DDS’s Unfair and Unequitable Practices

One of the most frustrating aspects of representing Social Security Disability ("SSD") claimants is when  a decision-maker forms an opinion about a case before fully reviewing the available evidence.

Recently, our office became involved with an SSD claim where the assigned Disability Determination Services ("DDS") analyst scheduled a Consultative Examination ("CE") on the first day the case was assigned to him. The analyst confessed that he always schedules a CE immediately.  The analyst was unable to explain why he did so without waiting for the claimant's medical records or review information from the claimant's treating physicians.  The analyst's actions directly conflict with the obligation of the Social Security Administration ("SSA") to provide the claimant with fair and equitable service, including seeking information from treating sources.

The situation became even more concerning when the analyst advised us that hospital records had been requested but never received. The claimant's file already contained more than 800 pages of hospital records that were readily available for review. When this was pointed out, the analyst shifted his position to asserting the hospital records did not support the claimant's disability claim.  The problem with that statement is obvious: since he never reviewed the records it was impossible for him to conclude they were unsupportive.

Our client has an established treatment history with his own physicians. His treating doctor has provided extensive treatment records as well as a Medical Findings Summary outlining the functional limitations that prevent the claimant from sustaining full-time employment. Those opinions come from medical professionals who have examined and treated the claimant over an extended period of time, and they are in the best position to evaluate the severity of his impairments.

The SSA's own policies recognize the importance of obtaining evidence from a claimant's treating sources whenever possible, as the preferred source for the CE.  Treating physicians have firsthand knowledge of a claimant's symptoms, treatment history, response to care, and functional limitations. While DDS has the authority to order a CE when evidence is unavailable or insufficient to make a determination, a CE is intended to supplement the record with information that could not be obtained from the treating sources--not replace a thorough review of the medical evidence already available.

Despite being reminded about the substantial medical evidence already in the file, and that additional supportive opinions from treating sources would be forthcoming, the analyst continued to insist that, "in my professional opinion, the claimant will still need to attend a CE."  That assertion is disturbing on many levels, but especially since the analyst is not a doctor, and is blatantly ignoring SSA’s regulation to handle this claim and every claim equitability.  Such assertions raise legitimate concerns about whether the disability determination process is being conducted in the manner intended by SSA regulations. A CE is not supposed to be a routine step taken before the available medical evidence has been reviewed. Claimants should not be subjected to CEs simply because that is what a lazy analyst "always does."

Every disability claim deserves an individualized review based upon the evidence, and to be treated fairly and equitably. Decisions should be guided by medical records, treating source opinions, and the facts of the particular case; not by preconceived notions or standardized assumptions. Claimants who have spent years treating with their doctors deserve to have those records carefully considered before CEs are scheduled or conclusions are reached.  It is no wonder that DDS now conceals the analysts’ names. 

Cases like this highlight the importance of experienced representation. Attorneys can help ensure that medical evidence is properly submitted, challenge inaccuracies in the record, and advocate for a fair evaluation of the claim. The disability process works best when decisions are based on a complete and thoughtful review of the evidence—not when conclusions appear to be reached before that review has even begun.