In order 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 disability analysis to determine who qualifies to receive SSDI. It is important to understand this analysis before filing for disability benefits.
Basically, in order to qualify for SSDI a person’s disability must be serious enough to limit the person’s ability to work for a living. It is possible to still work to a limited extent and receive SSDI, but there are limitations on the amount of income one can earn while receiving SSDI.
As a threshold matter, a person must have accumulated enough work credits with the SSA through working to qualify for SSDI if the person becomes disabled. The number of work credits you have is based on how much a person earns in a year. The SSA allows workers to earn no more than four credits per year. As of 2020, the SSA will give you one credit for every $1,410 you earn.
The maximum of four credits is allotted once you have earned $5,640 in one year. Generally, a person needs 40 work credits to qualify for SSDI. Twenty of those credits must have been earned over the last 10 years. However, if a person is under 50 years old and has a qualifying disability, the SSA may approve your SSDI application with fewer than 40 credits.
The steps for analyzing an SSDI claim are as follows:
Step 1: Are You Working?
If a person is performing “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.
Every year, the SSA sets an income threshold for SGA. If a person’s income meets or exceeds this threshold, the person cannot receive Social Security disability benefits, even if they satisfy the SSA’s medical criteria for disability.
For the year 2020, the SGA thresholds were set at:
- Non-blind workers: $1,260 per month, and
- Blind workers: $2,220 per month.
Not all work is considered SGA, however. 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.
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.
A person who needs help determining whether their work activities qualify as “substantial gainful activity” should contact an experienced Social Security lawyer. Or, if a person’s work might qualify as subsidized work that could be valued below the threshold, the person would want to consult an experienced Social Security lawyer.
Step 2: Do You Have a Severe Impairment?
At Step 2, a person must prove that 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.
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. If a person’s medical condition causes functional limitations, such as difficulty walking, standing, or lifting, it could be considered a severe impairment.
Keep in mind that there must be evidence supporting a person’s diagnoses or conditions. Medical records, like clinical notes and diagnostic studies, such as X-rays, MRI’s, and the like, are almost always necessary. Social Security will not approve a person’s claim based on a self-made diagnosis.
Step 3: Do You Meet or Equal a Listing of Impairment?
If a person has a severe impairment, the SSA will consider whether the person’s impairment is on its “Listings of Impairment”. If a person suffers from a qualified impairment, the person’s claim for SSDI should be approved.
The “Listings of Impairment” describes specific conditions and symptoms and sets out specific disability criteria. If a person has very severe symptoms related to a medical condition, the person may meet a Listing criterion. The Listings are medically technical. 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 have knowledge of the person’s impairment and its effect on their activities. If a person has questions about the Listings, the person should consider discussing the criteria with their doctor and a Social Security lawyer.
Most SSDI claimants do not have one of the impairments on the “Listing”. If a person has severe impairments, but does not qualify according to the Listing, the SSA will proceed to Steps 4 and 5 of the evaluation process—which focuses on a person’s functional ability to work.
Step 4: Can You Perform Past Relevant Work?
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 past work is evaluated.
Past relevant work (PRW) includes any SGA-level work the person performed over the past 15 years. Additionally, the job must have lasted long enough for the person to learn to do it. A very brief work attempt may not be considered past relevant work.
A person’s 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 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 work can be performed within these restrictions, their claim for SSDI will be denied. Only if the person cannot perform their past relevant work will their claim be allowed.
For example, a person may become confined to a wheelchair after having lost the use of their legs because of injury or illness. However, if their past relevant 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.
Step 5: Can You Perform Other Work?
If a person cannot perform their past relevant work, the SSA will then determine if the person is able to do other full-time work. If the person is capable of doing other work within the national economy, their claim may be denied.
However, the SSA’s Medical-Vocational Rules set different rules for older workers. If a person is over the age of 50, the person may be considered disabled if they are unable to perform their past work and have significant functional limitations. As a person ages, the criteria become more and more lenient. A Social Security lawyer can help a person apply the Medical-Vocational or “Grid” Rules to their claim.
Should I Contact a Social Security Lawyer?
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. An experienced social security lawyer can help you prepare your claim, file for benefits, and guide you through the appeals process. You have the best chance of success with your claim if you have an experienced Social Security lawyer fighting for you.