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The Social Security Disability Five Step Sequential Evaluation Process

Qualifying for Social Security Disability benefits can be a complicated process. Claimants applying for Social Security Disability Insurance (SSDI) must have enough work credits to qualify. Claimants applying for Supplemental Security Income must meet income and resource requirements. Claimants must be determined disabled and have a severe mental or physical health condition which is expected to last at least 12 months or result in the claimant’s death to qualify for both programs.

State disability determination offices will review the claimant’s Social Security Disability application and gather medical evidence from the claimant’s doctors, hospitals, clinics and any other medical facility which have treated the claimant. The disability determination center will find answers to the following questions:

The Social Security Disability Five Step Sequential Evaluation Process

After the Social Security Administration has gathered all of the claimant’s medical records it is time for them to make their decision. To do this the Social Security Administration uses a five-step decision making process called the Sequential Evaluation Process.

1.     Is the claimant engaged in substantial gainful activity (SGA)?

The Social Security Administration will evaluate the earning capacity of the claimant and determine if they are able to work despite their impairment. Work or “substantial gainful activity” is currently defined as making a gross income of more than $1,000 per month for 2010 (the amount varies for claimants with Social Security Disability blindness). This amount is updated periodically by the Social Security Administration.

The type or severity of the claimant’s condition is not considered if they are making too much money, in fact, in most cases if the Social Security Disability Field Office has properly evaluated the claimant’s SSD application the claimant’s application will be denied before it is forwarded to the disability determination office. If the claimant is not working at SGA level, the DDS office will proceed to step number 2.

2.     Is the claimant’s condition “severe”?

Conditions must be considered severe and be expected to last at least 12 months or result in death. Social Security Disability benefits are not awarded for partial disabilities or short-term disabilities. Severe conditions are those which significantly limit the claimant’s ability to perform basic work activities such as: walking, standing, lifting, stooping, performing simple routines, speaking, etc.

3.     Does the claimant have a mental or physical health condition which meets or equals a listing?

The Social Security Administration publishes a listing which identifies impairments by body system. Each listing describes conditions and symptoms which must be present for the DDS to consider the impairment severe. Claimants may review their condition in the List of Impairments to determine if they qualify for disability benefits. If the claimant’s condition does not meet a listing they may still qualify for benefits but they must pass the next 2 steps in the SSA sequential analysis.

4.     Can the claimant do the work they have done in the previous 15 years?

What happens if the claimant’s condition is severe but it does not meet a listing? The DDS examiner must determine if the claimant’s condition is severe enough to affect their ability to work. This is done by examining the claimant’s Residual Functional Capacity. Work history information is documented on the claimant’s work history form. DDS examiners will evaluate the work history form and analyze the activities the claimant was required to perform for jobs in the past 15 years. For example, the examiner might analyze a job and determine how much the claimant had to sit, stand, bend, twist or crawl. The examiner will compare the job requirements to the residual functional capacity of the claimant and decide if the claimant can do the work they have done given their current level of physical or mental functioning. Claimants who are unable to perform their past jobs will move on to step five.

5.     Does the claimant’s condition prevent them from performing any other type of work?

If the Social Security Administration determines the claimant can not do past relevant work due to their mental or physical impairments they will consider their claimant’s ability to be retrained for a new job. The DDS examiner will consider the residual functional capacity outlined in step four and additional vocational factors including the claimant’s age, education and work experience. Given all of these factors, the DDS examiner decides if the claimant can adjust to another type of job. Claimant’s who can not work any other type of job will be considered disabled.

Understanding the Social Security Administration’s List of Impairments, how to complete your work history forms and having your doctor document your residual functional capacity are important steps in the disability determination process. What can you do to help? Make sure to get consistent medical care for your mental or physical impairment. Develop a strong doctor/patient relationship with your primary care physician. Talk to a Social Security Disability lawyer who can answer your questions and make sure you get the Social Security Disability help you need.