When you file your Social Security claim, the Social Security Administration will put it through a 5‐step evaluation process to determine if you are disabled, determine the extent of your disability, and see whether you are eligible for disability payments through the SSA.
This evaluation is made by an examiner, along with the Disability Determination Services department (DDS), including a medical team that reviews each case file.
Step 1: Are You Working?
We call it “working” the SSA calls it “engaging in substantial gainful activity” or SGA. (The government loves giving things complicated titles—and this is not just a term or definition, it is more of a concept or a “legal term of art”…)
Basically, the SSA is looking to see if you worked and earned more than $1,130 per month on a sustained basis. ($1,820 if you are blind). If so, that’s enough to likely get you disqualified from receiving Social Security Disability payments.
Note: The SGA amount is reviewed every year, and may change each year.
Step 2: Is Your Condition Considered Severe by the SSA?
Your condition must be “severe” enough to interfere with your ability to perform the most basic work activities required in any job. This can include: seeing, hearing, speaking, walking, sitting, reaching, responding to supervisors, etc. (By now, you may have guessed that “Severe” is also a “legal term of art” and can get complicated.)
If your disability is considered “severe” under the regulations, then they will move to Step 3.
Step 3: Is Your Disability on either of the SSA’s Lists of Disabling Conditions?
The SSA has two lists of conditions it considers disabling— one list for children and one for adults. The adult list breaks conditions into fourteen high‐level categories according to body system. We refer to these lists of conditions as“The Listings”.
If your specific condition is not listed, then the DDS (a State Agency that makes the medical decisions at the lower adjudication levels) will look to see if it is “equal” to one ofthe disabling conditions on the list.
This is really a cut and dry decision, either you meet/equal one of the conditions or not. If not, then we move to Step 4. These listing are very specific and meeting them is difficult for most people. An experienced Social Security lawyer will be familiar with these listings and whether you can show SS that your case meets or equals them.
Step 4: Can You Do the Same Work You’ve Done in the Past?
The DDS will look to see if you are able to do the same work that you have done in the past, despite your disability. If you can, they will deny your claim.
If you cannot, they will proceed to the fifth and final step…
Step 5: Are You Able to do any other Type of Work?
So, you can’t perform your current work… but can you perform ANY other work at all? That’s what they will look atnext.
The DDS will review your age, education, physical/mental condition, skills, and work experience to determine what other work, if any, you’re able to perform. If they find you are able to switch jobs and be able to work, they will deny your claim.
IMPORTANT NOTE: Merely making it to Step 5 is not a guarantee that your claim will be approved. The burden of proof shifts to the SSA at Step 5, but they have many ways to meet their burden of proof, which can result in a denial of benefits.
If you need help filing your SSDI or SSI claim contact the Hartwig Law Firm at (508)732-8989 today.