications as an experienced disability examiner (see Section E of this EM).

This initiative allows the state DDSs to use DEDA for a temporary period of two years, from the date the DEDA authority is implemented nationally (01/17/2025 through 01/16/27) to the Social Security Act.

1. When DEDA applies

A disability examiner who qualifies for the DEDA process (see Section E of this EM) may complete the medical portion of the initial disability claim without an MC, including signing the medical assessment(s) (i.e., SSA-416 (Medical Evaluation) and SSA-4734 (Physical Residual Functional Capacity (RFC)) and overall medical signature when:

· The adult initial sequential evaluation process applies (see DI 22001.001),

· The medical assessment(s) of the claim is based on the physical impairment(s) alone, and

· The claimant is determined to be disabled with an established onset date (EOD) on or before the potential onset date (POD).

IMPORTANT : If a mental impairment is alleged or discovered, and the determination is fully favorable based on only the physical impairment(s), discontinue development when a fully favorable allowance is documented based on a physical impairment(s). See DI 24505.030E.1.


NOTE: For Title XVI claims, the Field Office (FO) does not complete the POD field on the SSA-3367 (Disability Report – Field Office) if the protective filing date is the POD. For details, see DI 11005.045A.1.c. If the FO did not provide the POD in a Title II claim as required, send an assistance request to the FO to ask them to add the POD in EDCS via update-after-transfer (UAT) per DI 22501.002D. For information on the UAT utility, see DI 81010.095. For information on electronic assistance requests, see DI 81020.100.


2. When DEDA does not apply

DEDA authority cannot be used for the following claims:

a. Claims that are less than fully favorable (i.e., EOD after POD).

NOTE: SSR 18-1p states the POD is the earliest date considered for the EOD because it affords the claimant the maximum possible benefit.

b. Claims in which the evidence does not establish a fully favorable determination based on physical impairments alone.

c. Claims in which a prior denial that is administratively final should be reopened and revised. For information on the conditions for reopening a final determination or decision, see DI 27505.001.

d. Claims in which the favorable determination is based on medical equivalence.

NOTE: SSR 17-2p requires adjudicators at the initial and reconsideration levels to obtain MC/PC administrative medical findings. For information on equaling a listing, see DI 24508.010.

e. Title XVI childhood disability (DC) claims.

f. Age 18 redeterminations.

g. Reconsideration claims.

h. Continuing disability reviews (CDR) cases.


IMPORTANT: If DEDA does not apply, do not “apply” a medical assessment(s) signed by an individual with DEDA signature authority to the Disability Determination Explanation (DDE).

Adjudicating sites must demonstrate “every reasonable effort” has been made to recruit and obtain sufficient MC services. Adjudicating sites will be required to document and maintain records that identify the date and activities completed to meet the minimum “every reasonable effort” requirements.

To ensure national uniformity in the disability program, each State DDS may assign DEDA to qualified disability examiners (see Section E of this EM) after demonstrating and documenting each of the “every reasonable effort” requirements outlined in subsection 1 through 5 below. Each of the requirements must be met within the prior 18-month period. (NOTE: The authority can be applied regardless of the State DDS’ success to recruit MCs, understanding that additional MC capacity in a DDS will be made available for national capacity assistance).

1. Compensation rates


Take the necessary steps within applicable state rules or regulations to raise state agency level compensation to meet the prevailing rates for MC services, if those services are unobtainable because of low salary rates or fee schedules.

Each state should also memorialize in writing and maintain records outlining the steps taken to raise compensation and document the controlling rules and regulations that may prevent further increases.

2. Publish job announcements


Advertise in at least two channels below as allocations or funding is made available for additional hires and contractors:

· State government website.

· Recruitment sites (e.g., Indeed, LinkedIn, Handshake, etc.).

· Newspapers.

· Newsletters.

· Medical journals.

· Alumni websites/newsletters.

· Medical Association/Organization Websites.

· Contract recruitment services.

3. Attend job fairs/conferences (virtually or in-person) and/or send recruitment mailers to licensed medical professionals


Complete at least two of the following recruitment activities as allocations or funding is made available for travel or mail activities when allocated for additional hires and contractors.


· Recruit at medical professional organization meetings.

