The Hidden Value of a DDS Denial

Welcome to Season 2, Episode 15 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into The Hidden Value of a DDS Denial.

A denial at the initial or reconsideration level can feel like the end of the road - but in many Social Security Disability cases, it’s actually where the real opportunity begins. Long wait times, financial strain, and a flat “No” from a state agency can make the process feel arbitrary and discouraging. But that denial often reveals exactly how your claim was evaluated, what evidence was missing, and where the decision-maker found your case lacking. Instead of signaling defeat, it can serve as a roadmap for building a stronger, more targeted claim. In this episode of Winning Isn’t Easy, we explain the hidden value behind early-stage denials, why the “paperwork phase” is often just a gateway to a more meaningful hearing, and how administrative law judges approach cases differently than initial reviewers. We break down how denials expose weaknesses, how to use that insight to strengthen medical and vocational evidence, and why many successful claims are won only after reaching the hearing level.

In this episode, we'll cover the following topics:

One - The DDS "Black Box": Why Paperwork Fails

Two - The "Roadmap" in the Denial Letter

Three - This Is Where I Find My Gold

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Christy Monaco [00:00:00]:
 Foreign. Well, I'm gonna say something that might sound crazy. Getting denied at the initial or reconsideration stage of your Social Security case might be the best thing that ever happens to your case. Welcome back to Winning Isn't Easy. Social Security Disability Benefits, the podcast where we break down everything you need to know about navigating the Social Security system. I'm your host, Christy Monaco. Before we get started, I have to give you a legal disclaimer. This podcast is not legal advice.
 
 Christy Monaco [00:00:45]:
 The Florida Bar association says I have to say that, so I've said it. But nothing prevents me from giving you an easy to understand overview of the Social Security disability claims process and the games that you're playing during it and what you need to know to get the disability benefits you deserve. So off we go. Now, don't throw your phone across the room just yet. I know you're frustrated. You've waited six months, you're out of money and a state agency just told you no. But as an attorney, when a client comes to me with that denial letter, I don't see failure. I see a blueprint for a win.
 
 Christy Monaco [00:01:23]:
 So today I'm going to talk to you about the hidden value of that denial. How it exposes Social Security's hand, how it sets you up for a judge who's actually going to listen, and why the paperwork phase is often just a necessary hurdle to get to the human phrase let's go. Today, I'm talking about three things. One, the DDS black box, why paperwork fails. Two, the roadmap and the denial letter. And three, this is where I find my gold. We'll take a break for a quick moment before we really dive into this episode.
 
 Speaker B [00:01:59]:
 Are you considering filing for Social Security Disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Christy Monaco [00:02:49]:
 Welcome back to Winning Isn't Easy. Let's talk about the DDS black box and why paperwork fails. So let's talk about who just denied you. Actually, let's take a step back. When you filed your claim, you filed your claim with your local Social Security office. That's the Social Security office that's closest in vicinity to you from your zip code. Once you pass the non medical requirements at the local office, they send your file to a place called DDS Disability Determination Services. Those are the people that just denied you.
 
 Christy Monaco [00:03:26]:
 It wasn't a judge. The individuals at dds, they're state level employees who process thousands and thousands of files. They're adjudicators, not doctors or judges. So here's the problem with dds, the paper person. At the DDS level, you're just a barcode. They don't see your symptoms, they don't hear the tremor in your voice. They don't see the tears of frustration. You also have the consultative examination trap.
 
 Christy Monaco [00:03:56]:
 DDS oftentimes gets lazy and sends you to one of their doctors for a 10 minute exam. These doctors, the consultative examiners, are notorious for saying you're fine because you could sit in their waiting room for 15 minutes. This is one of the most frequently asked questions that I get. When an individual is scheduled for a consultative examination, what can I expect? Well, it is the hardest question for me to answer, and here's why. Every time one of our clients gets scheduled for a consultative examination, we send them a consultative examination questionnaire. And that questionnaire just asks them questions about the examination that they attend. And we ask them to fill it out. And as soon as they leave that examination, it's asking questions like, who examined you? Was a nurse present? Did they do a physical examination? Did they run any testing? Did they ask you any questions? Did they have any medical records? And we want our clients to fill that out.
 
 Christy Monaco [00:04:54]:
 And every time I get one back, it's different. Sometimes I hear, well, I waited for five minutes in the waiting room, A nurse called me back. I never once saw a doctor. I was in the room for six minutes and then I left. Then I get the report and I read the report. The report's written by the doctor as if the doctor examined them. The report says there was physical examination, but that's not what my client said. And so now I have questions for Social Security and that doctor.
 
