The Social Security Sequential Evaluation Process
Whether one is applying for Social Security Disability Insurance (SSDI) benefits or Supplemental Security Income (SSI) benefits, or both, it is important to understand that the Social Security Administration (SSA) applies what is called a 5 step sequential evaluation process to each claim. Proving that one is disabled under Social Security’s rules requires that one prove that they remain totally disabled from all forms of gainful employment and are likely to remain so disabled from gainful employment for a year or longer.
Step 1 of the evaluation process requires one to show that they are not undertaking substantial gainful activity (SGA). Each year SSA revises the amount deemed to constitute substantial gainful wages: for 2015, SGA is defined as $1090.00 per month, and for 2016, SGA is defined as $1130.00 per month. If one is earning SGA level wages at the time of their application, they will be denied at Step 1 of the sequential evaluation process. Thus, it is important to understand that one should not be applying for benefits if they are presently undertaking SGA level wages.
At Step 2 of the sequential evaluation process, one must establish that they are suffering from a “severe medically determinable physical or mental impairment” or combination of impairments which is or are expected to last a year or longer. Many times, we find that claimants will contact our office not understanding that 1) their condition must be medically determinable, 2) severe and 3) likely to remain disabling for a year or longer. A severe impairment is defined as one which “significantly limits your physical or mental ability to do basic work activities.” Assuming one does not have a diagnosis yet, it will not be possible to establish a medically determinable impairment. Likewise, if it remains unclear that the condition will remain severe for a year or longer despite prescribed treatment, then they will be denied at step 2 of the sequential evaluation process.
At step 3 of the sequential evaluation process, SSA will look to see if the medical conditions meets or equals in severity one of their Listings of Impairments in Appendix 1 of this subpart. Assuming one’s medical condition meets the requirements of one of the listed impairments, SSA will find the individual disabled under their rules without any consideration as to one’s age, education and work experience (and whether one might be capable of performing other employment). Assuming, however, that one does not meet the requirements for any of the listed medical impairments, it will be necessary to proceed to step 4 of the sequential evaluation process.
Step 4 of the sequential evaluation process requires SSA to look at an individual’s past relevant work experience (which is defined as the work they performed in the 15 years prior to becoming disabled). Assuming SSA determines that one remains capable of performing their past relevant work, SSA will make a finding that one is not disabled under their rules. Assuming, however, one is found incapable of performing their past relevant work given their medical condition(s), SSA will turn to step 5 of the sequential evaluation process.
At the last stage of the sequential evaluation process, step 5, SSA will take a look at one’s age, education and past work experience, in conjunction with their physical and mental residual functional capacity, in order to determine whether they can make an adjustment to other work that exists in the national economy in significant numbers (in either one or more regions of the national economy). If one is found capable of returning to other work for which they are deemed to be capable of making gainful wages, then they will be found not disabled according to Social Security Rules at the final step of the evaluation process.
Prior to applying for Social Security disability benefits, one should contact a lawyer specializing in disability law to determine how their circumstances might satisfy the different requirements set forth in the 5 step sequential evaluation process. Call the Law Offices of Russell J. Goldsmith at 1-800-773.8622 for a free assessment of your claim.