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How Does the Social Security Administration Decide if I am disabled?

How does Social Security Decide if I Am Disabled? 

 

Social Security law contains a basic and broad definition of what it means to be disabled.  Here is the definition:  The Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. Title 42 U.S.C. 423 

 To determine if you are disabled, the Social Security Administration uses a 5 step process. Here is the process: 

STEP 1:  Are you working? Contrary to popular belief, you can work, but you cannot be doing “substantial gainful activity” .  Substantial gainful activity typically means earning less than $1180 per month. 

STEP 2:  You must establish that you have one or more  “severe” medical impairments -  Basically, this means that medical records will show that you have some kind of medical impairment that, at a minimum, affects your ability to function physically or mentally. For example, many people have back pain.  Sometimes that back pain is disabling and sometimes it is not.  In order to move past Step 2, you must prove that their back pain has at least some impact on their ability to stand, walk, sit etc.  Once this requirement is met, we move to Step 3.  

STEP 3: Do your severe impairments meet one of the Social Security Administrations  Listing of impairmentsBasically, this is list of impairments for each body system that are considered so severe that they are presumed to be disabling of the factors are met.  These "listings" are set out in the law.  If an individual meets the requirements, they are considered disabled.  If not, the process continues to Step 4. 

STEP 4: If you do not meet  listing, can you perform yoru past work -- If you have a severe impairment, but do not meet a listing, you may still be considered disabled.  First, the Social Securit Administration will determine if you can do any of your "Past Relevant Work".  Past Relevant Work is work that you have done in the past 15 years in which you had substantial earnings and lasted long enough that you learned how to do the job.  The Social Security Administration will assess your "Residual Functional Capacity" to determine if you can perform your past work. This involves deciding the most amount that you can lift, stand, walk etc. and if you have any mental impairments that impact your ability. If your "RFC" prevents you from doing your past work, the process continues to Step 5.  If not, you are deemed no disabled. 

STEP 5: If you cannot perform your past work, can you perform other work If an individual is unable to perform Past Relevant Work, the SSA evaluates whether the claimant can adjust to any other work that exists in “significant numbers”  In making this determination, here are the most important factors: 

  1. Age -- The older the better and the harder it is to show that the claimant can adjust to other work.
  2. Education -- High School or less education, particularly at certain ages, significantly erodes the potential job base.
  3. RFC -- Most important factor. What do the medical records say about the claimant's physical and mental functional abilities?

Technically, the Social Security Administration engages in this process at every stage of the claim and appeal process. However, this becomes most relevant at the hearing stage when the Administration generally has an "expert" witness to testify about what jobs exist in the economy that a disabled person can do.  

This 5 step process is just the process for determining disability. In making this decision, Social Security law allows for various levels of appeal and a relatively complex claims process. In addition, a successful claim consists of medical record evidence and, in some cases, testimonial evidence.  Our law firm has handled hundreds, if not thousands, of Social Security Claims. Do not hesitate to contact us for assistance with your claim. 

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