Q: How does Social Security decide whether someone is disabled?

A: There is a complicated process that the Administration follows for determining whether someone is disabled under Social Security rules. There are basically five steps which are followed. If it is determined that the Claimant is or is not “disabled” at a step of evaluation process, the evaluation will NOT go on to the next step. When we present our evidence to the Judge, we make sure that all of the steps have been covered.

STEP ONE
SSA must determine whether the claimant is engaging in substantial gainful activity. Substantial gainful activity (SGA) is defined as work activity that is both substantial and gainful. “Substantial work activity” is work activity that involves doing significant physical or mental activities. “Gainful work activity” is work that is usually done for pay or profit, whether or not a profit is realized. Ssa link – http://www.ssa.gov/oact/cola/sga.html

Generally, if an individual has earnings from employment or self employment above a specified level set out in the Social Security Regulations, it is presumed that the Claimant has demonstrated the ability to engage in SGA. If an individual engages in SGA, s/he is NOT “disabled” regardless of how severe his/her physical or mental impairments are and regardless of her age, education, and work experience. If the individual is NOT currently engaging in SGA, the analysis proceeds to the second step.

SGA is a determination made by SSA and is generally dependent upon the earnings a claimant is able to make. Generally, if the claimant is earning more than the SGA threshold the claimant would be considered capable of substantial gainful activity and would therefore be found “not disabled.” It is possible to argue a finding of substantial gainful activity. As advocates for our clients we will analyze the work and present many different arguments to persuade the Administration to allow benefits.

STEP TWO
SSA must determine whether the claimant has a medically determinable impairment that is “severe” or a combination of impairments that is “severe.” An impairment or combination of impairments is “severe” within the meaning of the Regulations if it significantly limits an individual’s ability to perform basic work activities.

If the claimant does NOT have a severe medically determinable impairment or combination of impairments, s/he is NOT DISABLED. If the claimant has a severe impairment or combination of impairments, the analysis proceeds to the third step.

STEP THREE
SSA must be determined whether the claimant’s impairment or combination of impairments meets or medically equals the criteria of an impairment. SS website If the impairment or combination of impairments meets or medically equals the criteria of a listing and meets the duration requirement (20 C.F.R. §4041509 and §416.909), the claimant is “disabled.” If it is not, the analysis proceeds to the next step.

STEP FOUR
Does the claimant have the residual functional capacity to perform the requirements of his/her past relevant at work (20 C.F.R §40431520(f) and §416.920(f)). IT IS AT THIS STEP WHERE TREATMENT NOTES AND MEDICAL OPINIONS OF THE CLAIMANTS’ TREATING SOURCES IS CRITICAL! The Social Security Administration uses the Dictionary of Occupation titles which has classified jobs as SEDENTARY, LIGHT, MEDIUM, HEAVY, AND VERY HEAVY when determining the physical exertional requirements of the Claimant’s past relevant work.

STEP FIVE
The ALJ must determine whether the claimant is able to do any other work considering his/her residual functional capacity, age, education, and work experience. If the claimant is able to do other work, s/he is “not disabled.” If the claimant is not able to do other work and her impairments meets the duration requirements, s/he is “disabled.” Although the claimant generally continues to have the burden of proving disability at this step, a limited burden of going forward with evidence shifts to the SSA. In order to support a finding that an individual is not disabled after this step, SSA is responsible for providing evidence that demonstrates that other work exists in significant numbers in the national economy that the Claimant can do, given the residual functional capacity, age, education, and work experience.

Posted in: Social Security Disability FAQ