What is the process for determining whether you qualify for Social Security Disability (SSDI or SSI) benefits?

Many people applying for Social Security Disability benefits are confused about the process the Social Security Administration (SSA) goes through in order to determine whether someone is eligible for Social Security Disability (SSD) benefits. The Social Security Administration has actually laid out specific steps that they follow to determine if someone is disabled and therefore qualifies for SSD benefits. In this post, I provide a simplified description of the sequence of steps the SSA takes to evaluate whether you are disabled per Social Security’s regulations. 

       1.    Did you earn more than a specific amount of money since your alleged onset date of disability (the date that you claimed you became disabled)?

In this first step, the SSA will obtain a report of your earnings to determine if you have earned money since the day you claimed you became disabled. If you have earned money since the day you claim you became disabled, the SSA will look to see if the average monthly amount you earned is more than the SGA or the Substantial Gainful Activity amount for that year. This is the maximum monthly amount of money you can earn while still being eligible for SSD benefits during that period of time. This amount changes from year to year. For 2012, for example, the SGA amount is $1010 per month if you are not blind and $1690 per month if you are blind. As I mentioned, the SGA amount differs each year and you can determine the SGA amount for each year by going to the SSA.GOV website (http://www.ssa.gov/oact/cola/sga.html).

In general, if your average monthly earnings exceed the SGA amount for that particular year, then the SSA will determine that you are not eligible for SSD benefits. There are certain exceptions that apply to this rule and if you have been denied on this basis, you should contact an attorney experienced in handling Social Security Disability claims. If you have not earned more than the SGA amount, then SSA will move your claim to Step 2.

       2.    Is the claimant’s condition “severe”?

· The second step is to determine if your condition is “severe.” SSA defines a condition as “severe” if it has more than a minimal effect on your ability to do basic work activities. This is a very low threshold to meet as most impairments will have some effect on a person’s ability to perform basic work-related activities, even if the condition does not completely prevent work activities. If your condition is considered “severe”, then the SSA will progress your claim to Step 3.

      3.    Does your condition meet a medical listing?

The third step in the process is to determine if your medical condition meets a medical listing. In order to meet a medical listing, specific criteria must be met which deem the condition (in and of itself) severe enough to automatically warrant SSD benefits. The SSA maintains a list of such medical conditions for each major body system, all of which can be found on the SSA website. If your condition meets a medical listing then you are considered disabled for purposes of SSD benefits. In some cases, people applying for SSD may not see their condition(s) specifically acknowledged by the SSA as a potential medical listing. In such a situation, the SSA will determine if your condition is equivalent in severity to a related medical condition that is actually on the list.

Even if their condition is listed, however, most people applying for SSD do not have a condition(s) severe enough to automatically qualify for benefits via a medical listing. If your condition does not meet a medical listing all is not lost. If your condition does not meet or equal a medical listing, the SSA will move to Step 4.

      4.    Can you perform past relevant work?

If your condition does not meet or equal a medical listing, the SSA will then determine whether you are capable of performing “past relevant work.” “Past relevant work” is work performed within the previous 15 year period, assuming that it lasted long enough to be learned and was substantial gainful activity (SGA). If the answer is no (you cannot return to any past relevant work) the SSA will proceed to Step 5.

      5.    Can you perform other work?

If it is determined that you cannot perform your past relevant work, the SSA will try to determine whether there is any other work you could reasonably do based on your age, education, and transferability of job skills. This decision will also be based on your residual functional capacity. This term refers to what tasks and skills an individual can still perform despite the functional limitations and restrictions caused by the physical and/or mental impairments stemming from a documented medical condition. The types of jobs that SSA can determine you are capable of performing diminishes with older age, less education and less previous work experience. That means that the older you are, the less education you have and the less previous work experience you have, the more difficult it is for the SSA to determine that there is other work that you can do. If you are unable to perform any past relevant work or any other work (based on your age, education and work experience), then you should be approved for Social Security Disability benefits.

This is NOT legal advice.  This blog provides general information about Social Security Disability cases.  To discuss your particular circumstances and claim, please contact a lawyer in your area.