Disability benefits are available to claimants under both disability benefit programs established under the Social Security Act (the “Act”), i.e., the regular Social Security disability program under Title II of the Act, and the Supplemental Security Income program under Title XVI of the Act.

Social Security Disability (“SSD”) Benefits:

Social Security Disability benefits are available to a blind or disabled worker who:

1. applies for benefits;
2. has not reached full retirement age;
3. has sufficient Social Security earnings to be deemed insured for disability;
4. is disabled;
5. has been disabled for a 5-month waiting period within the last 17 months prior to the month of application.

Supplemental Security Income (“SSI”) Benefits:

Supplemental Security Income benefits are available to an aged (65 or older), blind or disabled individual who:

1. applies for SSD and all other benefits for which he/she may be entitled;
2. is a U.S. resident or qualified alien;
3. is not a resident of a public institution;
4. is disabled (if applicant is seeking eligibility based upon an alleged disability);
5. meets the income and resource requirements; and
6. is not fleeing to avoid prosecution for a felony or violating probation or parole.

“Disability,” Defined

Congress defined the term “disability” as follows: An inability “to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” In other words, there must be a severe physical or mental impairment, or combination of impairments, that can be expected to last for a continuous period of at least 12 months, or result in death.

Social Security’s Five-Step Disability Evaluation Process 

Social Security regulations provide a five-step sequential evaluation process for determining whether a claimant is “disabled” under the law. The first two criteria are as follows:

(1)           The claimant is not engaged in “substantial gainful activity” (“SGA”); and,

(2)           The claimant has a “severe” impairment, which will last at least 12 months (or result in death).

If the claimant satisfies the above two inquiries, the severity of the impairment is then analyzed as follows:

(3)           The impairment meets or equals the severity of the listed impairments as defined in the medical listings.

If the answer to this question is in the affirmative, then the claimant is disabled, according to medical listings. Otherwise, the inquiry is as follows:

(4)           The claimant is unable to perform his/her “past relevant work;” and,

(5)           The claimant is unable to perform other work within his “residual functional capacity.”

If these latter questions are answered affirmatively, then the claimant is disabled according to vocational factors, even though the claimant has not satisfied the medical listing. 

A commonly used diagram of the disability determination process follows: 

Diagram of Social Security’s Disability Decision and Sequential Evaluation Process

Step 1: Substantial Gainful Activity (SGA) 

The Social Security Administration has established certain earnings levels as reasonable signs that a person can perform SGA.  As of 2016, that level is $1,130 per month for disabled persons, and $1,820 per month for a blind person.  If one can potentially earn $1,130 or more (or $1,820 or more if blind), then Social Security presumes that that person is able to engage in SGA.  The presumed SGA amount is indexed to an annual cost of living allowance and is adjusted in January of each year.  

Step 2: Determining “Severity” 

Social Security is supposed to consider the combined effects of all impairments, including multiple non-severe impairments as well as subjective symptoms that arise from medically determinable impairments, in assessing whether an impairment or group of impairments reduces a claimant’s ability to do basic work activity. Close cases must be decided in favor of finding that an impairment is severe.   

Duration Requirement 

Unless it is expected to result in death, an impairment must have lasted or be expected to last for a continuous period of 12 months before the impairment will be considered disabling. 

Step 3: Listing of Impairments 

To be found disabled at Step 3, a claimant’s disability must meet or equal one of the impairments found in the Listing of Impairments. The Listing of Impairments is a set of medical criteria for disability found at Appendix 1 of the Social Security disability regulations, officially cited as 20 C.F.R. Part 404, Subpart P, Appendix 1. The Listing of Impairments can be found on the Social Security website, here:  https://www.socialsecurity.gov/OP_Home/cfr20/404/404-app-p01.htm.

Step 4: Past Relevant Work

Usually, the success of a disability case filed with the Social Security Administration will focus on Steps 4 and 5 of the sequential analysis. At Step 4, the claimant must prove that he or she is incapable of performing any “past relevant work.” “Past relevant work” refers to all work that was performed by the claimant in the 15 year period prior to the date of the disability claim. If the claimant retains the ability to perform “past relevant work,” the claimant will not be found to be disabled under Social Security rules.

Step 5: Other Work Within “Residual Functional Capacity”

If the claimant proves that he or she cannot perform past relevant work, the claimant must show that he or she cannot make the adjustments necessary to perform any other work that exists in the national economy, considering the claimant’s “residual functional capacity” (i.e., remaining work capacity given the claimant’s disability), age, education and work experience. 

If, because of the claimant’s impairments (either physical or mental), the claimant can no longer perform the physical and mental demands of past employment, or do other work based upon the claimant’s residual functional capacity, age, education, and work experience, then the claimant is disabled. In making this determination, SSA will consider both medical and non-medical information.

Routes to Disability Finding

The five-step sequential evaluation process provides two main routes for a finding of disability. One route culminates at Step 3 by proving that the claimant’s disability meets or equals one of the impairments found in the Listing of Impairments. This is the least traveled route to success in the Social Security arena. The other route culminates at Step 5 and involves proving that the claimant can no longer perform past employment, or do other work based upon the claimant’s residual functional capacity, age, education, and experience. Most Social Security disability claims are won or lost at Step 5.

For additional information concerning social security disability appeals, visit: https://vanarellilaw.com/social-security-disability-appeals/

Vanarelli & Li, LLC website: http://VanarelliLaw.com/