How does Social Security determine disability?

If you’re applying for Social Security disability, your number one question may be “how does Social Security determine disability?” You may be wondering what the Social Security disability requirements are. Here, we’ll walk through the requirements for Social Security disability and explain how Social Security determines disability.

How does Social Security determine disability?

The Social Security Administration uses a 5-step sequential evaluation process to determine whether or not you will receive disability benefits. The disability rules of the Social Security Administration are different from those of private plans or other government agencies. The fact that you qualify for disability from another agency or program does not mean you will be eligible for SSD or SSI disability benefits. Moreover, having a statement from your doctor indicating you are disabled does not mean you will automatically be eligible for Social Security disability benefits.

The 5-step sequential evaluation process for determining eligibility for Social Security disability benefits

All claims are evaluated using the same 5-step process which we have outlined below.

Step One: Are you working?

How does Social Security determine disability at step one?

Step 1 determines if a person is “working” under the definition of the Social Security Administration. Sometimes, this is referred to as engaging in “substantial gainful activity” or SGA. This step does not restrict you from making any money; it simply disqualifies you from receiving disability benefits if you are earning money at the level of SGA. The level of SGA changes from year to year. As of 2020, the level is $1,260 per month. You can lose your claim for benefits at Step 1.

Example: Journalist
• He has a college education.
• He is a paraplegic with no use of his legs and is restricted to a wheelchair.
• He has severe rheumatoid arthritis in his hands that prevents him from typing more than a few hours per day.
• He works a few hours per day writing articles for the local newspaper and earns, after deductions for expenses related to his impairment, about $1,270 per month on average.

Because his earnings are above the level of SGA, he is not disabled and would therefore be denied benefits at Step 1.

As with every rule, there are exceptions. If you are working when you apply for benefits and you are denied benefits for that reason, contact an experienced Social Security disability attorney immediately. In some circumstances, a disability attorney can apply certain exceptions to your case.

Step Two: Is your condition severe?

How does Social Security determine disability at step two?

Step 2 evaluates whether your medical condition is severe enough to significantly limit your ability to perform basic work activities. Additionally, your impairment must last, or be expected to last, for a continuous period of 12 months or result in death.

For most claimants, Step 2 is a question of whether your disability is expected to last for a period of 12 months or more. SSD and SSI are not meant to replace short term disability insurance. Your condition must last, or be expected to last, 12 months or result in death. You can lose your claim for benefits at Step 2.

Example: Factory worker
• He is 52 years old.
• He has a high school education.
• He has done unskilled factory work for the past 33 years.
• He had a heart attack on January 1 and was taken to the emergency room where his condition stabilized.
• His doctors instructed him that he is not to work at the factory while he is recovering.
• He learned after meeting with his cardiologist that after 11 months, he should make a full recovery and be cleared to return to work at the factory.

Because his condition is only expected to last less than 12 months, he is not disabled and would therefore be denied benefits at Step 2.

Step Three: Is your condition a “listed” impairment?

How does Social Security determine disability at step three?

Step 3 asks if your impairment meets or equals a medical “Listing.” “Listings” refer to sets of medical criteria for disability found in the Social Security Administration’s Listing of Impairments. These Listings are considered by the Social Security Administration to be severe enough to prevent an individual from working. The Social Security Administration provides more than 150 categories of Listings which describe, for each major body system, specific impairments which are pre-determined by the Social Security as medically severe enough to qualify a person as disabled. Even if your impairment is not in the Listing of Impairments, it is possible to argue that your impairments are medically equivalent to a Listing.

If you meet or medically equal a Listing, you can win your claim at Step 3. If you do not meet a Listing, take a breath and relax. You cannot lose your claim at Step 3. If you do not meet a Listing, you must simply proceed to Step 4 of the 5-Step evaluation process.

Example 1: College Professor
• He is 37 years old with 11 years of experience as a professor.
• He has a Ph.D. in his field.
• He is not working, but he is looking for a job.
• He lost his right foot and right hand in a car accident a year ago.
• Even with a prosthetic foot, he is unable to walk one block at a reasonable pace. He can, however, walk distances shorter than one block, such as moving around an office or apartment.
• When he must travel longer distances, he rides a motorized scooter.

His condition meets a specific Listing regarding amputation. He is disabled at Step 3.

