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Social Security Disability Claims

Authored By: Alaska Legal Services - Anchorage LSC Funded

Social Security Disability Claims: How SSA Decides if you are Disabled

How SSA Decides if you are Disabled

Authored By: Alaska Legal Services - Anchorage LSC Funded
Contents
Social Security Disability Claims Link to Social Security Disability Listings Link to Social Security "Grids" Social Security Disability Claims Link to Social Security Disability Listings Link to Social Security "Grids"

Social Security Disability Claims

Link to Social Security Disability Listings: www.ssa.gov

Link to Social Security "Grids": www.ssa.gov

Social Security Disability Claims

The SS disability program is an extremely complicated program. There are hundreds of pages of rules governing the program and it’s not easy to qualify for benefits. Currently, less than half of people that apply for disability benefits receive them. We don’t want to discourage you from applying if you believe you are disabled, but you should be prepared for what could be a long frustrating process. 

How Social Security defines “disabled”

Contrary to what many people believe, it takes more than just a doctor saying “this person is disabled” in order to qualify for benefits. That’s because the word “disabled” is defined differently by many programs. A law to protect “disabled” persons from discrimination uses a different definition of disability than a program offering transportation assistance to the disabled. For social security purposes, disability is based on the inability to work. Specifically, it is defined as the inability to do any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

What does this definition mean?

First, Social Security usually uses the "substantial gainful activity" (SGA) level to determine what is too much work. In 2017, SGA is defined as earning $1,170 or more a month from working, or $1,950 for blind people (these numbers usually rise each year to account for inflation).  A person who is earning more than the SGA amount is presumed to be engaging in SGA and not disabled.  There’s also a medical requirement, that is, the cause of disability must be medically determinable. Impairments can be either physical or mental impairments. Finally, there’s also a durationalrequirement. Your impairment must be expected to last 12 months or to result in death. So, merely having a diagnosis is not enough to qualify for disability benefits.  What is important is proving that you have a medical condition that affects your ability to work so severely that you cannot work. The focus is upon how you can function.  SSA considers an individual disabled if, due to an established medical condition, you:

  • meet or equal one of the Listings of Impairments (certain medical conditions that are presumed to rule out work for most people); or
  • cannot perform any work that you have done before and cannot make an adjustment to other work.

How SSA decides a claim - The 5 Step Evaluation Process

SSA uses what is called the “sequential evaluation process” when deciding claims. This process consists of a series of five "steps" that SSA follows in a set order. If SSA finds that an individual is disabled or not disabled at a step, it will make its decision at that step and not go on to the next step.

Step 1 - SGA

The first step in the process is to determine whether you as the claimant are currently working at level which would indicate you are engaged in “Substantial Gainful Activity” (SGA). If you’re currently working and pulling in enough money to meet the SGA level, you are presumed to be not disabled and SS will not look at your claim any further.

Step 2Severity

At the second step, SSA considers whether you have a physical or mental impairment that is “severe” and meets the duration requirement. Having a “severe” impairment does not mean you’re disabled. Rather, it merely means that you have an impairment that imposes more than a minor or temporary level of restriction upon your ability to work. If the impairment is not severe or does not meet the duration requirement, the individual is found not disabled.For instance, say you are a construction worker and break your leg. You may be temporarily unable to work due to the broken leg, but you would be expected to recover within a year. Therefore, you don’t meet the durational requirement. If the impairment is severe and meets the duration requirement, SSA will proceed to the next step.

Step 3- Meet or Equal a Medical Listing

Through its many years of experience deciding claims, SSA has compiled a list of various medical conditions and impairments that are considered to be so severe that if you meet specific requirements and criteria, your claim will be approved. The criteria are very detailed and typically require specific objective test results. Not surprisingly, these are called the Listings of Impairments. The Listings are divided by different body systems. Here’s how the listings are organized:

  • Musculoskeletal System
  • Special Senses and Speech
  • Respiratory Disorders
  • Cardiovascular System
  • Digestive System
  • Genitourinary Disorders
  • Hematological Disorders
  • Skin Disorders
  • Endocrine Disorders
  • Congenital Disorders that Affect Multiple Body Systems
  • Neurological Disorders
  • Mental Disorders (these are handled a little differently)
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders

Details on all of these can be found here: https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm. If a person has an impairment that meets or equals one of the listings and meets the duration requirement, he or she is found to be disabled. If an individual does not have an impairment that meets or equals one of the listings or the duration requirement is not met, SSA will go to Step 4.

Step 4Ability to Perform Past Relevant Work

At Step 4, Social Security must decide whether you do any kinds of jobs that you’ve done in the past, despite your current limitations. Before going from step three to step four, SSA will need to assess what is called your residual functional capacity (RFC). SSA will consider how your impairments affect your ability to perform work. An RFC does not consider factors such as sex, age, or physical conditioning.  Your physical RFC is described in terms of “exertional” levels, such as whether you can be expected to do sedentary work, light work, medium, heavy, or very heavy work.

