A client recently informed me that she had no idea what I was talking about, and asked me to speak in regular English. I had just told her that the ALJ at OHO would pose a hypo to the VE based on an RFC tied to the psych CE – what could be clearer?
As with many governmental agencies, the Social Security Administration (SSA) has its own unique language composed of acronyms. Initial contact with SSA is usually made at the local District Office (DO), where a claim for Social Security Disability (SSD, Title 2) and/or Supplemental Security Income (SSI, Title 16) benefits is filed. The claims are not actually adjudicated by SSA at this level of review (Initial), but rather by Disability Determination Services (DDS, the State Agency). At DDS, the claim is handled by a Single Decision Maker (SDM, Adjudicator), with input from a medical consultant (MC) and/or a psychological consultant (PC). You will never meet an MC or PC, unlike a Consultative Evaluator (CE), who is hired by DDS to examine you.
If the claim is denied at Initial, a Request for Reconsideration (Recon) must be filed within 60 days. At Recon, SSA again sends the case to DDS, to be reviewed by a different Adjudicator and MC/PC.
If the claim is denied at Recon, a Request for Hearing must be filed within 60 days, and the file is sent to the Office of Hearings Operations (OHO). This is a new name for this office, which until last month was called the Office of Disability Adjudication and Review (ODAR). People who have been doing this work for a few years recall when OHO/ODAR was called the Office of Hearings and Appeals (OHA). The only thing more fun than obscure acronyms is randomly shifting acronyms.
At the disability hearing at OHO, the Administrative Law Judge (ALJ) may call on the services of a Vocational Expert (VE) and/or a Medical Expert (ME, which in the past has also been dubbed a Medical Advisor or MA). As with MC/PCs, the VE/MEs have never met you. The ALJ is required to make a finding of Residual Functional Capacity (RFC) and to determine if you are capable of Past Relevant Work (PRW). If your RFC is inconsistent with PRW, the ALJ will determine (with the assistance of the VE) if there are any other jobs you can perform – often referred to as a Step 5 finding.
Assuming you are found disabled by an ALJ, be aware that most claims are reviewed every 3-7 years. This is called a Continuing Disability Review (CDR). If your claim is denied by an ALJ, you may file an appeal with the Appeals Council (AC), and possibly Federal District Court (FDC).
Hopefully, this will guide you through the fundamentals of SSA-speak. A qualified representative can translate the more advanced acronyms – or, like my bewildered client, you can simply ask everyone to speak English.
Have more questions about social security and disability? Give us a call. We are here to answer your questions and assist with all your legal benefits needs.