The 5 Steps of a Social Security Disability Case
Many people seeking Social Security benefits apply and go through the entire process without ever realizing that there is a method to the madness. The Social Security Administration, under the authority of the Social Security Act, has established a five-step process that it uses to determine whether an individual is disabled or not. It’s a sequential process, meaning that if it is determined that you are or are not disabled at a particular step of the evaluation process, the evaluation will not go on to the next step. In other words, these five steps are followed in order.
The first step of the process is determining whether or not you’re working at SGA. Many people thinking of applying for benefits believe that if they are working, they will not qualify since disability benefits are for those that cannot sustain employment. Unfortunately, it’s not quite that simple. You can work…but you can’t work at “SGA.” “SGA” means “Substantial Gainful Activity” and it is defined as work that is both “substantial” and “gainful.” “Substantial” means work that involves significant physical or mental activities and “gainful” means work done for pay or profit, whether or not you actually make a profit. Generally, although there are exceptions, if you are working and making more than a certain amount, you are not going to be found disabled. The amount is set out in the regulations and changes yearly so it’s important to inform your lawyer or representative that you’re working, how many hours you’re working, and how much income you’re making. If you are not working at all, or not working at SGA, you pass this step and go to the next step in the process.
The second step of the process is determining whether or not you have a medical condition that is severe, or a combination of medical conditions that are severe. Social Security will find that your condition, or a combination of your conditions, is severe if they significantly limit your ability to do basic work activities. If the evidence in your case only proves that your condition, or that a combination of your conditions, should have very little effect on your ability to do basic work activities, you won’t pass this step of the process. That’s one of the reasons it can be beneficial to hire an attorney. Your attorney should work with you to gather all of your medical records and submit them to Social Security. If social security finds that you have a severe medical condition or that a combination of your medical conditions are severe, you pass this step and go to the next step in the process.
The third step of the process determine whether your medical condition, or a combination of your medical conditions, “meets or medically equals” the criteria of an impairment listed in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 416.920(d), 416.925, and 416.926). This part follows the law, and it can be hard to explain in simple terms, but what it basically means is this: Social Security has put together a book called “the listings.” The listings list all of the medical conditions that Social Security believes are disabling. If you can prove that you have one of the medical conditions in the book, or if you can prove that your medical conditions combined cause you to have problems equal to the conditions listed in the book, then you will be found disabled and you will get your benefits. For people who meet a listing, they are found disabled, and they do not have to continue past step 3. If you cannot find a listing that your conditions meet or equal then you go forward to the next step in the process.
The fourth step of the process determines your “residual functional capacity,” and whether you have the “residual functional capacity” to do your “past relevant work.” “Past relevant work” means the kind of work you did long enough to have learned to do the job and to have been “SGA” (Remember “Substantial Gainful Activity” above) in the last 15 years or 15 years before you were disabled. Basically, social security has to figure out what ability you have to do physical and mental work activities on a sustained basis. To do this they consider all of your medical conditions (including those social security may think are not severe) and whether your conditions leave you with the ability to do the kind of work you did before you became disabled. If you are found capable of returning to past relevant work, you would be denied and not be found disabled. But if you are unable to do the kind of work you used to do, or if you do not have work history that qualifies because you didn’t do it long enough, you move onto the final step.
The fifth and last step of the process determines whether you can do any other work, considering your “residual functional capacity,” age, education, and work experience. If social security finds that there are other jobs you could do, then you are not disabled. If social security finds that you cannot do any other work, and your condition is expected to last 12 months or more, then you will be found disabled and you will get your benefits. At this step the burden of proof somewhat shifts to the Social Security Administration, they have to provide evidence that other work that you could do, given your residual functional capacity, age, education and work experience, exists in significant numbers in the national economy. At step five if Social Security thinks you are capable of working in any position then you will not be found disabled, but if you are found incapable of working anywhere you will be found disabled.
Disability cases follow a process, but they are still complicated because everyone’s facts and circumstances are different. Do your medical conditions meet a listing? Are you working at SGA? What is your residual functioning capacity, and is that diminished enough that you will be found unable to work at steps 4 and 5? No one knows these answers without reviewing your case, and ultimately the Social Security administration will be the one who decides your case.
After reading the five steps of a Social Security Disability case I’m sure you agree that these questions above are all important factors to assess in your disability case. If you need help evaluating your own case you may want to talk with a Social Security Disability lawyer, most only charge a fee if they win your case for you, and the fee comes from your back benefits.
We hope the information on this page will help you regardless of where you are in the process. If you have a question about your disability case that you don’t find answered in the resources linked to above, then contact us here or give us a call at (800) 584-3700.
For more information on our attorneys, please visit Our Attorneys page.
For more information on Social Security Disability, please see:
Social Security Disability Income (SSDI) FAQs
Supplemental Security Income (SSI) FAQs
Social Security Disability Links
Social Security Glossary