How the Social Security Administration determines whether someone is disabled.
To be disabled, you have to be unable to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment or combination of impairments that can be expected to result in death or that has lasted or can be expected to last for at least 12 consecutive months.
Sounds simple enough, right?
It’s so simple that Social Security uses a five step process to determine whether someone is disabled as defined by their regulations.
The first step requires that you are not performing substantial gainful activity. You can work and be found disabled, but if the amount of money you receive per month is over a listed amount OR the type of work you are doing is totally inconsistent with why you are claiming disability, you will be denied.
The second step is to determine whether you have a severe medical impairment. This is a pretty easy bar to clear because you basically have to show that you have a physical or mental impairment that impacts your ability to perform essential work functions. A medical professional has to make the diagnosis of the condition.
“My back hurts” is not enough to show a severe impairment.
An x-ray showing degenerative disc disease is.
If you cannot show a severe impairment, your case will be denied.
The third step involves the Listed impairments that Social Security states will automatically prove disability. The Listed impairment are broken down by body systems and require very detailed records. The vast majority of cases do not have the documentation to show a Listed impairment, so the case moves on to the next step.
The fourth step requires Social Security to determine your residual functional capacity, which is what you can do physically and mentally. Social Security then determines whether your past relevant work is precluded by your residual functional capacity.
Let’s say Social Security finds you can only lift up to ten pounds but your past relevant work required you to lift 50 pound. Your past relevant work would be excluded. If your past relevant work only required you to lift five pounds, then it would not be excluded and your case will be denied.
If your past relevant work is excluded, you go to the fifth step, which considers whether your residual functional capacity precludes your ability to work in a job that exists in significant numbers in the national economy.
This is where most Social Security cases are won or lost. Social Security relies on vocational experts to determine what jobs are out there.
If there are a significant number of jobs you can do, your case is denied.
If not, your case is approved.
Easy as pie, right?