 Christy Monaco [00:05:23]:
 Other times I get consultative examination questionnaires back from our clients. And the consultative examination was 40 minutes long. And they did an in depth physical examination. And they asked me to get on and off the table. And there was not a nurse present. And it was the doctor himself and he had all of my medical records. And so every time I read one of these consultive examination questionnaires, they're different. So I don't know what you can expect.
 
 Christy Monaco [00:05:48]:
 I can tell you how I would want it to go. Right? It's a physician who has reviewed all of your medical records that were provided by Social Security, which is not really realistic. And I can tell you that I would hope that they do a physical examination and that they, they do focus on the areas in which you're suffering from. But that doesn't always happen. So we want to talk about what we tell our clients to do. Right. When you go to these ces, fill out the questionnaire afterwards, give it to us so that when we review it, we can make sure that DDS and these consultative examiners are telling the truth. Now, DDS also has this checklist mentality.
 
 Christy Monaco [00:06:27]:
 When they're reviewing your paper file, they're looking to see if you meet a medical listing under the Social Security rules, which we discuss in another episode. If you don't fit perfectly into that predefined box, like a specific spinal curvature or specific IQ score, denied, they're hitting that button. So now let's talk about the hidden value of that denial letter. The denial letter tells us exactly which box you didn't fit into. It lists the evidence that they used to make their determination. And if they missed your favorite neurologist records, boom. We just found our first way two year appeal. Let's take a quick break.
 
 Christy Monaco [00:07:45]:
 Welcome back to Winning Isn't Easy. Let's talk about the roadmap in the denial letter. When you get that denial letter, don't just look at the work denied. Look at the explanation of determination. This is where the hidden value lies. Typically, it's the very last page that's going to reveal a lot to us, like your past relevant work reveal. The letter will say, we found you can return to your past work as a cashier. Well, I'm sure you're asking me, Kristi, what's the value in that? Well, now we know their strategy.
 
 Christy Monaco [00:08:20]:
 My job as your attorney is to now prove that the physical demands of being a cashier, standing for six hours, handling stress, the ability to use both of your hands on a consistent basis, are impossible for you. They've given us a target to aim for. Also, I'm going to be able to find out whether they denied you at step five, your past relevant work, or step five, any other work in the national economy. Oftentimes the letters will say, well, we understand that your condition keeps you from doing your past relevant work. We believe that there's other work in the national economy that you can do. Well, now I know. I know their strategy. Now let's talk about the residual functional capacity, or like we like to call it, the rfc.
 
 Christy Monaco [00:09:03]:
 DDS creates a ghost version of you. They may say you can lift £20. What's the value of that? Well, now we can take that ghost version of your actual to your actual treating doctor and say DDS thinks your patient can lift 20 pounds all day. Do you agree with and when your doctor writes back, no, my patient can't lift a gallon of milk, that DDS denial becomes the catalyst for evidence that wins the case. Now let's go to the leap to the hearing level from no to a maybe. The hidden value of that denial letter is that it's your ticket to an administrative law judge. Statistically, the odds of winning at the initial level and DDS level are around 30%. But at the hearing level, those odds often jump to 50 to 60%.
 
 Christy Monaco [00:09:50]:
 Why? Because a judge is a de novo reviewer. So let's talk about the administrative law judge advantage. One, Credibility matters. For the first time, a judge is going to be reviewing your file and potentially speaking with you. When you explain that you can't work and you have to lie down for hours in a day, the judge can assess if you're telling the truth. How does he do that? Well, we've talked about that in another episode. He's going to listen to your testimony, he's going to look at your medical records, and he's going to look at your forms you filled out. And we want those three things to be consistent because that's how the judge is going to be identifying and weighing your credibility in this case.
 
 Christy Monaco [00:10:35]:
 DDS can't do that. And then two, we've got a vocational expert who's going to be at the hearing. And at that hearing, we as your attorney get to cross examine that job expert and we can ask them if a person needs three extra breaks a day, are there any jobs available to them? And the VE will say no. That testimony, which only happens after a denial, is often a golden ticket to an approval. Now, I want to talk about something that is the most beneficial to having an attorney. When you're denied at the initial and the reconsideration level, we as your attorney get access to something called a dde, the Disability Determination Explanation. This is a four to five page document that shows me, as your representative, exactly what was in the mind of that disability determination examiner or the physician who reviewed your file when they made that decision. This is where I get real excited.
 
