Disability

5-step disability approval process

Once you submit a disability application to the Social Security Administration (SSA) for review, SSA makes a determination through a five-step sequential disability approval process. You must show the following five things for SSA to find you disabled:

  1. You are not engaging in substantial gainful activity (SGA).
  2. You have a severe impairment or combination of impairments.
  3. Your impairment(s) meet or equal one of the impairments described in the SSA regulations known as the Listing of Impairments.
  4. You are unable to perform your past relevant work.
  5. You are unable to perform any other work in the regional and national economy.

If SSA can find that you are disabled or not disabled at certain steps in the process, they will make a determination right then, without moving on to the next step. While the steps may seem simple, the evaluation is quite complex.

disability approval process flowchart

Step 1: Substantial gainful activity

Substantial gainful activity (SGA) is the term SSA uses to describe work activity and earnings. Under SSA’s rules, work does not have to be fulltime to be “substantial,” because it is based on monthly earnings. For 2016, SGA is considered $1,130 gross per month for a nonblind individual and $1,820 for a blind individual. If you are making over this amount when you apply for disability, your application will be denied—because, under SSA’s Step 1 evaluation, you are still able to work substantially.

Step 2: Severity and durational requirement

There are two criteria that must be satisfied to get past Step 2: medical severity and duration. An impairment or a combination of impairments is considered “severe” if it significantly limits an individual’s physical or mental abilities to perform basic work activities. Then, the severe impairment must have lasted or must be expected to last for a continuous period of at least 12 months, or be expected to end in death.

Step 3: Listing of Impairments

SSA’s Listing of Impairments describes the medical conditions, severity and evidence required for an impairment to warrant a finding of disabled. Listings for adults and children are separate, both organized according to body systems (musculoskeletal, senses, respiratory, cardiovascular, etc.).

If your condition meets or equals a listing’s requirements, SSA can find you disabled at this step, and will not move on to Step 4 or Step 5. To meet a listing requirement, your condition must be the same as the criteria of a listed impairment. To equal a listing requirement, your condition must be equal in severity and duration to the criteria of a listed impairment. Generally, people use an “equals to” argument in one of the following circumstances:

  1. Your impairment does not meet one or more of the medical criteria specified in the listing.
  2. Your impairment does meet all of the criteria, but one or more of the criteria is not as severe as specified in the listing.
  3. Your impairment is not described in the listing but may be as severe as an analogous impairment.
  4. You have a combination of impairments, none of which meet a listing, but the cumulative total of your impairments could equal one or more listings.

Step 4: Past relevant work

At this step, SSA will determine if you are able to complete any of the work you performed in the prior 15 years. This only applies to work you performed that was above SGA. You also must have performed the work long enough to learn it, which depends on the nature and complexity of the work. If you had five jobs in the past 15 years, but only three were above SGA, SSA would only analyze the three above-SGA jobs. If your current physical abilities fit into the requirements of a past job, SSA can decide that you can still do that job and deny you disability.

Step 5: Ability to perform other work

If you are unable to perform any of your past relevant work, SSA may still find that you can perform other jobs in the regional or national economy, resulting in a denial. This step is where SSA issues the largest number of denials. It can be relatively easy for SSA to find some work in the national or regional economy you would be capable of performing. SSA will consider your medical conditions, your age, education, past work, and any transferable skills you may have. If you cannot adjust to any other work, your claim will be approved.

This five-step analysis applies if you file for Social Security Disability Insurance, Supplemental Security Income, child’s insurance benefits, and widow’s or widower’s benefits. The five-step process makes the analysis of every disability case uniform across the country, regardless of age, diagnosis or jurisdiction.

The disability approval process is very complicated and if you have questions, or if you wish to apply for Social Security disability benefits, the Disability team at CVC can help!

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