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.
People with mental disabilities are often reluctant to apply for Social Security Disability Benefits or SSI. Because mental conditions do not appear in x-rays or an MRI, many people who suffer feel the stigma of not being believed. Social Security takes mental conditions very seriously if presented through the correct lens and applied to precise criteria in the law.
Social Security primarily evaluates mental conditions in listings 12.00-12.15. Listings are criteria designated to specific medical conditions where, if every element is satisfied, the claimant is automatically considered medically disabled. There are listings for Neurocognitive disorders (12.02), Schizophrenia (12.03), depression (12.04), intellectual disorders (12.05), Anxiety/OCD (12.06), somatoform disorders (12.07), Personality/impulse control disorders (12.08), autism (12.10), neurodevelopmental disorders (12.11), eating disorders (12.13), and Post-traumatic stress disorder “PTSD” (12.15). Each listing has criteria specific to the condition. Evaluating whether someone meets the criteria of a listing requires an understanding of law and medicine.
If you don’t meet a listing, you still may be found disabled. If the criteria of a listing isn’t satisfied, Social Security will look to the work restrictions created by the medical condition. For instance, a person with post traumatic stress disorder may not meet a listing but have work restrictions as a result of the mental disorder. That individual will most likely not be able to perform all a job requires if the symptoms force him to be absent from work more than twice a month. In such an example, this person would be found disabled.
Mental Disorders And Physical Disorders
Mental disorders can also combine with physical disorders and, as a result, a claimant may be found disabled. It is also important to remember age can be a factor in this analysis. For example:
55-year-old Sandra suffers from depression and a herniated disc in her lower back. In her past, she worked as a banker. This job required her to sit all day and was very skilled. Her back pain limits her to doing “light work (lifting up to 20 pounds/standing and walking six hours), but her depression limits her to “Simple repetitive tasks.” Physically she can do her job, but her mental limitations preclude the advanced work she did in the past. Under these facts, she would be found disabled under grid rule 202.06.
There are endless laws and exceptions to laws that are used to determine one’s disability. This is why it is always best to hire an attorney to represent you in your claim for Social Security Disability or SSI benefits.
The most straightforward answer is to hire the right attorney. What does an attorney need to be successful in a claim for Social Security Disability or SSI benefits? MEDICAL EVIDENCE.
Every person who applies for disability benefits says they’re disabled. It is unheard of for someone to apply for benefits and say “I’m fine. I want money.” The way Social Security separates those that are disabled, from those who think they’re disabled but aren’t, from those who are faking a disability is medical evidence. Medical evidence is the medical records created when patients see doctors. Social Security looks to the records under the theory that an MRI cannot be faked and it is difficult to argue with years of mental health treatment.
The reality is just going to doctors is unlikely to result in a favorable decision for Social Security Disability. The medical evidence needs to be presented and argued in the right way to result in a successful claim for disability benefits. Having an experienced, knowledgable, attorney who cares for his clients will put a claimant in the best possible position to receive benefits.
Social Security Disability and SSI applications can be done partly online and partly through physically submitted documents. There are a series of forms that encompass the minimum requirements for a completed application.
If you wish to have an attorney represent you, a “1696” must be submitted. The attorney and the claimant must sign this form. It contains the contact info for both including the addresses to which mail will be sent. The address on this form will most likely decide which court and district office will be handling the adjudication of the claim for benefits.
Social Security will also require the claimant to sign an “SSA-827”. The “827” allows Social Security to acquire your medical records from the doctors from whom you’ve receive medical treatment. It is essential to notify Social Security of the various places you currently seek medical treatment, but also the sites you have treated in the past. In this regard, it is generally better to put too much than too little. Do not omit a clinic or doctor’s office because you feel the treatment received wasn’t related to your disability. Let your attorney and Social Security decide what is relevant to the claim.
You will be asked to describe your past work. This is where a lot of claimants make a mistake, and it often costs them dearly. In most cases, Social Security will decide whether the claimant is capable of performing his/her past work.
Generally speaking, if a claimant is capable of performing his/her past work, then a finding of non-disability will be issued. Frequently claimants describe their past work as easier and than it was performed. One of the most common examples is that of a “caretaker.” A caretaker cares for other disabled people. Most of the time isn’t spent lifting or carrying. For this reason, when described, many claimants represent the job as requiring minimal lifting. They forget they needed to help the person they cared for stand up or get into a bathtub or shower. When doing this task, the caretaker was required to brace the weight of the disabled client. This is well over 50 pounds, usually. Although this task was necessary only a few times a day, it remains an essential component of the job. Therefore lifting that amount of weight was part of the job’s duties and the occupation could not be performed without the capacity to raise a substantial amount. When a claimant leaves out the job required to lift 50 pounds and instead describes the duties as lighter, this can often lead to an unfavorable decision.
Social Security may send you to a medical evaluation called a “consultative exam.” The exam is intended to be a thorough evaluation of your health and capacity to perform work. In my opinion, it will be a rushed exam done by a subpar doctor. The doctors who do these exams get paid per exam, not by the hour. This motivates them to squeeze in the most amount of exams possible in a day, and this is done by spending very little time per patient. The consultative exams are one of the reasons it’s necessary to treat frequently. Your treating physician’s opinions and records can be used to contradict the findings of the consultative exams.
Eventually, the claimant will receive a letter with either a finding of disability or denial for disability benefits. If a denial is received, the next step is filing an appeal. If an appeal is necessary the claimant is on track to plead their case in front of an administrative law judge.
Filling out an application for Social Security Disability or SSI can be a daunting and intimidating process.
SSD/SSDI and SSI Applications
Many questions in the applications seem deceptively simple but are in actuality complex, and the answers can be the determining factor between winning and losing a claim for benefits. Answers regarding past work must be analyzed in detail as well as questions regarding functional capacity.
Social Security Disability
At Devermont and Devermont, our staff sits with each claimant applying for disability and goes through the application question by question. First, we explain what every question is asking and clarify your answers when needed. Next, We will make sure that everything written in the application for benefits is accurate, precise, and in the best interest of the claimant.
Too often are people denied benefits because they didn’t understand the questions on the application and the impact of their answers. At Devermont and Devermont, we seek to cure the pitfalls of the application process that cost people their benefits and result in denials.