When the SSA evaluates your application for benefits, it uses a sequential evaluation process for social security disability approval. This is a five step process that has to be done in a specific order. In this post, we will briefly review each of these steps. Other posts will look at each step in more depth.
Step 1: Is The Claimant Performing Substantial Gainful Activity?
The first thing you have to know about social security benefits is that the program only pays if you have a total disability. Benefits are not paid for partial disability. Total disability means that you cannot perform substantial gainful activity, or SGA. This means that you cannot perform work that is both substantial AND gainful.
Substantial work usually requires significant physical or mental activities. Gainful work means that you earn wages that exceed that year’s threshold amount to be called gainful. In 2020, you would have to make more than $1,260.00 per month for it to be considered gainful activity. So, it is possible to continue to work and still qualify for benefits through this sequential evaluation process for social security disability.
Another component of this question is called the durational requirement. This means that you have to be unable to earn these wages for at least twelve consecutive months. Whether you have already been off work for twelve months, or you EXPECT to be off work for twelve months. Either way, you can meet the durational requirement.
Step 2: Is The Condition, Or Combination Of Conditions, Severe?
Congress outlined the requirements for qualifying for social security disability years ago. They stressed that a person’s inability to work had to be based on a severe impairment. A severe impairment limits your ability to do basic work activity. These are things like sitting, standing, walking, bending or stooping. It also includes understanding, carrying out and remembering simple instructions.
One of the best parts of this part of the process is that a combination of conditions can be used to get to a severe impairment. Every ailment or condition alone does not have to equal a severe impairment. All of them combined can equal a severe impairment.
Step 3: Does The Condition Meet Or Equal A Listing, Looking At The Medical And Other Evidence?
A listing is a set of rules applicable to certain medical conditions. For instance, a diagnosis of lumbar stenosis can get you benefits. It just has to cause a specific set of problems as outlined in the listing. When you meet the criteria for a listing, it is presumed that you are disabled. Your medical records are the most important part of this equation. If you are proven disabled at this step, then the sequential evaluation process for social security disability ends.
Step 4: Is The Claimant Able To Perform Past Relevant Work?
Past relevant work is the work you have done for the 15 years prior to becoming disabled. It includes all jobs you have done long enough to have learned it. Only jobs where you performed at SGA levels count. This means that it is important that you explain how you performed these jobs in detail. Make sure you describe the physical and mental requirements of the work you performed. Ask your doctor to explain what physical and mental limitations you have from your medical conditions in a written report. The evaluator, or a judge, will decide if you can perform that work now that you have a severe impairment.
Step 5: Can The Claimant Perform Any Other Work Which Exists In Significant Numbers In The National Or Local Economy, Considering His Or Her Age, Education, and Work Experience?
At this step, the SSA finally looks at your age, education and the skills you developed through your work experience. Your age can have a significant impact on your eligibility for benefits. The law expects much more exertion from a 25 year old than a 55 year old. Someone who has only performed hard labor doesn’t have the same skills as an office professional. A judge will also find that your education level impacts the kind of work you can do.
The sequential evaluation process for social security disability has a method for taking all of this into account. In this stage, you will hear people talk about the grids. A grid mixes age, exertional levels, education and such together to see if you can automatically qualify for benefits due to your unique situation. So, a 58 year old who has only a high school education and hard labor related skills may qualify for benefits through a grid. A 58 year old CEO type with a masters degree may not. It all depends on how the evidence developed.
The sequential evaluation process for social security disability is how the SSA and a judge will look at your eligibility for benefits. At a hearing, these are the types of questions that will be asked. Your attorney will present evidence about these issues to help a judge award benefits. It is important to note that all of the questions you are asked through the application process have a purpose. They fuel this sequential evaluation process.