How does Social Security decide if I am disabled?

Answer: The Social Security Administration will consider many factors in determining whether you are disabled. It will consider both medical and non-medical factors. Every case handled by Social Security must pass through the 5 Step Sequential Evaluation Process (20 CFR 404.1520). The following are the steps used by the Administrative Law Judge (ALJ) to award or deny a person’s benefits. Although this outline is included to better explain the process a Judge goes through in determining a persons eligibility at a hearing, the actual evaluation used by the ALJ is far more involved and will include Federal Statutes, the Code of Federal Regulations, Case Law, Program Operations Manual Systems (P.O.M.S.), The Listing of Impairments, and The Grids.

1. Is the claimant engaged in “Substantial Gainful Activity” (Working)?

• YES – Claimant working – claim is denied

If you are working and the work you are doing is substantially gainful activity, SSA will find that you are not disabled regardless of your medical condition or your age, education, or work experience. (Naturally a person who is working is not disabled).

This is why a claimant may not be working while a claim is being processed.

• NO – Claimant NOT working—Evaluate further (Go to Step 2)

2. Is there a severe physical or mental impairment(s)?

• YES – Evaluate further, if significant impairment(s) are present.

Most claimants are found to have a severe impairment(s); however the existence of the impairment must be of such magnitude as to prohibit the individual from performing work. (Usually this is not a difficult requirement to meet).

• NO – Claim Denied.

You must be found by Social Security to have a severe impairment. If you don’t have any impairment or combination of impairments which significantly limits your physical or mental ability to do basic work activities, SSA will find that you do not have a severe impairment and are, therefore, not disabled. SSA will not consider your age, education, and work experience. However, it is possible for you to have a period of disability for a time in the past even though you do not now have a severe impairment; this is called a “closed period” of benefits.

3. Does the Impairment(s) Meet or Equal a Listing?

• YES – Claim Allowed

If you have an impairment(s) which meets the duration requirement and is listed in appendix 1 or is equal to a listed impairment(s), Social Security will find you disabled without considering your age, education, and work experience.

The Listing of Impairments describes, for each of the major body systems, Impairments which are considered severe enough to prevent a person from doing any gainful activity. For all others, the evidence must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months.

The duration requirement is defined as follows: An 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.

  • NO – EVALUATE FURTHER.

4. Does the Claimant have the Residual Functional Capacity to perform Past Relevant Work?

• YES – Claim Denied

Your impairments(s) must prevent you from doing past relevant work. If we cannot make a decision based on your current work activity or on medical facts alone, and you have a severe impairment(s), we then review your residual functional capacity and the physical and mental demands of the work you have done in the past. If you can still do this kind of work, we will find that you are not disabled.

A simplified definition of residual functional capacity is “the ability of an applicant to do work done in the past, despite the existence of a severe impairment”. At this step a Vocational Expert may be called as an expert witness in the area of vocational rehabilitation and give opinions to hypothetical questions asked by the judge based upon restrictions given in the medical reports by all the doctors that have examined the claimant. A doctor reporting that the claimant can still do “sedentary” or “light” work are reasons to be turned down for benefits.

• NO – Evaluate Further.

5. Is the Claimant able to perform any other type of work?

• YES – Claim is Denied.

• NO – Claim is Approved.

At this state the government has the burden to prove that a claimant can do other work in the national economy.

If you cannot do any work you have done in the past 15 years because you have a severe impairment(s), we will consider your residual functional capacity and your age, education, and past work experience to see if you can do other work. If you cannot, we will find you disabled.

The claimant’s age education, work experience, and residual work capacity are considered along with the testimony from a vocational expert as well as the Medical Vocational Guidelines commonly known as “The GRIDS” to make a decision. If there is any type of work that you can still do on a full time basis, then you are not disabled.

The GRID found at Code of Federal Regulations title 20 Part. 404, subpt. P, App.2 to Subpart P is used when a claimant’s impairments are not severe enough to meet or equal a listing. These vocational disability rules are used to decide whether a claimant can receive benefits on a vocational basis. The claimant’s age, education, and work experience over the past 15 years are plugged into tables along with claimant’s Residual Functional Capacity “RFC”. The results are mechanical and a person under the age of 55 will usually be denied.

A person over the age of 55 is not assured of winning if the claimant does not “meet” or “equal” a listing. If the over 55 claimant has transferable skills that would allow the person to do sedentary or light work requiring little or no training the “grid rules” would find this person not disabled.

It takes an experienced Social Security Disability Attorney who know all of the Social Security rules to find an exception that will allow a person under 55 who does not “meet” or “Equal” a listing to receive benefits