Social Security Administration’s process to determine disability

One of the most trying times that a person will face is a disabling health crisis. Sadly, some of these conditions will make holding down a job impossible.  Financial concerns and the disruption of health insurance benefits are often at the forefront of a person’s mind when that individual can no longer work.  Social Security disability is designed to help people who can no longer work because of disability.  So, what does the Social Security Administration (SSA) consider when trying to determine if a person is disabled?

The (SSA) uses a five step process called the Sequential Evaluation.  This process is followed in a specific order.  The five steps are found in the Social Security Act, the Code of Federal Regulations (CFR 20), and Social Security Rulings (SSRs). 

What is disability?  Disability is the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment that meets the duration requirement. 

 The duration requirement is met if the impairment: 

1. can be expected to result in death
2. or has lasted for 12 months
3. or will last for at least 12 months
   
   

Step 1

Is the person working above SGA level?  The amount for SGA changes each year.  The monthly SGA amount for statutorily blind individuals for 2024 is $2590.  For non-blind individuals, the monthly SGA amount for 2024 is $1550.  SGA for the blind does not apply to Supplemental Security Income (SSI) benefits, while SGA for the non-blind disabled applies to Social Security and SSI benefits.

If an individual is working and his or her earnings average more than the SGA limit a month, then he or she is found not disabled.  At this point, there is no need to go to step 2.  If an individual is not working or his or her earnings are less than SGA, the adjudicator goes to step two.

Step 2

Is the individual’s physical and/or mental condition severe?  At the second step, the adjudicator will consider the medical severity of an individual’s impairment(s).  An individual must have a medically determinable physical or mental impairment (or a combination of impairments) that is severe and meets the duration requirement.

To be severe, the impairment or impairments must interfere with basic work-related activities. If there are no severe impairments or the duration requirement is not met, the person is not disabled and there is no need to go on to step 3.  If there is a severe impairment and the duration requirement is met, then the adjudicator will go on to step three. 

Step 3

Does the individual’s medical condition meet or equal the severity of a listing?  At the third step, the SSA considers the medical severity of an individual’s impairment(s).  SSA maintains a listing of medical criteria that are considered to be so severe that an individual is found to be disabled if his or her medically determinable physical or mental impairment(s) matches them. If an individual’s impairment(s) can be found to meet the listed criteria exactly or to be of equal severity and the duration requirement is met, he or she will be found disabled.  If an individual does not have an impairment that meets or equals one of the listings or the duration requirement is not met, the adjudicator goes to Step 4.

Step 4

Can the individual do any of his/her Past Relevant Work (PRW)? PRW is any work that you’ve done in the last 5 years (as of 06/22/2024.)  If an individual retains the physical and mental capacity to perform any PRW, he/she is found not disabled. If no PRW can be done, or the individual has no relevant work, the adjudicator goes to step five. 

Step 5

Can the individual make an adjustment to any other work?  At the fifth and last step, an individual’s Residual Functional Capacity (RFC) and age, education, and work experience are considered to see if he/she can make an adjustment to other work.  If an individual can make an adjustment to other work, he or she is found to be not disabled. If an individual cannot make an adjustment to other work, he or she is found to be disabled.

The disability process can be a very difficult and lengthy process.  With your health crisis, you are dealing with enough; let me fight this battle for you.   Contact the Law Office of Jennifer L. Foster, PLLC, at 1-833-543-0888 to discuss which legal strategies will get you the benefits you deserve.