Example 2: College Professor
• He is 37 years old with 11 years of experience as a professor.
• He has a Ph.D. in his field.
• He is not working, but he is looking for a job.
• He lost his right foot only in a car accident a year ago.
• He has no stump complications and uses a prosthetic foot without incident; however, even with a prosthetic foot, he is unable to walk one block at a reasonable pace. He can walk distances shorter than one block, such as moving around an office or apartment.
• When he must travel longer distances, he rides a motorized scooter.

His condition does not meet or medically equal a Listing regarding amputation. He is not disabled at Step 3. We must proceed to Steps 4 and 5 to determine if he is disabled.

Notice how slight differences in impairments can make or break your claim at Step 3. This is why it is imperative you speak with an experienced Social Security disability attorney regarding your claim for benefits. An experienced disability attorney can identify appropriate Listings for your claim and argue your case before the ALJ in a way which could show you meet or equal a Listing.

Step Four: Can you perform the work you have in the past?

How does Social Security determine disability at step four?

Step 4 asks whether you are capable of performing work you have done in the past. Sometimes, this is referred to as “past relevant work” (PRW). If the Social Security Administration finds that you are capable of performing past relevant work, you will be denied benefits. The Social Security Administration asks not only if you could perform the work as you have performed it in the past, but also if you could perform it as it is generally performed in the United States.

This is simply a question of how your impairment prevents you from working. When evaluating Step 4, the Social Security Administration does not consider whether you are capable of finding a job – they only consider whether you are capable of performing the job. Your employer going out of business or shipping the jobs overseas will not help you proceed to Step 5. You can lose your claim for benefits at Step 4.

Example: Weight Trainer
• He is 61 years old.
• He worked as a weight trainer his entire life except for a two-year period when he was 51-53 years old.
• During that time he was transitioning to a new job with a different gym. Due to his experience, that gym requested that he help manage the business for two years. This managerial position was a sedentary office job. After this two-year period, he returned to weight training.
• Due to a recently developed muscular condition, he is limited to sedentary work. He is no longer capable of lifting the weight required in his job as a weight trainer.

Because he is still capable of doing the office job, he is not disabled. He would be denied benefits at Step 4.

Step Five: Can you perform any type of work?

How does Social Security determine disability at step five?

Step 5 asks what other work, if any, you can perform. To make this determination, the Social Security Administration would consider your age, education, work experience, and physical/mental condition.

If the Social Security Administration determines you cannot make the transition to other work, you will be granted benefits at Step 5. If, however, the Social Security Administration determines you are capable of performing any work, you will be denied benefits. This is true even if you are not capable of finding a job in that field.

Remember, your age is a consideration at this step. There are special rules regarding Step 5 if you are over the age of 50.

Example: Construction worker
• He is 49 years old.
• He has done construction work for his entire working life.
• He does not have a high school diploma or G.E.D.
• He is now limited to sedentary work after being diagnosed with breathing impairments.

If the Social Security Administration determines he is capable of working as a jewel stringer, he will be denied benefits at Step 5. This is true whether or not he can find work as a jewel stringer.

These examples illustrate how age can affect your case. It is entirely possible that you would be “not disabled” at age 49 and then become disabled simply by turning 50 years old. There are other cases in which you could be “not disabled” at age 54 and become disabled by turning 55 years old.

This is sometimes difficult for my clients to understand. Unfortunately, it’s the harsh reality of the system. The older you are, the more relaxed the rules become. Age is one of the biggest factors in a disability case.

This isn’t to say that you can’t win if you’re under 50, but it does make your case more difficult. Certainly, we’ve won cases for 18 year olds, but that is the exception, not the rule.

What conditions qualify for Social Security disability?

There is no official list of conditions that qualify for Social Security disability. Any condition that is medically determinable (and diagnosed by a physician) that impairs your ability to work can be considered disabling if it meets the Social Security disability requirements discussed above.

Sometimes, people look at he Social Security Administration’s Listing of Impairments and think that this is a list of impairments that qualify for Social Security disability. That is only partially true. If you meet every single requirement of a listed impairment, it would be disabling. But certainly impairments that do not rise to this level or impairments that are not on this list can also be disabling. In reality, most cases do not meet the strict requirements of the Listing of Impairments. Instead, most cases win at step five by showing you cannot perform other work in the national economy (step five).

