How does Social Security Decide if I am Disabled?

continued from: If you are denied for disability, is this based on your ability to do your past work?

Whether a claim is being decided at the disability application level, the reconsideration appeal level, or the disability hearing hearing level (where all facts of the case are heard by a federal administrative law judge), the process is the same. All claims undergo a process known as sequential evaluation, in which the claimant's condition is compared to the type of work that they did in the past and is also considered in context with whatever education and skills they possess.

Here is an explanation of the sequential evaluation process used by both disability examiners (at disability determination services, the agency that processes disability claims for the social security administration) and social security ALJs (administrative law judges):

Security Disability and SSI Determinations made under the Sequential Evaluation Process

A) Is the person working and earning a substantial and gainful income at the time they make an application for disability? If they are, their case will be denied. If they are not working at all, or they are working and earning less than the SGA limit, then their case moves on to the next step.

B) Does the person have a severe impairment? Most impairments will be considered severe, simply because most impairments have at least some built-in potential to last at least one full year. However, there are some conditions for which people file claims that can never be considered severe, such as minor sprains and lacerations and seasonal flu. Disability examiners (the individuals who decide claims at the application and reconsideration appeal levels) do encounter claims based on these kinds of trivial allegations and when this happens the case is denied for NSI, or non-severe impairment. Having said this, though, most claims do involve legitimate and severe impairments and, therefore, the case can move on to the next step in the sequential evaluation process.

C) Does the applicant meet or equal a listing in the blue book? A better way of saying this, of course, is "Does the applicant have a condition for which their medical records satisfy the requirements of a blue book listing (for example, there are listings for seizure disorder, conditions of the spine, various forms of heart disease, various forms of cancer, depression, traumatic brain injury, diabetes, vision and hearing loss, skin disorders, etc, etc). If the applicant cannot satisfy a listing requirement, the case moves on to the next level which involves past work.

D) Can the applicant perform their past work work? This determination is made by assessing what the applicant is currently capable of doing, both mentally and physically, and then comparing it to the demands of their relevant past jobs. If the demands of those jobs are greater than what they are currently capable of doing, it will be determined that they cannot return to their past work.

Now, the inevitable question: if an applicant for disability benefits cannot do their past work, will they be approved for disability? And the answer is, maybe. This is because if a person is judged to be unable to do their past work, there is still one more step:

E) Can the applicant who cannot do their past work still do some type of other work?

Other work includes jobs that the applicant's job skills might qualify them for. However, whether or not a person will be considered capable of doing past work will also depend on their age, education, and remaining functional capabilities.

So, to answer the question with which we started is, yes, a denial of disability benefits will involve the consideration of a person's ability to do past work, but the process does not stop there. A person will typically only be approved for disability benefits if it is determined that they cannot do their past work and, in addition to this, they cannot do other jobs that their age and training might otherwise qualify them for. Satisfying this criteria will result in them being found disabled.

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.

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