When seeking disability benefits, the Social Security Administration (SSA) undergoes a thorough process to determine eligibility. Familiarizing yourself with their decision-making framework, the 5-step sequential evaluation process can empower you to tailor your application for the best chance of success. After your initial application, the SSA assesses whether you meet specific criteria:
- Work Activity: Are you currently engaged in substantial gainful employment?
- Severity of Impairment: Do you have a severe impairment that significantly limits your ability to work?
- SSA Definition of Disability: Does your condition align with the SSA’s definition of a qualifying disability?
- Past Work Capability: Can you perform tasks related to your previous employment?
- Other Work Capability: Are you able to undertake alternative forms of employment, given your current limitations?
While not all cases necessitate all five steps, the SSA strives to reach a decision promptly. If additional information is required, the process continues. Should your application be denied and proceed to a hearing, the administrative judge will also employ the same sequential evaluation process to reach a final decision on your eligibility for disability benefits. Understanding these steps allows you to optimize your submission and effectively navigate the evaluation process.
Step 1: Are You Currently Engaged In Substantial Gainful Employment?
The initial evaluation step scrutinizes your engagement in substantial gainful activity (SGA), a level of work and earnings that demands significant mental or physical performance. The Social Security Administration (SSA) sets a threshold, currently at $1,470 per month, for non-blind individuals in 2023.
If your earnings surpass this limit, your disability claim will likely be denied. Conversely, if you’re not currently working or your income falls below this threshold, your likelihood of qualifying for disability benefits increases substantially.
Step 2: Do You Have A Severe Impairment That Significantly Limits Your Ability?
Moving to the second step, the SSA evaluates the presence of a severe impairment or disability. Beyond identifying the condition, they assess its impact on your daily life and whether it is anticipated to persist for more than 12 months.
A severe impairment is characterized by its substantial limitation on fundamental work tasks, encompassing physical activities such as standing, and mental functions like responding to instructions. The holistic evaluation considers the comprehensive effect of the impairment on your ability to perform essential activities required for gainful employment.
Step 3: Does your condition align with the SSA’s definition of disability?
Moving forward to the third step, the SSA employs its Blue Book as a guide for decision-making. This handbook contains a comprehensive Listing of Impairments, outlining specific illnesses or conditions and the required severity for disability consideration. (See more about What Conditions Automatically Qualify You For Disability?)
It’s not merely sufficient for your diagnosis to be on the list; it must meet the stipulated severity level. Substantiating medical evidence is crucial, illustrating the extent of your limitations.
For example, if you have epilepsy, your symptoms must align with specific criteria, including the type and frequency of seizures and the enduring impact on your physical or mental capabilities, even with treatment. Meeting these criteria is pivotal for progressing through the disability evaluation process.
Step 4: Can You Perform Tasks Related To Your Previous Employment?
In the fourth step, the evaluation assesses your ability to perform work previously undertaken. The Disability Determination Services (DDS) examines your employment history over the last 15 years, considering whether you had substantial experience in a particular role.
Simultaneously, they evaluate your residual functional capacity (RFC), which represents the maximum level of work you can currently undertake despite your limitations. This determination relies on information extracted from your medical records, providing a comprehensive understanding of your current capabilities in your work history.
Step 5: Are You Able To Undertake Alternative Forms Of Employment?
The conclusive phase of the process determines your capacity to engage in any form of work with your existing impairment. The Social Security Administration (SSA) considers your residual functional capacity, age, education, and experience.
For an application denial, the Disability Determination Services (DDS) must identify three jobs theoretically feasible given your limitations. Notably, if you’re 50 or older, the process concludes at step 4, focusing on your inability to perform past work. (Get more information on Social Security Disability Rules After Age 50)
However, if you’re under 50, the SSA assesses your adaptability for retraining and alternative employment, considering your limitations. This underscores the significance of Step 5, where you must establish the absence of full-time work options given your current capabilities.
How Can A Disability Lawyer Help You?
A Social Security disability lawyer plays a pivotal role in the sequential evaluation process by providing expert guidance, compiling crucial medical evidence, and ensuring a thorough presentation of your case during hearings. They navigate the complexities of appeals, communicate with the SSA, and understand regional nuances that may impact the application process.