The Virginia Department for Aging and Rehabilitative Services

Disability Determination Services

Overview and Decision Criteria

The Disability Determination Services (DDS), a division within DARS, processes disability claims for benefits under the Social Security Disability Insurance and Supplemental Security Income Disability Programs. Following federal regulations, DDS commits to making accurate and prompt decisions on disability based on the following:

  • Medical Criteria
  • Medical and Psychological Evidence
  • Vocational Criteria
  • Consultative Evaluation
  • Continuing Disability Review

Disability Determination Services processes claims for benefits under the Social Security Disability Insurance and Supplemental Security Income Disability programs. A division within the Virginia Department for Aging and Rehabilitative Services (DARS), DDS works in partnership with the Social Security Administration and follows federal regulations in making its decisions. For more information about Social Security, go to www.ssa.gov.

MISSION: DDS is committed to making accurate, prompt decisions on disability claims under the Disability Insurance Benefits (Title II) and Supplemental Security Income (Title XVI) Programs.

DISABILITY INSURANCE BENEFITS PROGRAM (SSDI): This program requires a person with a disability to have worked for a substantial period in employment covered by Social Security. Beginning at age 18, a dependent, adult child of a worker who is retired, disabled or deceased, may be eligible for benefits if the child became permanently disabled before age 22. Benefits also may be paid to a widow, widower or surviving divorced wife of an insured worker, SSDI is funded through the Social Security Trust Fund.

SUPPLEMENTAL SECURITY INCOME PROGRAM (SSI): This federally funded program is based on financial need - it is not necessary for persons with disabilities to have worked under Social Security. Basic medical criteria for eligibility are the same for both SSI and SSDI. Recipients of benefits under both programs also may be eligible for Medicaid or Medicare benefits.

TREATING PHYSICIAN: Medical information describing a patient's physical and/or mental status is requested from the treating physician. Federal legislation emphasizes the importance of medical evidence from the individual's own physician or psychologist.

CONSULTATIVE EVALUATION: When a decision absolutely cannot be made based on evidence from treating sources, DDS authorizes and funds a consultative evaluation. DDS consultants supply these services according to a fee schedule established by DARS' Medical Advisory committee. The applicant's own treating physician may provide the consultative examination if he/she has the special qualifications and equipment necessary.

CONTINUING DISABILITY REVIEW: Enacted by Congress in 1980, the Continuing Disability Review process affects almost everyone receiving disability benefits. Most beneficiaries have their cases reviewed at least once every three years to assure that only those eligible continue to receive benefits.

DISABILITY DECISION: A team comprised of a staff physician or clinical psychologist and a professionally trained analyst makes this decision locally at one of four DDS regional offices statewide. Applications for Social Security Disability Insurance (SSDI) disability benefits along with the Adult and Child Disability Reports are completed on line at Apply for Benefits. To apply for Supplemental Security Income (SSI) for an adult or child, call SSA’s toll-free number 1-800-772-1213 to schedule an appointment to be helped in person or by phone.  People who are deaf or hard of hearing may call the toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday.  The most convenient Social Security office can be found at the Social Security Office Locator

MEDICAL CRITERIA: Federal regulations list medical criteria for disability. Benefits are allowed if an applicant's physical and/or mental status meets requirements in the listed criteria or is determined to be of equivalent severity to those listed.

MEDICAL AND PSYCHOLOGICAL EVIDENCE: Requests for this evidence are sent to public and private treatment or evaluation facilities including health departments, Veterans Administration facilities, schools, mental health clinics, private physicians, and hospitals.

SCHOOL EVIDENCE: For the convenience of school professionals, and in order to expedite the process of responding to information requests for school professionals, the forms necessary to comply with SSA/DDS requests for information may be obtained by selecting the options listed below (Teacher's Questionnaire SSA-5665-BK and Administrative Information SSA-5666 forms). Further information to help school professionals understand the disability process can be viewed by clicking on "Childhood Disability for School Professionals" below. We have also included a direct link to SSA's secure website so that completed forms may be uploaded and sent to SSA quickly and efficiently.

Directions for electronic transmission of school records and informational questionnaires:

  • Click on the appropriate selection below.
  • Complete the selected form and save it as a word document on your computer.
  • FAX - Use your office fax to send records at your convenience. Use the 800 fax number listed on the DDS request letter. The first page of the fax must be the bar coded request letter from the DDS. The fax pages are digitized for claims processing.
  • SSA SECURE WEBSITE - Click on the SSA secure website link below.
  • Log on and complete the information requested (if you do not currently have a PIN and passcode, one may be obtained by contacting your local Professional Relations officer listed below).
  • Upload the completed forms.
  • Click the send button - your report will automatically be sent directly to the student's electronic disability claim folder.

