The Sequence of Steps to be Approved for Social Security Disability or SSI
The steps, in order, for being evaluated on a Social Security Disability or SSI claim, are:
1. Is the person working and earning a substantial and gainful income or SGA? For each year, Social Security establishes the limit for what an individual can earn and still either apply for disability benefits, or continue to receive them. This is done because SSA recognizes that many disabled individuals are still able to engage in some level of work activity, though not at a level that would provide adequate support.
In any given year, a person who is working cannot have gross monthly income that matches or exceeds the SGA limit. To see the current limit: The earned income limit for Social Security Disability or SSI.
If a person works and earns the SGA amount, a claim could be taken on them for disability but would be immediately denied (called a technical denial on the basis of SGA).
If a person was working but not making at least this amount, they could successfully file a claim for disability benefits (which means the claim would be taken at a social security office and then transferred to disability determination services and assigned to a disability examiner who would request the claimant's medical records and process the case to a decison--none of which happens when a person is making too much when they try to file for disability).
The ability to work, of course, is a big component for Social Security Disability and SSI. The social security administration does not state that a person cannot work in order to apply for, or receive, disability benefits. And this allows claimants and recipients to supplement their monthly disability checks.
However, SSA does put a limit on how much a person can work. Simply put, if you are working and are earning under the limit for SGA, you may be considered disabled based on what your medical records have to say about your functional limitations.
However, if you are working and working at the SGA limit, or earning more than this amount, you cannot be granted disability benefits no matter how severe your physical or mental condition is.
2. Does the person have a severe impairment? What is, and what is not, a severe impairment, tends to be a bit of a subjective determination. However, most head injuries would be considered severe, while most minor sprains would not be considered severe. Unfortunately, there are some individuals who do not realize that their likely-to-heal-within-two-weeks condition...is not considered by SSA to be severe.
On this subject, as a disability examiner I have actually seen numerous individuals file for disability for no reason other than that they had a normal pregnancy with zero complications.
3. Does the person's condition (or one of their conditions) meet a listing in the blue book manual? If it does, processing, at least for the disability examiner, ends here and the case will typically be approved. If the case does not involve a listing-level impairment, then the sequence of evaluation moves on to the next step.
4. Can the person do their past work? If yes, the person cannot be considered disabled by SSA and the case will be denied. How is the past work stage decided? A disability examiner (or a judge if a case is at the hearing level) will review the claimant's work history (which they submitted at the time of making the disability application). From this, they will consider the jobs that are actually relevant.
To be relevant, a job must have been performed sometime in the last 15 years, and must have been done long enough by the claimant so that they could actually learn the job, and also earn a substantial and gainful income while doing the job.
Whoever evaluates the claim (an examiner or judge) will review the physical and mental requirements of the claimant's relevant past work and compare those demands to their remaining physical and mental capabilities. If their past jobs demand more than they are currently capable of doing, they will be considered unable to return to their past work.
However, this by itself does not mean that the individual will qualify for disability benefits. There is still the final step, which involves other work.
5. Is the person who is unable to do their past work, able to do some form of other work? If the answer is yes, they will be denied for disability. If the answer is no, they will be medically approved for disability.
What is other work? Other work is a very broad category of jobs that a person who cannot do their past work might posssibly be able to do. This category of jobs may vary from person to person as it is based on a person's age, level of education, their job and work skills, and their level of physical and mental functioning (which is determined by a disability examiner or a judge based on a review of the claimant's medical records and, hopefully, medical source statements from their treating physicians).
For example, Other Work that a person might be thought capable of switching to could not include the job of tractor-trailer-truck driver if they have been limited to light-exertion work. This is because the job of tractor-trailer-truck driver is considered to be a medium duty job.
Therefore, even a person whose entire work history involves driving for a living would never be expected to switch to this kind of job if their functional limitations did not allow them to work at the medium-duty level.
Other work tends to be a catch-all for many denials. Meaning that at the disability application and reconsideration appeal levels, disability examiners find it convenient to deny a claim on the basis that the claimant can use their existing skills to do some job they have never done, even if that job does not even exist where they live (this is common).
At a disability hearing, however, judges pay more attention to the fact that while a person may be able to switch to a type of work that involves their job skills, that does not help them much if the jobs are all located in Alaska and they happen to live in New Hampshire.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
Most popular topics on SSDRC.com
Social Security Disability in North Carolina
Common Mistakes to avoid after being denied for Disability
Tips to Prepare for Filing for Social Security Disability or SSI
Advice to Win SSD and SSI Benefit Claims
Social Security Disability SSI Questions
What is the difference between Social Security Disability and SSI?
How to get disability for depression
Getting disability for fibromyalgia
SSI disability for children with ADHD
What is the Application Process for Social Security Disability and SSI?
Social Security Disability SSI Exam tips
More Social Security Disability SSI Questions
What makes you eligible for Social Security Disability or SSI?
List of Conditions for Disability in North Carolina
Tips for Getting Disability Approved
How Long Will It Take To Get Approved for Disability and what determines this?
Can you be approved for disability without having to go to a hearing?
How Often Does Social Security Approve Disability The First Time You Apply?
How To Get Disability Through SSDI or SSI Approved
Is There A Way To Get Automatically Approved For SSI And Social Security Disability?
How Many Times Will Social Security Disability Deny You before You Get Approved for Disability?
What are the Odds or Chances of Being Approved for Disability?
How do you find out if a Social Security Disability claim has been approved or even denied?
Can You Get Approved For Social Security Disability if you do not take medication or go to a doctor?
What are my chances of being approved for disability benefits in North Carolina?