HOW DOES SOCIAL SECURITY DEFINE DISABILITY?
The Social Security Administration (SSA) defines disability as being unable to engage in any substantial gainful activity (SGA) because of a medically determinable physical or mental impairment(s):
- That is expected to result in death, or
- That has lasted or is expected to last for a continuous period of at least 12 months.
The SSA then uses a five-step process called the “Sequential Evaluation” to determine whether you are eligible for benefits.
The Five Steps
STEP 1—Are You Working?
SSA uses the term “substantial gainful activity” to describe a level of work activity and earning.
The Administration considers work to be “substantial” if it involves doing significant physical or mental activities or a combination of both.
“Gainful” work activity is
- Work performed for pay or profit; or
- Work of a nature generally performed for pay or profit; or
- Work intended for profit, whether or not you profit from the work
If you are working in 2020 and your earnings average more than $1,260.00 a month, SSA will generally not consider you to be disabled.
If the Administration determines that you have not engaged in SGA, they then assess whether or not you have a “severe impairment”
Step 2 : Is Your Medical Condition “Severe”?
SSA defines a “severe impairment” as a physical or mental medical condition that significantly limits your ability to work for at least twelve (12) months.
When you apply for disability, you will provide SSA with a list of all your impairments, conditions, and symptoms, as well as a list of doctors, hospitals, and clinics that have treated you for your health conditions. When reviewing your records, SSA or an ALJ (administrative law judge) will evaluate whether your physical impairments impact your ability to:
- Sit, walk, and stand;
- Lift and carry;
- Reach, finger, and handle; and
- Stoop, crouch, climb, crawl, and balance
SSA will also evaluate your records to determine what impact your mental impairments have on your ability to:
- understand, carry out, and remember instructions;
- using judgment in making work-related decisions;
- respond appropriately to supervision; co-workers, and the public; and
- deal with changes in a routine work environment.
SSA must evaluate the impact of both your physical and mental impairments on your ability to work. If SSA determines that your impairment have more than a minimal impact on your ability to work, then you move on to the next step.
STEP 3: Does Your Medical Condition Meet or Equal One of the Listed Disabling Conditions?
If the Administration determines that you suffer from severe impairments, they will evaluate your conditions to see whether it meets or equals the necessary criteria for one of the Listings of Impairments. The Listings are a list of medical conditions maintained by SSA covering all major body system that are deemed so severe that it prevents a person from working. The published guide helps disability examiners quickly identify applicants who qualify for Social Security disability benefits. Some of the conditions that automatically qualify for disability are:
|Body System||Qualifying Conditions|
| ||Dysfunction of weight-bearing joint, degenerative disc disease with nerve root compression, amputation|
| ||Vision loss, blindness, and hearing loss|
| ||Cystic fibrosis, lung transplant, asthma, COPD|
| ||Chronic heart failure, ischemic heart disease, recurrent arrhythmias, heart transplant, chronic venous insufficiency|
| ||Chronic liver disease, short bowel syndrome, extreme weight loss related to any digestive disorder|
| ||Chronic kidney disease|
| ||Bone marrow failure, sickle cell disease|
| ||Bollus disease, chronic skin infections, dermatitis, extensive burns|
| ||Diabetes, thyroid gland disorders, adrenal gland disorders|
| ||Down syndrome|
| ||Epilepsy, Parkinsonian syndrome, Amyotrophic lateral sclerosis (ALS), peripheral neuropathy, muscular dystrophy|
| ||Intellectual disorder, schizophrenia, autism, bipolar|
| ||Lymphoma, leukemia, skin cancer, breast cancer, lung cancer, intestinal cancer|
| ||Lupus, HIV|
The Listing of Impairments offers details for each condition that clarifies what makes a condition severe enough to automatically qualify for disability benefits. For example, disorders of the spine requires evidence of nerve root compromise demonstrated by neuroanatomic distribution of pain, limited range of motion in the spine, muscle loss or atrophy with associated sensory and reflex loss, and, if involvement in the lower back, positive straight leg raise testing.
Having a condition that meets or equals the severity of one of the Listings can be difficult. However, just because you don’t meet a Listing, does not mean that you do not qualify for benefits. Instead, the Administration evaluates the impact of your severe impairments on your ability to work—known as residual functional capacity (RFC).
What is Residual Functional Capacity or RFC?
RFC is a function-by–function assessment of your maximum ability to do sustained work-related physical activities on a regular and continuing basis. In other words, what physical and mental activities can you perform 8-hours a day for 5 days a week despite the limitations and restrictions stemming from severe impairments.
After the Administration determines your RFC, they will evaluate your case at Step 4.
STEP 4: Are You Able To Perform Your Past Relevant Work?
At Step 4, the Administration evaluates your work history to determine your past relevant work. To be considered past relevant work, SSA uses a three-part test that requires that the work was:
- Performed at Substantial Gainful Activity (SGA);
- Performed in the fifteen year relevant period;
- Performed long enough to learn it.
After determining your past relevant work, SSA or the ALJ evaluates whether the your mental and restrictions or RFC would allow you to return to that work. If SSA finds that your RFC would prevent you from performing your past work or that you have no past relevant work, then SSA moves on to Step 5.
STEP 5: Are There Other Jobs That You Can Perform In The National Economy?
Finally, if someone is found to not be able to do their past relevant work, SSA or the ALJ evaluates whether you can do any other work in the national economy, considering your age, educational background, work experience and, of course, impairments. To make this determination, SSA or ALJ’s may consult with vocational experts. During a social security hearing, a claimant or their attorney will have the opportunity to cross-examine the vocational expert. If, however, a person makes it all the way to Step 5 and the administration finds that you are unable engage to perform other work in the national economy, you will be deemed disabled and entitled to benefits, possibly including back benefits.
The 5 steps outlined above are just a glimpse of the requirements necessary to be deemed disabled by the Social Security Administration. If you have applied or are considering applying for Social Security benefits, you should consult with an experience Social Security attorney.