Sedentary work means you have the ability to lift no more than ten pounds at a time, and occasionally lift or carry things like files or small tools. A sedentary job is mostly sitting, but you must be able to walk and stand occasionally, and you must also be able to use your fingers (fine dexterity).

Light work means you can lift up to 20 pounds occasionally, and frequently lift or carry up to ten pounds. Light work requires frequent walking and standing and the ability to push and pull with your arms or legs. If you can do light work, you can do sedentary work.

Medium work means you can lift up to 50 pounds at a time, and frequently lift or carry up to 25 pounds. If you can do medium work, you can also do light and sedentary work.

Heavy work means you can lift up to 100 pounds at a time, and that you can frequently lift or carry up to 50 pounds. If you can do heavy work, you can do medium, light, or sedentary work.

Very heavy work means you can lift objects that weigh more than 100 pounds, and frequently lift or carry 50 pounds or more. If you can do very heavy work, you can do all other levels as well.

At Step 4, SSA will review your past work history (going back 15 years) and determine whether you still have the ability to perform any of your past jobs. If you retain the physical and mental capacity to perform any of your past relevant work you will be found to be not disabled. For instance, let’s say your most recent job was cutting timber. However, 5 years ago you worked in retail sales. If you hurt your back, you might not be able to work as a logger any longer, but you might be able to work in retail sales. If so, SSA will find that you are not disabled. If no past relevant work can be done, or you have no relevant work, SSA will move on to step five.

Step 5 - Able to Perform Any Other Work

Assuming you cannot go back to any of your past jobs, SSA will then proceed to step 5 of the process, at which it will decide whether there are any other jobs in the national economy that you can do. If you can make an adjustment to other work, your claim will be denied. If you cannot make an adjustment to other work, you will be found to be disabled.  An important thing to point out is that job availability and an unimpressive resume do not affect SSA’s decision as to whether you are disabled or not. Since Social Security is a national program, its rules apply the same to everyone. If there is a job that exists in sufficient numbers nationally and you have the ability to perform the job, that is what matters.  As an example, let’s say SSA decides you have the ability to work as an usher in a movie theater. It doesn’t matter if you live in small village in rural Alaska where there probably isn’t a movie theater. All that matters is whether there are usher jobs in the United States and that you have the ability to perform the job. Likewise, if your work history is spotty or you have a criminal record, the fact that you might not actually get hired doesn’t really matter to SSA. It only wants to know whether you have the ability to work.

The Grid Rules

At Step 5, SSA will refer to something called the “grid rules” to decide if you are disabled. The grids are a series of tables that take into account several factors such as your age, education, whether you have acquired any specific job skills, and whether any of those skills could be transferred to another job. Each grid is divided into tables based exertional levels (sedentary, light, medium, heavy, and very heavy); that is, what level of work your RFC (residual functional capacity) assessment states that you can do. The grid tables are too bulky to show here, but below you’ll find a link to the actual SSA website: https://www.ssa.gov/OP_Home/cfr20/404/404-app-p02.htm

Age as a Vocational Factor

SSA recognizes that the older you get, the more difficult it might be for you to work. Therefore, they classify people into various age brackets such as:

  • Younger persons age 18-44
  • Younger persons 45-49
  • Persons Closely Approaching Advanced Age 50-54
  • Persons of Advanced Age 55-59
  • Persons Closely Approaching Retirement Age 60-64

Education as a Vocational Factor

Another factor considered at this stage is education. The less education a person has, the less likely they’ll be able to transition to a new job. Educational classifications are divided as such:

  • The Illiterate or those unable to communicate in English
  • Those with a Marginal Education  (6th grade or less)
  • Those with a Limited Education  (7th - 11th grade)
  • Those with a High School Education and Above (including GED high school equivalent diplomas)

Work as a Vocational Factor

Work experience, in particular relevant work performed in the past 15 years, is also a factor at step 5. Work Experience in the grids is expressed in terms of the skill levels (unskilled, semi-skilled, skilled).

Transferability of Skills

Finally, SSA will consider whether you have gained any skills while working that are transferrable and will make your transition to another job more likely.

Alcoholism and Drug Addiction can affect your claim

Even if SSA finds that you are disabled at step 5, you still may not be home free. That’s because there is a final hurdle that must cleared, and that is, if SSA finds that you are disabled and that there is evidence of drug addiction or alcoholism, it must determine whether your drug addiction or alcoholism is a “contributing factor material to the determination of disability,” unless you are eligible for benefits because of your age or blindness. The key factor SSA examines in determining whether drug addiction or alcoholism is a contributing factor is whether it would still find you disabled if you stopped using drugs or alcohol. Many times this final hurdle comes into play with people claiming disability based upon a mental impairment. And it means that some people will be denied benefits even if they meet social security’s definition of disability.

Link to Social Security Disability Listings: www.ssa.gov

Link to Social Security "Grids": www.ssa.gov