Filing for Disability: Evaluation of Your Claim

May 11,2017
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When it comes to filing for disability, the Social Security Administration has a five-step process for evaluating claims for eligibility. The SSA uses multiple criteria, including medical and vocational, that can be quite confusing. An experienced disability lawyer goes over the process below.

Step 1 of the Sequential Evaluation Process

The first step in the evaluation process is to determine whether or not the claimant is engaged in what is termed by SSA as “substantial gainful activity.” The finding as to what constitutes substantial gainful activity is not always clear-cut. It involves exercising judgment as well as applying a set dollar amount to whatever earnings the claimant may have. Generally, claimants whose earnings exceed the dollar limit of substantial gainful activity are denied benefits. You should have a disability lawyer represent you even at this early stage of filing for disability.

Activities that the SSA does not consider substantial gainful activity include:

  • self-care
  • household tasks
  • unpaid training
  • hobbies
  • therapies
  • school attendance

However, while the SSA field office may not consider these to be substantial gainful activity in this step, the Disability Determination Service may use this as evidence the claimant can do substantial gainful activity and is therefore not disabled.

If you are found to be engaged in substantial gainful activity at this step, you will be denied benefits without the SSA having to consider any medical criteria.

Step 2 of the Sequential Evaluation Process

Step 2 is a determination whether:

  • medical evidence demonstrates the existence of an impairment, or
  • a combination of physical or mental impairments severe enough to keep you from engaging in any substantial gainful activity.

When the medical evidence establishes only a slight abnormality or a combination of slight abnormalities which have no more than a slight effect on your ability to work, the SSA will determine that you are not disabled.

Even if it is found at Step 2 that you have a severe impairment, your claim can still be denied if the impairments do not meet the duration test. The duration test is a finding that the impairment is not expected to result in death, and neither lasted 12 months or is expected to last for a continuous period of 12 months.

Step 3 of the Sequential Evaluation Process

If you are found to have a severe impairment and such impairment or combination of impairments is expected to last at least 12 months, the process moves to Step 3.

Step 3 is the point where Disability Determination Service (DDS) uses a systematic collection of medical criteria known as the Listings of Impairments. The Listings have 10 categories containing about 110 different mental and physical ailments with detailed diagnoses.

Many of the conditions contained in the Listings require particular tests. If your condition meets the Listings, your application will be approved with no further evaluation.

When filing for disability, you may be wondering, “How do I know if my condition meets the Listings?” The short answer is – you won’t know until the medical evidence is evaluated by an experienced disability advocate in cooperation with a medical doctor or psychiatrist. The Listings are intended to be specific. If your impairments meet the medical conclusions contained there, your medical evidence must show it nearly word for word.

If all the above was not confusing enough, it is possible to have a claim approved if the disorder is considered to medically equivalent to a listed impairment.

If, however, your condition does not meet or equal a Listing, the claim will move to Step 4.

Step 4 of the Sequential Evaluation Process

Step 4 considers whether you have the residual functional capacity (RFC) that allows you to perform your past relevant work. Residual functional capacity is used to determine whether you can do basic work-related activities associated with jobs previously held in the 15 years before the date you believe you became disabled. If you are deemed to be able to do your past relevant work, your claim will be denied.

If the DDS finds that you cannot do your past relevant work, the process moves to Step 5.

Step 5 of the Sequential Evaluation Process

In Step 5, the SSA answers the question whether or not your can perform other work in the national economy. The concept of residual functional capacity returns in Step 5. This time Residual Functional Capacity is evaluated with vocational factors. “Vocational” in the sense used here means areas that relate to an occupation, education, skills, training, etc.

The SSA uses the residual functional capacity along with vocational factors – age, work experience and education to determine if you can do other work than those jobs previously held despite your severe impairments.

It does not matter if there are no local places hiring for those jobs. However, those jobs must exist in significant numbers in the national economy.

If You Are Filing for Disability, Contact Us Today

When the entire 5-step process is walked through, a final decision as to your disability will be made by DDS. If you are considering filing for disability, you can clearly see that you need an experienced disability to guide you through the disability claim maze. Contact Hermann Law Group, PLLC today to learn more about Social Security disability requirements.