In order to receive Social Security Disability or SSI benefits, you must meet the Administration’s definition of disability. The Administration uses a five-step sequential disability analysis. It is important to understand this analysis before filing for disability benefits.
Step 1: Are You Working?
If you are performing “substantial gainful activity” (SGA), you cannot receive Social Security disability benefits. Every year, Social Security sets an income threshold for SGA. If your income meets or exceeds this threshold, you cannot receive Social Security disability benefits, even if you meet the Administration’s medical criteria.
In 2016, the SGA thresholds were set at:
- Non-blind workers: $1,130 per month, and
- Blind workers: $1,820 per month.
However, not all work is considered SGA. For example, some work is considered subsidized. Subsidized work occurs when your wages exceed the actual value of your 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.
If you need help determining whether your work activities reach the level of SGA, contact an experienced Social Security lawyer.
Step 2: Do You Have a Severe Impairment?
At Step 2, you must prove that you have a severe, medical impairment. A medical condition is “severe” if it is a medically determinable impairment that:
- Significantly limits your physical or mental ability to do basic work activities, and
- The medical condition or conditions have existed or will last for at least a year.
If your conditions cause functional limitations (like difficulties walking, standing, or lifting), it should be considered a severe impairment.
However, there must be evidence supporting your diagnoses or conditions. Medical records, like clinical notes and diagnostic studies (x-rays, MRI’s, etc.) are almost always necessary. Social Security will not approve your claim based on a self-made diagnosis.
Step 3: Do You Meet or Equal a Listing of Impairment?
If you have a severe impairment, Social Security will consider whether you meet one of its Listings of Impairment. If you meet or equal a Listing, your claim should be approved.
The Listings of Impairment describe specific conditions and symptoms and set out specific disability criteria. If you have very severe symptoms related to a medical condition, you may meet a Listing. The Listings can be very technical and require a thorough review of your medical records. If you have questions about the Listings, you should consider discussing the criteria with your doctor or a Social Security lawyer.
Most Social Security claimants do not meet or equal a Listing. If you have severe impairments, but do not meet a Listing, the Administration will proceed to Step 4 and 5 of the evaluation process—which focus on your functional ability to work.
Step 4: Can You Perform Past Relevant Work?
When you apply for Social Security benefits, you will give the Administration information about your work history. At Step 4, your ability to do your past work is evaluated.
Past relevant work (sometimes abbreviated as PRW) includes any SGA-level work you performed over the past 15 years. Additionally, the job must have lasted long enough for you to learn to do it. (A very brief work attempt may not be considered past relevant work.)
Your past work will be categorized based on its 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.
Based on its review of your medical conditions, Social Security will assign you a set of functional limitations (called your “residual functional capacity” or “RFC”). If your past work can be performed within these restrictions, your claim will be denied.
Step 5: Can You Perform Other Work?
If you cannot perform your past relevant work, the Social Security Administration will then determine if you are able to do other full-time work. If you are capable of doing other work within the national economy, your claim may be denied.
However, Social Security’s Medical-Vocational Rules set different rules for older workers. If you are over the age of 50, you may be considered disabled if you are unable to perform your past work and have significant functional limitations. (As you age, the criteria become more and more lenient.) A Social Security lawyer can help you apply the Medical-Vocational or “Grid” Rules in your claim.
Should I Contact a Social Security Lawyer?
Yes. To win a Social Security disability claim, you must interpret medical evidence, your vocational background, and the law. Many disabled workers cannot handle these tasks themselves. A Social Security lawyer can help you prepare your claim, file for benefits, and guide you through the appeals process.