527. How to Read and Understand the Initial Determination

After the Disability Determination Services (DDS) completes its initial review of your application, a letter, which SSA calls a "notice," is mailed to you or your representative, if you appointed one, to explain the determination in your case and your right to appeal.

Initial determinations will include information about whether or not you have been found disabled. The following are three possible outcomes for medical determinations:

• Fully favorable--means that SSA has found that you are disabled as of the date you allege your disability began. If you are filing for Supplemental Security Income (SSI), a finding that your disability began as of the month of your application is a fully favorable determination because SSI payments cannot begin earlier than the month after the month of your application.

• Partially favorable--means one of two things. Either SSA has found that you are currently disabled, but SSA has determined that your disability started sometime after the date you said you became disabled, or SSA has determined that you were disabled for a specific period in the past but are no longer disabled.

• Unfavorable--means that SSA has found that you do not meet the requirements for disability benefits.

The second part of the initial determination is a form letter which tells you how to appeal this determination. If a determination is fully favorable, there is never any reason to appeal the medical determination. If a determination is partially favorable, you must carefully review the reason behind this determination before deciding whether you should appeal. The benefit of filing an appeal is that you could be found to be disabled as early as the date you say your disability began. This could possibly provide you with retroactive payments and medical benefits.

However, you should be aware that by filing an appeal on a partially favorable determination, you must appeal the entire determination. This means that, on appeal, you could be found "not disabled". It also means that you will not receive any benefits while you are waiting for further appeals of your determination, whereas if you do not appeal the partially favorable determination, you will receive benefits shortly after receiving the determination. If a determination is unfavorable and you are not engaging in substantial gainful activity (SGA) (see §603 for the definition of SGA), and you disagree with SSA's determination, you or your representative should consider an appeal.

Last Revised: Jan. 22, 2008