The Social Security Administration’s Approach To Disability Determination
The Social Security Administration follows a standardized five-step process when evaluating claims for Social Security Disability benefits. These five steps are critical in determining whether an individual is eligible for these benefits. In this section, we’ll provide an overview of each step and delve into the specifics of what’s considered at every stage of the evaluation.
Step One: Assessing Your Work Activity
The first step of the sequential evaluation process involves a thorough assessment of your current work activity. To qualify for Social Security Disability benefits, you must have a work history that meets certain criteria. Essentially, you need to have accumulated enough work credits to be eligible. However, if you are currently engaged in substantial gainful activity (earning over $1,200 a month as of 2023), you may not be eligible for these benefits. This applies whether you’re working for someone else, freelancing, or in self-employment.
It’s worth noting that some exceptions exist. If your work is considered “sheltered work,” where you receive higher pay due to accommodations made by friends or family, you may still be eligible. Additionally, if a significant portion of your earnings goes toward necessary accommodations for your disability, that expense can be deducted when assessing your income.
In certain cases, individuals receiving unemployment benefits may encounter eligibility challenges for Social Security Disability benefits. This discrepancy arises from the contrasting certifications required for the two programs. Applicants for Social Security Disability are asserting that they cannot work due to a physical or mental impairment, while those seeking unemployment benefits declare their readiness and willingness to work. This discrepancy can affect eligibility until it is resolved.
Step Two: Evaluating Medical Severity
The second step of the evaluation process focuses on the medical severity of your impairments. To be considered disabled under Social Security Disability laws, you must demonstrate the presence of severe impairments, whether physical or mental. The definition of “severe impairment” is broad, including conditions that limit your ability to perform work-related activities. Typically, the more severe and numerous your impairments, the higher the likelihood of being deemed disabled.
The Social Security Administration meticulously examines each impairment and assesses whether it qualifies as severe. Some well-known impairments, such as cancer or orthopedic issues like back problems, can lead to approval for Social Security Disability benefits. However, even conditions like high blood pressure or obesity can be considered severe if they significantly impact your daily life and work capabilities. The key here is whether these impairments cause limitations or difficulties in performing work-related tasks.
It is also important to note that, to be eligible for benefits, the severe impairment must be expected to last for at least one year or have already lasted for a full year. This requirement can pose challenges, especially for conditions that may improve within a shorter timeframe.
Step Three: Meeting Or Equaling A Listing
Step three of the evaluation process involves determining whether any of your severe impairments meet or equal a listing in the Social Security Disability list of impairments. The Social Security Administration has developed specific criteria for many medical conditions, and if you meet all the criteria for a particular listing, you will be considered disabled. For example, a listing for multiple sclerosis may require the presentation of an MRI showing specific white matter lesions on the brain.
Meeting these criteria can be challenging, and most claimants progress to the next step, as the criteria are often rigorous. Nevertheless, the Social Security Administration has expanded the listing process to accommodate individuals with severe diagnoses. In some cases, a diagnosis alone, without meeting all the detailed criteria, can lead to approval under the Compassionate Allowance Program, which offers a streamlined path to benefits for individuals with terminal conditions, such as stage four cancers.
Step Four: Assessing Residual Functional Capacity (RFC)
In step four, the Social Security Administration assesses your residual functional capacity (RFC) and determines whether you can return to your past relevant work. RFC is a critical concept. It combines all your impairments, including both severe and non-severe ones, and outlines the limitations they impose. This comprehensive assessment informs the most work you can do based on your limitations.
The RFC assessment also considers mental limitations, such as your ability to learn new tasks, interact with others, or maintain consistent attendance due to factors like depression. The Social Security Administration uses the Dictionary of Occupational Titles, a reference dating back to the 1980s, to categorize work capabilities based on terms like “sedentary,” “light,” “medium,” and “heavy” work.
The key question at this stage is whether you can still perform your past relevant work, which refers to the jobs you’ve held in the 15 years leading up to your application. The Social Security Administration evaluates whether your RFC allows you to perform these jobs as they are typically performed in the national economy. If your RFC doesn’t align with the physical requirements of your past work, the evaluation moves on to the final step.
Step Five: Considering Age, Education, And Work Experience
At the fifth and final step, the Social Security Administration takes into account your RFC, determined in step four, and factors in your age, education, and work experience. The goal is to assess whether you can adapt to different types of work given your physical and mental capabilities. Even if you can’t return to your past relevant work, the agency explores whether you can make adjustments to perform other jobs.
Your past relevant work remains important during this step, as the agency considers whether skills acquired in those roles can be applied to other, potentially less demanding jobs. While the earnings from these new jobs may be significantly lower than what you were previously making, this does not impact the evaluation. The focus is on whether you can transition to different work given your limitations.
Naturally, there are some age-related expectations in this process. The “grids” outline what is expected of claimants based on their age, RFC, and vocational profile. These grids acknowledge that older, unskilled, and uneducated claimants may find it more challenging to adapt to different work. As such, older individuals who lack specific skills or experience may have an easier time being approved for Social Security Disability benefits.
In conclusion, if you meet the criteria of not engaging in substantial gainful activity, having a severe impairment lasting or expected to last for at least one year, being unable to perform your past relevant work or any other significant work in the national economy, and your age, education, and work experience align with the expectations outlined in the grids, you can expect to be approved for Social Security Disability benefits.
For more information on The Five-Step Sequential Evaluation Process For SSDI Claims, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (833)444-4127 today.