How Social Security Decides If I Am Disabled
Whether or not you are disabled seems like a simple question, but for Social Security this simple question becomes intimidatingly complex. Social Security’s method for determining disability is codified across thousands of pages riddled with legal terminology not easily understood by those who aren’t lawyers.
Social Security developed a 5 step methodology, titled the “sequential evaluation,” to determine one’s disability status. The Sequential Evaluation is the roadmap Social Security uses in every case where someone has applied for Social Security Disability or Supplemental Security Income (S.S.I.). It is expressly written in the Code of Federal Regulations at 20 C.F.R. § 404.1520. Each step is a single question where the answer mandates a determination or guides to the next step.
In this blog, I will take you through each of the five steps to clarify Social Security’s process and make their determinations understandable. Please note this is the determination process reduced to it’s most basic form as there are many more pieces to the disability benefits puzzle.
STEP ONE: IS THE CLAIMANT WORKING?
Generally speaking, if the person seeking disability is working, he/she is not eligible to receive Social Security Disability or S.S.I. Benefits.
“Work,” however, must be defined. “Work” is defined by Social Security as work for pay where the earnings amount to “Substantial Gainful Activity”(S.G.A.). Whether work is considered S.G.A. is dependant on the amount garnered from employment and the year of the wages. As of 2019 employment must pay $1,180.00 a month, or more, to be considered Substantial Gainful Activity. When income is below $1,180.00 eligibility to receive disability benefits will not be hindered, but S.S.I. will most likely be subject to offset by the income.
If you are working the Sequential Evaluation requires a finding of “not disabled.” If you are not working the evaluation guides analysis to step two.
STEP 2: DOES THE CLAIMANT HAVE A SEVERE IMPAIRMENT?
Step two creates a seemingly easily answered question and complicates it. The term “severe” implies a high standard of impairment, but this is misleading. A “severe impairment” is a physical or mental condition that more than minimally interferes with basic work activities and meets the duration requirement. The duration requirement demands the physical or psychological condition that has lasted a year, be expected to last a year, or will result in death within a year. If you do not have a severe impairment, the analysis stops, and a finding of “not disabled” will be found. If you do have a severe impairment, the sequential evaluation will take you to step three.
Step 3: DOES THE CLAIMANT’S CONDITION MEET OR MEDICALLY EQUAL ONE OF THE LISTINGS.
Social Security recognizes there are many medical conditions of varying severity that can plague someone applying for disability benefits. To ensure the most severe are granted benefits early in the Sequential Evaluation, Social Security put “the listings” at step three. The listings are the set criteria for many common conditions that, if satisfied, require a finding of disabled. One of the more commonly considered listings is 1.04(a). This listing applies to orthopedic impairments in the neck and back. It states:
“1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With:
A. Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine)”
If a claimant meets all of the elements of 1.04(a) he/she will receive a medical finding of disabled. If not every element is “met” the claimant may still “equal” the listing. A listing is “equaled” when all the criteria aren’t satisfied, but the condition’s symptomology and intensity are of equal severity as would be expected in someone who’s condition satisfied all of the elements.
If a listing is “met” or “equaled” a finding of “disabled” is required. If not, however, all hope is not lost. We move on to step 4.
STEP 4: Can you do your past work
At this point, the analysis gets very complicated. Generally, if you are at step four and are capable of doing your “past relevant work” (work performed at S.G.A. level for the necessary period), then you will be found “not disabled.” It’s when there is a finding you cannot do your past relevant work the analysis becomes more in depth.
When deciding whether you can do your past relevant work Social Security first attempts to define the type of work performed. This is done by looking to the Dictionary of Occupational Titles (D.O.T.). The D.O.T. not only labels jobs and divides them into categories, but tells Social Security the necessary physical exertion and mental capacity each job requires.
After your job is defined, your “Residual Functional Capacity” (R.F.C.) must be determined. R.F.C. is the maximum amount of exertion you can perform considering the condition of your health. Your R.F.C. will include the maximum you can lift and/or carry as well as limitations on your ability to stand and walk. If your past work requires more exertion than you are capable, then you cannot perform your past work. This analysis is not limited to physical exertion. Mental health can eliminate past work at step four as well. If your prior employment required a higher capacity for concentration than you are capable, Social Security would determine you cannot perform your past work. If you can do your past work, the law requires you be found “not disabled.” If you aren’t able to perform your past work, the analysis moves to the last phase at step five.
STEP 5: IS THERE OTHER WORK IN THE NATIONAL ECONOMY THE CLAIMANT CAN PERFORM?
If you are unable to do your past work, a finding of disability may be afforded in your case. To determine whether a result of disability is appropriate at step five Social Security looks to “the grids.” “The Grids” are a series of guidelines used by the agency to determine disability for those who did not meet a listing. They consider age, education, past work, R.F.C., and skill applicability.
Age plays the most significant factor within the grids. The grids divide age into categories. They are: younger individuals (49 and below), Closely approaching advanced age (50-54), advanced age (55-59), and closely approaching retirement age (60 and above). Work is also divided into different categories. They are: Heavy (lifting 100 pounds occasionally, 50 pounds, frequently while standing and walking all day), medium (lifting 50 pounds occasionally, 25 pounds frequently while standing and walking all day), light (lifting 20 pounds occassionally, 10 pounds frequently while standing and walking all day), and Sedentary (lifting 10 pounds occasionally, 5 pounds frequently while sitting all day).
For example, if you are age 49 or below and are capable of any work in the national economy, you will be determined to be not disabled. Usually, however, if you are age 50 and your limitations lead you to only being able to perform work at the sedentary level, you will be found disabled. There are dozens of scenarios and caveats to each rule within the grids. There will be more articles on “the grids” throughout this site.
This article has been a very broad explanation of the methods and philosophy Social Security uses when determining disability. There are many more rules that complicate each application for Social Security Disability benefits. This is why it is imperative to have a lawyer who is proficient in the many laws which guide the system.
