Alphabet Soup Spelled Out-
(Where your disability claim goes after it's filed.)

by Alan Harder

It happens in every industry—jargon develops among folks who work there that makes their own communication easier and more accurate, but confuses outsiders who listen in.

Early in my career with SSA (before computers, so you can imagine how long ago THAT was) a visitor sat at my desk for the 2nd or 3rd time, and finally decided to file a claim for benefits.  I had set up a folder during her first visit, but couldn’t locate it quickly.  To avoid delay I created a 2nd folder.  And to avoid confusion later I labeled the 2nd folder according to our custom: “Dummy Folder.”  (You can see where this is going, can’t you!) I turned away to gather all the forms we would need, and when I turned back she was about to explode.  Her face was red as a beet and I thought steam was going to roll out of her ears like a Saturday morning cartoon.  About the time I realized what the problem was, she slammed her fist down on my desk and yelled:  “Well if you can’t find my folder, you’re not so @#*!!/^!*>! smart yourself, SONNY!”  She calmed down and even laughed as I explained and apologized.  From then on I was always careful to label those things “duplicate files” in spite of agency custom!

The Starting Point

Have you run into Social Security jargon?  SSA tries hard not to do that, but sometimes they slip.  Let me write a little sample with some common abbreviations, and then we’ll decode it.

“When you file a claim for SSDI or SSI, it is first handled by a CR in a DO.  CR’s and SR’s sometimes refer to SSDI as DIB or T2.  SSI is usually called just that, or sometimes T16.  After building your EF, the DO clears it to the DDS, although in some states that’s called a DDB.  Some DO workers still refer to DDS’s and DDB’s by their former designation—State Agencies.  If your case is an eDIB exclusion, it might be put in an MDF and transmitted via a paper -831.  After a DDS adjudicator makes a decision, your EF (or the MDF) is often transferred to a DQB (sometimes referred to as QA) for a review.  DDS’s sometimes call both DQB and the RO policy branch “the feds.”  If your claim is awarded, the DO triggers payment.  If your claim is denied, you can file a recon.  And if that’s denied, you can file a hearing request and the DO will send it to ODAR, which CR’s may still call OHA because they changed their name pretty recently.”

Uhhh, what?

The Translations

DO—District Office.  This is your local Social Security office.  They are located in many cities around the US.  They are the first stop on your application path.  You can file a claim by talking to them on the phone, going to the office in person, or by filing over the internet.

CR—Claims Representative.  This is the job title of the person in a District Office who accepts your claim, examines the documents you give them and makes a decision about what your benefit rate is.  He or she will also conduct a brief review of the forms you submit and tell you if there’s something missing that might delay your claim.  They help you complete the Medical Questionnaire and Medical Release forms, or review them with you if you prepared them ahead of time.

SR—Service Representative.  This is another job in the District Office.  Service Representatives specialize in taking care of questions that come up after benefits start.  Often, they also work at the reception desk and are the first to greet you when you walk into an office.

SSDI—Social Security Disability Insurance.  This is one of 3 programs that pays benefits based on your Social Security earnings.  Within the agency, we also refer to it as: “DIB” (Disability Insurance Benefits) or “T2” (because its legal authority is contained in Title 2 of the Social Security Act.)

SSI—Supplemental Security Income.  Until 1983, this was called State Aid to the Disabled, and was paid under 50 different state programs.  Although Social Security offices administer the program, it is financed by general tax revenues, not by Social Security payroll taxes.  Medical qualifications are the same as for SSDI, but the way benefits are figured relates to financial need, not to past earnings.  Within the agency, it is sometimes referred to as “T16” because its legal authority comes from Title 16 of the Social Security Act.

eDIB, MDF, EF and -831

“eDIB” is a way of filing your claim electronically and virtually all claims are handled this way now.  Rather than writing out your medical history, treatment and medication on a 10-page questionnaire booklet, either SSA types your answers on a computer screen, or you fill out an internet form.  Either way, no paper ever gets kept—everything is retained electronically: electronic disability insurance benefits.  An “EF” is the “electronic folder,” the place on SSA’s computer where your records are stored.  An “MDF” (modular disability folder) is the paper equivalent—a multi-section pasteboard file where paper records are organized and filed for the very rare cases where the electronic process can’t be used.  The -831 is a form that briefly summarizes your case—when you filed, what you filed for, where you filed, when your case was sent to what location, who worked on it and finally what the decision was.  

