To receive Social Security Disability benefits (SSDI), a person must meet the Social Security Administration’s (SSA) definition of “disability.” The SSA uses a five-step analysis to determine who qualifies for disability benefits.
Your disability must be serious enough to severely limit your ability to work for a living at any job at all (not just your current job) to qualify for benefits. Once you have qualified for SSDI, It is possible to supplement the disability benefits by working, but there are limitations on the amount of income you can earn without losing your benefits.
As a threshold matter, if you become disabled and want to file for benefits, you must have accumulated enough work credits with the SSA to qualify for SSDI. The number of work credits you have is based on how much you earn in a year. The SSA allows workers to earn no more than four credits per year. As of 2023, the SSA will give you one credit for every $1,640 you earn.
Thus, you get all four available annual credits if you make $6,560 or more. Generally, you need 40 work credits to qualify for SSDI, meaning you must have worked for at least 10 years. Twenty of those credits must have been earned in the last 10 years, not earlier. Since younger workers may not have enough credits built up, If you are under 50 years old and have a qualifying disability, the SSA may approve your SSDI application with fewer than 40 credits.
These are the 5 steps the SSA goes through to determine if you qualify for disability benefits:
Step 1: Are You Working?
SSDI benefits are meant to kick in if someone cannot work because of a qualifying disability. If a person performs “substantial gainful activity” (SGA), they cannot receive SSDI. In the definition of the SSA, “substantial gainful activity” means significant and productive physical or mental work. It can be difficult to determine what qualifies as “substantial gainful activity,” so the SSA has concluded that anyone whose income exceeds the annual thresholds does not qualify for benefits.
If a person’s income meets or exceeds this threshold, they cannot receive Social Security disability benefits, even if they satisfy the SSA’s medical criteria for disability. For 2023, the statutory amount is $1,470 per month. A different amount is set for blind workers.
Not all income is counted by the SSA, however. For example, some work is considered” subsidized.” Subsidized work occurs when the wages are higher than the actual value of the work. For example, subsidized work may occur in a sheltered workshop for disabled workers or when an employer offers a light-duty job to a disabled worker. The SSA tries to assess the true value of subsidized work with the result that even if a person doing subsidized work makes more than the monthly thresholds, if the true value of the work is less than the threshold, the person can qualify for SSDI.
If you need help determining whether your work activities qualify as “substantial gainful activity,” you should contact an experienced Social Security lawyer. Similarly, if your work might qualify as subsidized work, you would want to consult a lawyer to determine if you still might qualify even if technically you make too much money.
Step 2: Do You Have a Severe Impairment?
In Step 2, a person must prove they have a severe medical impairment. A medical condition is “severe” if it can be determined medically that the impairment:
- Significantly limits a person’s physical or mental ability to do basic work activities and
- Is caused by a medical condition or conditions that have existed or will last for at least a year or will result in death
If a person’s medical condition causes functional limitations, such as difficulty walking, standing, or lifting, it could be considered a severe impairment. A combination of impairments may limit a person’s physical or mental ability to do basic work, even if each impairment alone would not do so.
Keep in mind that there must be evidence supporting diagnoses or conditions. Medical records, such as clinical notes, and diagnostic studies, such as MRIs and X-rays, are almost always necessary. Social Security will not approve a person’s claim based on a self-made diagnosis. You must have a doctor – Social Security will want to contact them to verify how severe the disability is.
Step 3: Do You Meet or Equal a Listing of Impairment?
If a person has an impairment, the SSA will determine whether the person’s impairment is severe enough to qualify for disability benefits. The SSA maintains a “Listing of Impairments.” If a person suffers from an impairment that is on the list, the person’s disability is considered severe enough, and their claim for SSDI should be approved.
The “Listings of Impairments” describes specific conditions and symptoms and sets specific disability criteria. The Listings are available on the Web, but they are quite difficult to understand because they are medically technical. For example, the listing does not simply list “congestive heart failure;” but defines what medically qualifies as congestive heart failure. Determining whether a person has one of the impairments on the list requires a thorough review of the person’s medical records and possibly interviews with doctors, family members, friends, and others who know the person’s impairment and its effect on their activities. If a person has questions about the Listings, they should consider discussing the criteria with their doctor and a Social Security disability lawyer.
Most people filing a claim for benefits do not have one of the impairments on the list. If a person has severe impairments but does not qualify according to the official list, the SSA will proceed to Steps 4 and 5 of the evaluation process. These steps focus on a person’s functional ability to work.
Step 4: Can You Perform the Work You Have Been Doing?
When a person applies for SSDI, they will give the SSA information about their work history. At Step 4, the person’s ability to do their work is evaluated.
The SSA will look at the applicant’s work history. Past relevant work (PRW) includes work the person performed over the past 15 years, including their present job. The job must have lasted long enough for the person to have had to earn to do it. A very brief work attempt may not be considered past relevant work.
A person’s PRW will be categorized based on their physical and mental difficulty. For example, a computer programmer’s work may be considered skilled and sedentary, while a commercial janitor’s work is typically heavy and unskilled. This matters because when the SSA tries to determine if the claimant can do any work at all, it will use the PRW categorizations to determine what kinds of work the person is qualified to do.
Before deciding whether the work qualifies, the SSA will investigate what limitations the claimant has. Based on its review of a person’s medical conditions, the SSA will assign the person a set of functional limitations, referred to as “residual functional capacity” or “RFC.” If the person’s past and present work can be performed within these restrictions, their claim for SSDI will be denied. Only if the person cannot perform their past and present relevant work will their claim be allowed.
For example, a person may have lost the use of their legs because of an injury or illness, and they are now confined to a wheelchair. If their relevant work was as a computer programmer, and that type of work was entirely sedentary and did not involve walking, standing, or other use of their legs, they may not qualify for SSDI even though their impairment is significant. On the other hand, if they worked as a commercial janitor, this impairment would probably qualify.
Step 5: Can You Perform Other Work?
If a person cannot perform in their own field, the SSA will then determine if the person can do other full-time work. If the person is capable of doing any other work that is available within the national economy, their claim may be denied.
The SSA sets different rules for older workers via the “Medical-Vocational Rules.” If a person is over the age of 50, the person may be considered disabled if they are unable to perform work in their own field. As a person ages, the criteria become more and more lenient. A Social Security lawyer can help people apply the Medical-Vocational or “Grid” Rules to their claim.
Should I Contact a Social Security Lawyer?
Most disability claims are filed without using an attorney. The rate of successful claims is only 35%. Sometimes, this is because people who applied were not disabled “enough,” but often, it is because they did not submit enough evidence to support their application.
To win a Social Security disability claim on your own, you must be able to interpret medical evidence, your vocational background, and the law. Many disabled workers cannot handle these tasks themselves. An experienced Social Security lawyer can help you prepare your claim, file for benefits, and guide you through the appeals process if necessary. You have the best chance of success with your claim if you have an experienced lawyer fighting for you.