Steps to Win Social Security Disability benefits in California

I came across an article the other day that was a bit disingenuous. It was titled "The five steps to win disability".

Most people would read that title and believe that the article offered a real step-by-step plan for winning a Social Security Disability or SSI claim. But what the article really referred to was something known as sequential evaluation, which is the process of evaluation used by SSA to determine how a disability claim is evaluated and whether or not a person will be approved.

Here's my own rehash of sequential evaluation and it, of course begins with---

Step 1 - Is the claimant working?

Work is a huge factor in the disability evaluation process in California. Can you work if you apply for benefits? Yes. Can you work if you receive benefits? Yes. However, to apply for disability, your earnings need to be under what is known as SGA and here is a discussion of SGA, or substantial gainful activity. If a claimant is under the SGA limit when they apply for disability and has been unable to work and earn SGA for at least a year due to their condition (or this can be projected to be the case), we move on to step 2.

Step 2 - Is the condition severe?

This usually isn't a problem. Most claimants who file for disability will be considered to have a severe impairment and only a small percentage of claims will be denied on the basis of a non-severe impairment (e.g. stubbing your big toe). If the answer to this question is yes, we move on to step 3.

Step 3 - Does the condition meet or equal a listing?

This refers to the fact that a number of physical and mental impairments are listed in the blue book, the impairment listing manual that designates the approval criteria for these conditions. Not every condition is listed in this book and most claims that are approved are actually not approved on the basis of meeting or equaling the requirements of a listing. Instead, most claims are approved via a medical-vocational allowance which involves consideration of a claimants work skills, education, age, and functional restrictions (as rated by a physical or mental residual functional capacity assessment). If the answer to this question is no, we move on to step 4.

Step 4 - Can the claimant return to past work?

Step four involves past work and the question is "can you return to a job you performed sometime in the last fifteen years (considered the relevant work period), that you did, generally speaking, for at least a year?" If the answer to the question is no, then, according to sequential evaluation, we move on to step 5.

Step 5 - Can the claimant do other work?

This is where they often "get you". If your condition is severe, has lasted a year or longer (or can be expected to last a year or longer), has prevented you from working and earning SGA during this time, and has prevented you from going back to past work, then the next question is whether or not you can do other work.

What the heck is other work? That's a really good question. Other work is work that you can be expected to do based on a variety of factors, chief of which is your current physical or mental limitations. You can't be expected to do other work that your limitations prevent you from doing. However, other factors that are taken into consideration are your age, education, and transferrable work skills.

Unfortunately, SSA turns down a good number of cases based on "other work", even if the jobs they claim you are capable of doing only exist in Alaska or the louisiana bayou.

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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