According to data provided by the Social Security Administration (SSA), approximately 2 million Americans apply for public disability benefits each year. All of these applications for Social Security benefits on the basis of disability go through the same five-step review process. This review process, also called the “sequential evaluation,” asks a series of questions, the answers to which determine whether the applicant qualifies for benefits.
Remember that, before even beginning to answer these questions in the sequential evaluation, Social Security first looks to see if an applicant meets “non-medical” requirements qualify for Social Security Disability Insurance benefits and/or Supplemental Security Income benefits. For more information about the difference between the two, SSDI vs. SSI Benefits – Understanding the Difference. If Social Security determines right away that an applicant does not have sufficient work credits for insured status to qualify for SSDI, or that an applicant has too many assets to qualify for SSI, typically the agency notifies the applicant relatively quickly after the application is first submitted. Once the agency confirms that an applicant preliminarily meets the non-medical requirements, the application goes through the five-step sequential evaluation to determine if the applicant meets medical requirements for disability.
Keep in mind that this post reviews each step from a broad perspective. The analysis conducted at each step is significantly more granular, though some of the critical “sub-steps” are highlighted in this post. It is always best to consult an attorney on your specific case.
Step 1: Is the applicant currently working and earning more wages than allowed?
Social Security looks to see if an applicant is working and earning more than “substantial gainful activity level,” or “SGA.” This amount is set by Social Security, and changes each year. If an applicant is actively earning wages over SGA-level, the analysis stops here, and the applicant is denied.
Step 2: Does the applicant have a documented severe medical condition that will last at least twelve months?
This step is broken down into two parts: (1) What “medically determinable impairment(s),” e.g., severe medical conditions, does the applicant have, as documented by medical records and medical evidence? And (2) have the severe medical conditions identified been happening to the applicant for over a year, or will the severe medical condition last for at least a year?
If Social Security determines that an applicant does not have “medically determinable impairment(s),” or that the impairment(s) have not lasted, or will not last, a year or more, the applicant is denied.
Step 3: Is the applicant’s condition severe enough to meet criteria for conditions that Social Security has identified as disabling?
Social Security has established what are calling “Listings of Impairments.” The Listings describe, for each major body system, impairments generally considered severe enough to prevent an individual from doing any gainful activity. Most of the listed impairments are permanent or expected to result in death, or the listing includes a specific statement of duration. For this reason, it is uncommon for an applicant to meet or equal a Listing. If the applicant’s medical condition(s) meets or equals the relevant Listing, the applicant is approved. If not, proceed to the next step.
Step 4: What can the applicant still do, even with their medical conditions, and can the applicant still perform jobs they have done in the past?
This step is one of the most complex in the sequential evaluation. To start, it can be broken into two parts: First, what is the applicant’s “residual functional capacity,” e.g., what can they still do physically and mentally? The determination of an applicant’s RFC generally involves close review of the applicant’s medical records and reports completed by the applicant describing their symptoms and subjective abilities. Social Security has a number of regulations governing this part of the sequential evaluation.
Second, based on the RFC, can the applicant still perform any of the job(s) they have done in the past, as they performed it, or as the job is generally performed? This question inherently involves a determination of the applicant’s “past relevant work.” Generally speaking, social security considers jobs that the person worked on a full-time, or near full-time, basis, for six months or more, during the past 15 years prior to the applicant becoming disabled. Social Security then consults a vocational resource to categorize the applicant’s past relevant work according to the Dictionary of Occupational Titles (“DOT”). The DOT defines jobs by the duties involved and their physical and mental demands. If the applicant can perform their past work, abased on the RFC, the applicant is denied. If the applicant cannot perform their past work, proceed to the next step. NOTE: Social Security recently announced that, effective June 8, 2024, they will only consider the last 5 years before disability, rather than 15 years. The agency will also automatically not consider any work that started and stopped within 30 calendar days. This is a significant change and will result in less applicants being denied at this stage.
Step 5: Can the applicant perform other jobs?
This is most difficult step in the evaluation to meet. Even if the applicant cannot perform their past work, Social Security still considers whether the applicant is able to perform other work. Whether an applicant can perform other work involves consideration for the applicant’s RFC and the number of available jobs that are classified by the DOT as within the applicant’s restrictions. If there are jobs available to the applicant in “significant numbers,” the applicant is denied. If there are not, the applicant is approved.
At this step, Social Security recognizes that, the older a person becomes, the less able they are to adjust to new kinds of work, especially physical work. Therefore, they apply the Medical Vocational Rules at this step, more affectionately named by practitioners the “Grid Rules.” The Grid Rules generally provide that the older an applicant is, the less they are expected to adjust to other work that is physically demanding. The result of the Grid rules is that applicants under age 50 have a significantly harder time passing step 5 than those over age 50, and that the older an applicant is, the easier it will likely be to pass step 5 and be approved for benefits.
In order to determine whether jobs are available to an applicant with a particular RFC in “significant numbers,” Social Security consults vocational experts. Importantly, it does not matter whether the job identified that the applicant could perform is actually available to the applicant or in the applicant’s area. Social Security considers national job number data when determining if jobs are available to the applicant in “significant numbers.”
If you or someone you know is considering applying for Social Security Disability, the experienced attorneys here at Hawks Quindel are ready and willing to help.
- What is Social Security Looking for Anyway? The Sequential Evaluation Process - April 30, 2024
- Getting Divorced with Pets - October 5, 2023
- Disability Asset Limits: Understanding the Achieving A Better Life Experience (ABLE) Act - April 17, 2023