Regulations governing the Social Security Administration (SSA) set forth a five-step sequential evaluation process for determining disability. As a result, every applicant who files a claim for disability benefits under both the Social Security and Supplemental Security Income (SSI) programs must meet the five requirements in the rules in order to be approved for benefits. Thus, the following must be proven by a claimant in order to be found disabled:
- The claimant is not engaging in “substantial gainful activity” (SGA); and,
- The claimant has a “severe” impairment; and,
- The impairment meets or equals one of the impairments described in the SSA regulations known as the “Listing of Impairments,” or,
- Considering the claimant’s “residual functional capacity” (RFC), which refers to the claimant’s ability to work even with his or her impairments, the claimant is unable to do “past relevant work”(PRW); and,
- Other work within the claimant’s RFC, considering age, education and work experience, does not exist in the national economy in significant numbers.
The terms identified above in quotation marks have precise meanings in the SSA regulations and rulings which must be understood in order to make sense of the sequential evaluation process. These critical terms are briefly explained below.
Step 1: “Substantial Gainful Activity” involves the performance of significant physical or mental activity which is done for pay or profit of at least $1,000 per month. The SGA income level is adjusted every year.
Step 2: The “Severity” Requirement mandates that each claimant produce medical signs and laboratory findings demonstrating the existence of medically determinable physical or mental impairments.
Step 3: The “Listing of Impairments” is a set of medical criteria for disability found in Appendix 1 of the federal regulations governing SSA. In order to be found disabled, a claimant’s medical findings must meet or medically equal the Listing of Impairments.
Step 4: “Past Relevant Work” At Step 4, the claimant has the burden of proving that, given the claimant’s impairments, he or she is incapable of performing any “past relevant work.” PRW refers to any job the claimant performed during the fifteen (15) year period prior to becoming disabled at which the claimant earned income at the SGA level.
Step 5: “Other Work” This is the most complicated step. At Step 5, the claimant must prove that, given the claimant’s impairments, he or she is unable to perform any other work in the national economy, considering the claimant’s age, education and work experience.
In addition to meeting the five-step sequential evaluation process for determining disability, a successful claimant for SSA benefits must also meet the duration requirement. The claimant’s disability must be expected to result in death or have lasted or be expected to last at least twelve (12) months.