DDS/DDB/SA/State Agency—Four names, one place.  

It’s the organization that makes SSA's medical decisions on both initial claims and requests for reconsideration. They are most correctly referred to as a "Disability Determination Service" (DDS) or a "Disability Determination Bureau" (DDB) depending on which state you're in. These are divisions of state government that are under contract to SSA to make medical decisions. Years ago, they were called “State Agencies” or SA’s, and that name has endured as well.

Adjudicator.  This is the person in the DDS/DDB that will contact your doctors for medical records, send you questionnaires and/or schedule you for exams if they need more information.  They make the decision about whether you are disabled under SSA’s guidelines, and if so, when your disability started.  An adjudicator can ask for advice from a staff of medical doctors as they evaluate your claim.  Their decisions are always reviewed by a medical doctor.

DQB—The Disability Quality Branch.  

This is a federal office housed in one of SSA's 7 Regional Offices (“RO’s”). As their name implies, their job is to ensure that medical decisions are correct. They review a certain percentage of each DDS's allowances.  The DQB review usually doesn't take long--two to four weeks--and usually doesn't overturn the initial decision. Sometimes the decision is sent back to a DDS because it isn't correctly documented.

(This is different from the procedures at the second level of appeal, the Hearing. Hearing decisions can be reviewed and even reopened by the next and final appellate level within 60 days, but that is very rare. The time to implement a hearing decision is also much, much longer. )

RECON.  Short for Reconsideration.  This is the first appeal you file if your claim is denied.    In your appeal, which must be filed within 60 days of the date displayed on your denial letter, you have the opportunity to argue why your claim deserves reconsideration and to submit additional evidence.  A DDS/DDB again receives your recon, and a new adjudicator - someone with a higher level of expertise - will reconsider your claim.    The time it takes for reconsideration is usually less than the time it took for the initial claim.  During the initial claim, a lot of time was likely spent on gathering your medical records.  There are typically fewer details to gather for the appeal.

ODAR/OHA  The Office of Disability and Adjudicative Review (formerly known as the Office of Hearings and Appeals) is the agency that controls the second level of appeal, a Request for Hearing.  This is a federal rather than a state agency.  Your case will be assigned to the office nearest your home, and an Administrative Law Judge will give you the opportunity to explain, in person, why you believe the decision was wrong.  This can be a very lengthy process.

IMPORTANT NOTE:  Don’t let the prospect of a lengthy appeal discourage you from filing if you are not able to work.  Especially, don’t treat the initial filing (or reconsideration) casually because of the myth that “Social Security Always Turns You Down Twice.”  That’s patently false for everyone, and surveys on PHCentral indicate the allowance rate for PH patients is even higher than for the population at large. 

A Brief Summary of Your Claim’s Travel Itinerary

You file a claim in person, by phone, or over the internet at a District Office

The District Office makes sure everything is complete, and sends it to a DDS

The DDS gathers medical records and makes a decision on the medical aspects

A portion of the DDS decisions are reviewed by a federal quality office (the DQB)

You get a notice of decision, and (hopefully) the DO starts your payments.

Read Alan Harder's other articles:
Social Security Claims—Making Your Efforts Count
Social Security Claims—What's in YOUR File?
Work and Social Security: (Yes! You Can!)

Have a Question?  Ask the PHC Action Desk
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Ed. Note:
Alan Harder worked for Social Security for many years. To learn more about the author, visit his bio on the PHC Staff Page.