Social Security’s Five-Step Sequential Evaluation Process for Determining if You Are Disabled
If you are applying for Social Security in Hackensack NJ or elsewhere in the metro New York area, you are probably wondering how the Social Security Administration (SSA) will evaluate your claim. SSA evaluates a claim for Social Security or SSI disability benefits for adults using a Five-Step Sequential Evaluation process. It is a series of questions that, depending upon the answer, will lead to finding you are or are not eligible to be awarded benefits.
#1. “Are you working?” If you are working and that work is considered to be “substantial gainful activity” by SSA, then that is the end of the inquiry. You are not eligible to receive Social Security or SSI disability benefits. Full-time work will generally be considered to be substantial gainful activity. But, some part-time work could also be considered to be substantial gainful activity. SSA will look at how much you are earning. For 2016 the maximum amount of gross monthly income you can earn before those earnings are considered to be substantial gainful activity is $1,130.00 with some exceptions.
#2. “Do you suffer from a severe, physical or mental, medically determinable impairment or combination of impairments that have lasted or are expected to last at least 12 months?” An impairment is severe if it significantly limits a person’s ability to perform work-related activities. Most of the time the Social Security Administration finds there is a severe impairment or combination of impairments.
#3. “Do you meet the Listings of Impairments?” Federal regulations known as “the Listing of Impairments” divide the body into different systems, such as the senses, musculoskeletal, cardiopulmonary, etc. Under each system are specific medical conditions. For each of them, the regulations spell out medical findings that qualify a person for disability benefits. It is very difficult to meet the exact criteria in the Listings because the criteria describe very extreme and severe levels of impairment. If you don’t meet all of the criteria for your most significant impairment, you can argue that you have a combination of impairments that are the equivalent of meeting the Listing. In other words, you might be missing a particular medical finding or your medical tests show a problem slightly less severe than what is required, and you have another condition or conditions that similarly do not quite meeting the Listings. If you look at your impairments together, they are the equivalent of meeting a Listing. SSA has made this more difficult to do, as now the federal regulations call upon the evaluator to use a medical expert to evaluate equivalency arguments. When a case is at the hearing level, many of the ODARs (Office of Disability Adjudication and Review) do not want to go to the expense of hiring a medical expert and they do not have any already employed by them.
If you are found to meet or equal a Listing, however, you win. Of course, there are still questions that your local Social Security Office will have to go over with you to make sure that you meet all of the non-medical requirements of either Social Security or SSI disability. But, if you are not found to meet the Listings, don’t despair. Most cases are not decided at this Step of the Sequential Evaluation Process.
#4. “Can you perform any of your past relevant work?” Your past relevant work is defined as any work that you did at a level considered to be substantial gainful activity, during the last 15 years prior to the onset of your disability. If the work was not performed for at least 30 days or was part of a sheltered workshop, it will not be considered as past relevant work. In analyzing this, SSA will first look at how you have described this work in various documents, such as a Work History Report, which you will be required to complete. They will consider how much you had to sit, stand, walk, lift, climb, crawl, stoop, bend, handle large and small objects, and more. They will consider if you were a supervisor and had to complete various reports, or whether you were more of an unskilled worker, such as a laborer.
At the Initial and Reconsideration levels, the State agencies that SSA contracts with do not usually have vocational experts on staff to delve deeper into just what your past relevant work entailed. However, at the hearing level, the administrative law judge will often retain the services of a vocational expert to explain to the physical demands and skill level that would be required to perform your past relevant work. The vocational expert will also tell the judge if through your past relevant work, you have gained skills that could be transferred to less demanding work.
If SSA determines that you are still able to perform any of your past relevant work, despite having a severe impairment or impairments, then you will be found not to be disabled and your claim will be denied.
If it is determined that you can’t perform any of your past relevant work, then you move to Step 5.
#5. “Is there other work, existing in significant numbers in the national economy, that you could still perform?” At this level, the evaluator looks at your age, highest level of education, the skill level of your past relevant work, and whether you have transferable skills. The evaluator also looks at something called your residual functional capacity or RFC. Your RFC is an estimate of what level of activity you can still perform, despite having severe impairments. There are physical and mental RFC’s, but the main thing considered here, at least initially, is your physical RFC. So, for example, if you are 55 years old, have a 10th grade education, a history of heavy, unskilled work, and you are now able to lift only 10 lbs. and walk only 2 hours out of an 8 hour day, SSA will find that you are disabled at Step 5. If everything were the same, except you are only 35 years old, you would be found not to be disabled. You would be expected to find less demanding work. This is but one example.
Our disability attorneys can discuss these steps with you, applying the specifics of your particular case. For assistance with a claim for Social Security in Hackensack NJ or elsewhere in the New York metropolitan area, call the disability attorneys at the Hermann Law Group at 877-773-3030.