· Recruit at health care summits.

· Recruit during medical campus recruitment activities.

· Send recruitment mailers to general groups of licensed physicians.

· Send recruitment mailers to alumni of different medical universities.



4. Offer workplace flexibilities

Offer at least one workplace flexibility, as allowed by state rules or regulations.

· Telework.

· Expanded shifts.

· Flexible working hours.



5. MC peer recruitment

Assign and require a current Chief MC or MC to perform peer recruitment outreach/activities within state when allocations or funding is available for additional hires and contractors.

Examples of MC/PC Recruitment Adversities that may impact medical consultant recruitment:

· Adjudicating site received lack of or insufficient hiring authority.
· State specific limitations preventing hiring.
· Adjudicating site is at or over MC/PC capacity

· Adjudicating site is providing MC/PC assistance to other state and federal adjudicating sites.

NOTE: Sites requiring assistance with MC/PC recruitment or other recruitment adversities should reach out to their regional office for assistance.

E. Disability Examiner qualifications for DEDA

Each State DDS and federal assisting site must assess that each disability examiner meets the minimum qualifications to be given DEDA (authority) as outlined in subsection 1 below.

Each state may identify additional parameters to meet its own personnel rules and requirements. Adjudicating components are required to document and maintain records to identify how the following factors were determined for staff given the DEDA profile.

1. Minimum Qualifications

· Successfully completed Disability Examiner training and adjudicated adult initial cases for a minimum of 12 months (based on the expectation the Disability Examiner has completed disability examiner training and worked with supervisors, mentors, and MCs long enough to develop the skills necessary to accurately analyze medical evidence to assess functional limitations related to physical impairments).

· Demonstrated experience/autonomy in developing accurate medical assessments (i.e., SSA-416 (Medical Evaluation) and SSA-4734 (Physical Residual Functional Capacity (RFC)).

· Approval/endorsement from a Supervisor/Management.


2. Adjudicating Site Documentation

· The adjudicating component has the authority to establish additional rules and guidelines according to internal DDS performance standards and quality expectations.

· Adjudicating component must maintain appropriate documentation showing (a) minimum qualifications for the examiner and (b) the additional parameters set by the DDS are met by each DEDA disability examiner.

Examples of documentation may include but are not limited to:

o Probationary and performance review documents,

o Internal Quality Assurance (IQA) and/or Federal Quality Assurance (FQA) statistics,

o Records showing completion of training initiatives, etc.

1. Adjudicating sites assisting DDSs with workload processing are required to verify the state DDS they are assisting has met the “reasonable effort standard” for MC recruitment, and determine their disability examiners meet the minimum qualification standards for DEDA authority.


2. Assisting adjudicating sites are required to document and maintain records to identify how the factors outlined in Section E above (Disability Examiner qualifications) were met.

Prepare the SSA-831 (Disability Determination and Transmittal) following instructions in DI 26510.000, and:

· Item 32 and 33 (MC or PC Signature) – leave blank.

· Item 34 (Remarks) – add “Disability Examiner Decisional Authority.”

Direct all program-related and technical questions to your regional office support staff.

References

DI 11005.045 Completing the SSA-3367 (Disability Report – Field Office)
DI 22001.001 Sequential Evaluation of Title II and Title XVI Adult Disability Claims
DI 22501.002 Responsibilities for Case Development of Disability Claims
DI 24505.030 Expedients to Evaluate and Develop Evidence for Potential Mental and Physical Impairments
DI 24508.010 Impairment or Combination of Impairments Equaling a Listing – Medical Equivalence
DI 26510.000 Completion of Form SSA-831-C3/U3 -- Title II, Title XVI and Concurrent Claims
DI 27505.001 Conditions for Reopening a Final Determination or Decision
DI 81010.095 Using the Update-After-Transfer (UAT) Utility
DI 81020.100 Electronic Assistance Requests (AR)
Social Security Act §221(h)

SSR 17-2p Titles II and XVI: Evidence Needed by Adjudicators at the Hearings and Appeals Council Levels of the Administrative Review Process to Make Findings about Medical Equivalence

SSR 18-1p Titles II and XVI: Determining the Established Onset Date (EOD) in Disability Claims