That being said, there are a number of conditions that we see routinely that may qualify for Social Security disability benefits. This list is not exhaustive, but does set forth conditions we see routinely:

• Musculoskeletal impairments such as degenerative disc disease, herniated discs, degenerative joint disease, knee replacement, hip replacement, and amputation;
• Sensory impairments such as blindness, hearing loss, deafness, and loss of speech;
• Respiratory disorders such as chronic obstructive pulmonary disease (chronic bronchitis and emphysema, pulmonary fibrosis and pneumoconiosis, asthma, cystic fibrosis, and bronchiectasis, respiratory failure, chronic pulmonary hypertension, and lung transplantation;
• Cardiovascular impairments such as chronic heart failure, congestive heart failure, ischemic heart disease, heart transplant, aneurysm, chronic venous insufficiency, and peripheral arterial disease;
• Digestive disorders such as gastrointestinal hemorrhaging, chronic liver disease, inflammatory bowel disease, ulcerative colitis, short bowel syndrome, liver transplant, and any digestive condition resulting in significant weight loss;
• Kidney disorders such as chronic kidney disease, nephrotic syndrome, and any condition requiring dialysis;
• Hematological (blood) disorders such as anemias, sickle cell disease, thrombosis, and bone marrow disorder;
• Skin impairments such as ichthyosis, bullous diseases, chronic infections of the skin or mucous membranes, dermatitis, hidradenitis suppurativa, genetic photosensitivity disorders, and burns.
• Congenital disorders such as down syndrome;
• Neurological disorders such as epilepsy, stroke, brain tumors, parkinsonian syndrome, cerebral palsy, multiple sclerosis, ALS, muscular dystrophy, peripheral neuropathy (including that caused by diabetes), Huntington’s disease, traumatic brain injury (TBI), and coma;
• Mental disorders such as schizophrenia, psychotic disorders, depressive and bipolar disorders, intellectual disorders, anxiety and obsessive-compulsive disorders, personality disorders, autism spectrum disorders, and trauma related disorders (PTSD);
• Cancers such as skin cancer, sarcoma, lymphoma, leukemia, multiple myeloma, thyroid cancer, lung cancer, stomach cancer, pancreatic cancer, adrenal carcinoma, bladder cancer, prostate cancer, malignant melanoma, and breast cancer;
• Immune disorders such as systemic lupus erythematosus (SLE), scleroderma, connective tissue disease, immune deficiency disorders, inflammatory arthritis such as rheumatoid arthritis, HIV/AIDS, and Sjogren’s syndrome.

If any of these conditions prevents you from working, you may meet the requirements for Social Security disability.

Does my doctor’s letter stating that I’m disabled help with Social Security disability?

Yes and no. Yes, support from your doctor is extremely important. It’s arguably the most important type of evidence we have. But that’s not to say that a note from your doctor is enough to win your case.

When a doctor writes a letter to Social Security, it normally says something like “my patient can’t work and is disabled”. This isn’t helpful. Social Security has its own rules for determining disability and your doctor’s statement isn’t binding in any way.

Instead, we would ask your doctor to give opinions regarding specific functional limitations. For example, how much can you lift and carry? How long can you sit, stand, and walk? Do you have other limitations such as the need for breaks throughout the day? Do you have trouble staying on task due to pain or side effects of medication?

We have used our experience in handling thousands of disability cases to develop a number of “medical source statements”. These medical source statements are invaluable to helping us prove your case.

What is a medical source statement and why is it so important?

While a statement from your doctor that you are disabled is not binding, a statement from your doctor regarding very specific functional limitations can be binding. Depending on your specific impairment, we would send a specific medical source statement to your doctor. This would ask for very specific information on your condition. What tests support the diagnosis? What symptoms result from the impairments? What are the functional limitations.

These medical source statements are helpful in showing the Administrative Law Judge that you’re disabled, but are even more important if you lose at a hearing. We rely on these statements heavily when appealing a case to the Appeals Council or to Federal District Court.

Because neither the ALJ, the Appeals Council, or the District Court Judge are doctors, we rely on these medical source statements to show that your condition causes certain limitations. This allows us to show that your impairments are disabling.

In many cases, a medical source statement can be necessary to win.

Contact a Social Security disability attorney at ARM Lawyers today

How does Social Security determine disability? Well, it’s not really straightforward. The Social Security Administration denies many initial claims every year. Many claims are denied because they’re incomplete or completed incorrectly. Unfortunately, many individuals who truly qualify for and need the SSD benefits are denied. In order to ensure that your claim has the highest chance possible of being approved, you should have a disability attorney who knows the system.

Patrick J. Best of ARM Lawyers has helped thousands of individuals get their Social Security disability benefits. To get started on filing your claim today, call our offices now. The best part is that we can start the whole process over the phone or by video conference so you don’t even need to come into the office!