If I apply for disability in Texas, what is the process of deciding and making a decision on my SSDI or SSI case?

The disability system is fairly difficult to understand for anyone who has not worked in it. And while it would be difficult to explain every single thing about how a disability examiner in Texas makes a decision on a Social Security Disability or SSI case, we can still explain the basic system fairly easily.

It starts with this: Step 1: Is a person working and making at least the SGA amount when they apply for disability? If yes, the case is denied. It doesn't even make it to a disability examiner's desk so that medical records can be obtained and evaluated. This type of denial is known as a technical denial.

Step 2: Is the condition severe? This means "does it interfere with basic activities of daily living"? If the answer is no, and the condition is not considered severe (think, for example, of a minor cut or sprain), then the case is denied. If the condition is considered severe, the case moves on to step 3.

Step 3: Does the person have a condition that is listed in the SSA impairments list and does their medical evidence conform to the listing-level approval criteria. If not, the case cannot be approved on the basis of a listing but moves on to the next step of evaluation.

Note: not all conditions are listed in the impairments list. And when they are included, the criteria for approval is usually detailed and difficult to to satisfy.

Common questions about filing for disability in Texas
Step 4: Can the person do their past work? If the answer is yes, the case is denied. If they cannot do their past work, the case moves on to the final step. Note: past work can potentially include any jobs done in the last 15 years prior to becoming disabled.

Step 5: Can the person do some type of other work? Other work can include jobs that the claimant has not ever done as long as those jobs are not prohibited by the claimant's age or current level of physical and/or mental limitations and as long as the claimant has the necessary skills and education. If the claimant cannot, based on their age, education, skills, and rated limitations do some type of other work, then they will satisfy the Social Security definition of disability and they may be approved.

This is assuming, of course, that certain non-medical factors do not bar them from being approved, such as working and earning too much to be considered disabled. Or, for SSI claims, having too much in countable assets.

In essence, this is the five step sequential evaluation process used by all examiners and judges.

Note: a very high percentage of cases are denied in Texas and other states on the basis of the claimant being found able to do some type of other work. This fact accounts for why it is important to be very well prepared for a disability hearing because a judge may decide to have a vocational expert present to give testimony. That testimony may indicate that other work is possible. A VE or vocational expert, can be cross-examined, however, and their testimony should not be simply accepted at face value.

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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