Forms:

VOCATIONAL CRITERIA: When an applicant's impairment fails to meet or equal the listed severity, yet causes significant restrictions, vocational criteria are considered. These restrictions must be assessed in terms of the applicant's remaining capacity for work-related physical or mental activities. This "residual functional capacity" is then considered along with age, education and past work experience to determine the applicant's vocational outlook. Disability benefits are allowed when the vocational outlook is deemed unfavorable due to the applicant's inability to reasonably return to past work or adapt to a new, less demanding job.

INFORMATION FOR REPRESENTATIVES
All routine requests for status on pending claims with any of the Virginia DDS regional offices must be faxed to the appropriate office using the following fax numbers. If submitting medical evidence - Provide claimant name and SSN on your fax cover sheet and fax to:

DDS: Fairfax 703-934-7410 Richmond 804-527-4517 EST - Roanoke 540-857-6374 Roanoke 540-857-6374 Tidewater Status Fax: 757-455-3829

Medical Data Fax: Fairfax 866-843-3075 Richmond 866-323-4810 EST -Roanoke 866-802-5842 Roanoke 866-802-5842 Tidewater 866-773-0244

Once the case has been assigned, you may make direct contact with the analyst only for specific case discussion (e.g. new medical information or provision of medical records or claimant information).

FURTHER INFORMATION
Anyone interested in obtaining further information about DDS should contact the nearest regional office listed below:

CENTRAL REGIONAL OFFICE
9960 Mayland Dr., Suite 200
Richmond, VA 23233
(804)-367-4700 -- Office Voice
(804)-527-4523 -- Office Fax
(800)-523-5007 -- Toll Free Voice
Jay Windsor, Regional Director
Alvin Gritz, Professional Relations Officer

TIDEWATER REGIONAL OFFICE
5850 Lake Herbert Dr., Suite 200
Norfolk, VA 23502
(757)-455-3829 -- Office Fax
(757)-466-4300 -- Office Voice
(800)-379-4403 -- Toll Free Voice
(757)-466-4855 -- Office TTY
Cheryl McCall, Regional Director
Sandy Bouldin, Professional Relations Officer

NORTHERN REGIONAL OFFICE
11150 Fairfax Blvd., Suite 200
Fairfax, VA 22030-5066
(703)-934-7400 -- Office Voice
(703)-934-7410 -- Office Fax
(800)-379-9548 -- Toll Free Voice
(703)-934-7479 -- Office TTY
Sharon Gottovi, Regional Director
Tamera Hargrove, Professional Relations Officer

SOUTHWEST REGIONAL OFFICE
612 S. Jefferson Street, Suite 300
Roanoke, VA 24011
(540)-857-7707 -- Office Fax
(540)-857-7748 -- Office Voice
(540)-857-7748 -- Office TTY
(800)-627-1288 -- Toll Free Voice
Betsy Stone, Regional Director
Teresa Sizemore-Hernandez, Professional Relations Officer

SOUTHWEST EXTENDED SERVICE TEAM (EST) REGIONAL OFFICE
111 Franklin Road, S.E., Suite 250
Roanoke, VA 24011
(540)-512-1990 -- Office Fax
(540)-512-1880 -- Office Voice
They don’t have one -- Office TTY
(877)-892-6871 -- Toll Free Voice
Betsy Stone, Regional Director
Europai Parker, Manager
Teresa Sizemore-Hernandez, Professional Relations Officer

ADMINISTRATIVE OFFICE:
8004 Franklin Farms Drive
Richmond, Virginia 23229-5019
Leon Scales, DDS Director
(804)-662-7625 -- Dept/Unit Voice
(804)-662-9041 -- Dept/Unit Fax
(804)-662-7275 -- Dept/Unit Fax
(804)-662-9040 -- Toll Free TTY
(800)-552-5019 -- Toll Free Voice
Gloria Ford, Professional Relations Coordinator
Telephone: (804) 662-9322

Assistance from the Virginia Department for Aging and Rehabilitative Services is provided without regard to race, color, creed, sex, national origin or disability. (AA/EEO)

Prepared by the:
Disability Determination Services
8004 Franklin Farms Drive
P. O. Box K-300
Richmond, Virginia 23288-0300