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How Does Social Security Decide If You Are Disabled?

When you apply for Social Security disability benefits, in all likelihood you will be denied. The majority of applications are denied and your best chance of receiving benefits is to “hang in there” through the appeal process until you get to a hearing in front of an Administrative Law Judge (ALJ). Many people are completely baffled about the process the Social Security Administration (SSA) uses to determine who is, and is not, disabled. The determinations often seems to make no sense, particularly when you have significant disabilities and still lose your case.

Definition of “Disability”

Social Security disability law defines “disability” as an inability “to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than 12 months.” The fact that you can no longer perform your regular job duties does not necessarily qualify you for Social Security disability benefits.

There is a process which SSA follows in every case to determine who qualifies for disability benefits. The process is called the “five step sequential evaluation process”. If you are found to be disabled, or not disabled, after any of these steps, the process ends and SSA does not consider the next step.

Step 1. Are you engaging in “substantial gainful activity” (SGA)?

This is SSA’s determination as to whether you are working, as defined by SSA. They consider such things as what you are doing, if you are being paid and how much you are being paid. If your earnings are below a certain level, your work activities will not be considered substantial gainful activity.

Step 2. Do you have a severe, medically determinable impairment?

There must be medical evidence to support any claim of impairment. This generally means medical records or doctor’s reports which document your claim that you have an impairment of some kind which limits your ability to work. If SSA finds that you have impairments, but that they are not “severe”, the process ends. There is also a durational requirement, which means that your impairment must have lasted, or be expected to last, for a continuous period of 12 months.

Step 3. Does your impairment meet or equal a “Listing”?

If you are found to have a “severe” impairment, your claim moves on to step 3. SSA has a Listing of Impairments, which includes a wide variety of medical conditions, illnesses and other disorders. The listings include both physical and psychological conditions. (Examples: amputations, coronary artery disease, bipolar disorder, lumbosacral spine disorders, multiple sclerosis, etc.)

If the medical evidence establishes that your condition or conditions meets the requirements of a particular Listing, you are found to be disabled. Even if your impairment does not quite meet the definition in a Listing, SSA can find that your impairment is medically equivalent to, or “equals”, a Listing. If your impairment meets or equals a Listing, you are awarded disability. If not, the process continues to Step 4.

Step 4. Can you still do your past relevant work?

At this step, SSA will determine what your physical abilities are, based upon your impairments and the medical evidence. This assessment of your abilities is called Residual Functional Capacity (RFC). Your “past relevant work” means any job you have performed in the last 15 years. If SSA determines that you are capable of performing any of your past relevant work, you are not disabled. If you are not, the final determination of disability is made at Step 5.

Step 5. Are you capable of performing other work?

At this step in the process, there are a great many factors that come into play, including your RFC, age, education and work experience. This is often the hardest part of the process for most claimants to understand. SSA is not looking at your local labor market or your community in determining whether you can work. Rather, the question is whether you can perform work that exists in significant numbers in the national or regional economy. It makes no difference whether any of those jobs are close to where you live or whether they have openings. If SSA determines that you are physically capable of performing any of those identified jobs, then you are not disabled.

Summary

This was only intended to be a general summary of the disability determination process. There are many thousands of pages of Social Security regulations, rules, guidelines and decisions which govern the Social Security disability system. For every rule there are exceptions. At a Social Security disability hearing, a vocational expert and/or a medical expert frequently will be present to testify about your impairments, your RFC and your ability to perform past or other jobs. The judge will base her decision after reviewing all of the evidence and opinions from the witnesses.

What We Recommend

If you have any questions about the Social Security disability process or your claim, please feel free to contact us for your absolutely free consultation. Whether we can help you or not, you should always follow through on your claim through any appeals and hearings. You have nothing to lose but the time you have invested in your claim. The majority of people who ultimately receive Social Security disability benefits do so at the hearing level where they finally get to explain their disability to a real person – the Judge.

Except in rare cases, we generally do not become involved in a claim until after your second denial. That’s when you are requesting a hearing with a Social Security judge. At that point, we would begin to serve as your representative. We obtain medical records, request reports from your doctors and make sure that Social Security has everything in its file that might be helpful to your claim. We meet with you ahead of time to prepare you for the hearing and attend the hearing with you as your representative. Best of all, you only have to pay us if we win.

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