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Disability Determination In Social Security disability claims, the federal government uses a five step process to determine eligibility for benefits. The five step process is called "sequential evaluation." On this page, I have described in layman's terms the way the Social Security Administration generally uses the sequential evaluation process to determine whether you, as an adult disability claimant, are entitled to disability benefits. Disability claims for children are evaluated in a different way. Are You Working?
When you apply for disability, the first step is to determine whether you are engaging in substantial gainful activity. Are you still working? If so, how much money do you earn? A different kind of inquiry is made if you are self-employed. If you are engaging in substantial gainful activity, your claim is denied at the first step. If you are not engaging in substantial gainful activity, your claim proceeds to the next step. Do you have a severe impairment?
The second step is to determine whether you have a "severe" impairment. The term "severe" generally means that one or more of your medical impairments has significantly limited your ability to perform basic work activities. A "severe" impairment may be physical or mental. If you do not have a "severe" impairment, you claim is denied at this step. If you have one or more "severe" impairments, your claim proceeds to the next step. Does your impairment satisfy the listings?
The third step is to determine whether your "severe" impairment satisfies the disability criteria specified in the Listing of Impairments. Social Security has a list of most medical impairments divided into categories by body systems. For example, heart impairments are listed in the cardiovascular body system category. Social Security then specifies different disability criteria for each impairment. For example, the disability criteria specified for coronary artery disease is different from that for congestive heart failure. It takes a marked level of impairment to satisfy the disability criteria at this step. If your impairment satisfies the disability criteria of a listed impairment, you are considered disabled. Can You Perform Your Past Job?
If not, your claim proceeds to the next step. The fourth step is to determine whether your physical or mental impairment prevents you from doing your past relevant work. Social Security generally classifies work activity as requiring heavy, medium, light, or sedentary levels of exertion. For example, if your physical impairment has limited you to a "residual functional capacity" involving only light exertion and you have done only medium or heavy jobs in the relevant past fifteen years, then your impairment prevents past relevant work and you pass this test. Mental impairments are evaluated differently. If your impairment does not prevent you from doing your past job, your claim will be denied. If your impairment prevents you from performing past relevant work, your claim proceeds to the next step.
Can You Perform Other Jobs?
The fifth and final step is to determine whether your impairment prevents you from doing other kinds of jobs for which you are suited by age, education, past work experience, and residual functional capacity. Generally the older you are, the greater chance you have of winning your claim. If you are under age 50, it is difficult but not impossible to win your case. If Social Security determines that you can perform other work, your claim will be denied. If you cannot perform other work, then your claim will be approved. This explanation is provided for information purposes only. It is not intended to offer legal advice. Your claim may involve other more complicated considerations such as a closed period of disability or unsuccessful work attempts not discussed above. If you have filed or are considering filing a claim, you may want to consult a Social Security disability lawyer who has experience with the Social Security disability process. An experienced Social Security disability attorney should be able to explain this process and answer your general questions. J. Michael Duncan, Attorney At Law
1042 Washington Street
Raleigh, North Carolina 27605
Tel: 919-856-1500
Fax: 919-856-1506
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