 Christy Monaco [00:11:27]:
 But before that, let's take a quick break.
 
 Speaker B [00:11:30]:
 Struggling with your Social Security disability case. The right attorney can make all the difference. Get our booklet the key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Christy Monaco [00:12:26]:
 Welcome back to Winning isn't easy. Now I'm going to tell you where I find all my gold. When I'm preparing for a hearing or for appeals, I always go to the DDEs, the Disability Determination explanation. This explanation tells me everything that the disability determination examiner was thinking and what they used when they denied your claim. Here's what I pay attention to. One, that DDE is going to tell me. The medical records that were reviewed. The disability examiner is going to summarize what they feel the relevant medical records were and what they used to determine your functional capacity.
 
 Christy Monaco [00:13:02]:
 That gives me a very clear picture as to whether they missed any crucial objective evidence or medical records that are in your file that I know I now have to bring up on the appeal or to the judge. 2. The doctors that DDS examiners had your file reviewed by. You're probably asking why that's important. Well, I'm going to tell you. A lot of times I will read DDEs and my client who has cardiological issues, their file is reviewed by a gynecologist. And that doesn't really seem like the right specific specialist to be reviewing and making a decision on my client's file. And so oftentimes we use that as a at the hearing to say, your honor, we don't feel that a gynecologist should be reviewing cardiological records and making a determination on our client's functional capacity.
 
 Christy Monaco [00:13:47]:
 Doesn't seem right, our clients being treated by a cardiologist and you have our client's cardiologist's functional capacity opinion and that should be used. Three, Another thing that the DDE is going to show me is whether they did an occupational analysis. Remember, the disability determination examiners are going through the five step sequential evaluation. So they're looking to see if you can do your past relevant work and or any other job that exists in the national economy. And so they're having to determine what exactly your past relevant work is. So remember in the episode about our work history forms, I said, I don't care how annoying it is for this form to be filled out, we got to do it. And that's important because DDE is using that to determine what your past relevant work is. Right.
 
 Christy Monaco [00:14:33]:
 And so we have to make it clear what we did for previous work so that when they are analyzing whether or not we have the functional capacity to do that work, they're using the correct job. If they're not using the correct job in the dde, I can See how they got their occupational analysis, and now it gives me arguments. Lastly, the DDE tells me what the disability Determination examiner concluded your residual functional capacity is. I've been saying that a lot and I don't think I've told you what is an RFC or a residual functional capacity. Well, it's simple. It's what you can do functionally. How much can you lift, carry, push, pull? How long can you sit, stand, walk? Do you have any environmental limitations? That is what Social Security calls your RFC profile. So when I'm looking at a dde, I can see whether or not they're classifying you as an ability to do sedentary work, light work, medium work, heavy work, very heavy work.
 
 Christy Monaco [00:15:31]:
 And that gives me kind of a roadmap for what I can expect at a hearing. So I now know if they put you at a sedentary rfc, I know I need to find medical evidence in your file that eliminates sedentary jobs. So when I say this to you, when I say a denial could potentially be the best thing that ever happened to you, I'm saying it gives us as representatives an inside look at what Social Security used or how they came to their decision so that we can be better prepared to file your appeal or your request for hearing. So let's talk strategy. How do we use the denial to bulk up, using the time between your denial and your hearing, which can oftentimes be more than a year, to bulk up your medical file? If DDS denied you because your condition isn't expected to last 12 months or more, then the best way to prove them wrong is stay in treatment. By the time you get to the judge, you'll have 18 months of record showing you still aren't better. DDS denial actually gave you the time to prove the duration requirement of the five step sequential evaluation. So, like always, I'm going to give you some parting advice.
 
 Christy Monaco [00:16:38]:
 If you get that denial letter today, take a deep breath. Don't file a new application. That's a huge mistake. You want to file an appeal or contact an attorney or representative to assist you, that denial is just Social Security's way of saying, show me more. And we're going to do that. Okay? We're going to give them exactly what they asked for. Don't let a no be the end of your story. Let it be the beginning of your strategy.
 
 Christy Monaco [00:17:02]:
 Well, that's it for today's episode of Winning Isn't Easy. If you found this episode helpful, please take a moment to like our page, leave a review and share it with your friends and family. Don't forget to subscribe to the podcast so that you'll be notified whenever a new episode drops, and we'd also really love to hear from you. At the beginning of each episode description, you will find a link where you can send your questions or comments, and we may even feature them in a future episode. So join us next week for another insightful discussion on Social Security benefits, and thank you so much for listening. J.