Sequential Evaluation

Social Security Basics

There are two basic questions that must be answered to determine whether you can get monthly disability benefits.

First, is whether you are disabled under the Social Security rules? The second is, are you eligible for one of the Social Security programs?

FIRST QUESTION: ARE YOU DISABLED?

There is a five-step assessment SSA will use in order to determine whether you are disabled. This is also known as the “Sequential Evaluation.”

STEP ONE:  Are You Performing Substantial Gainful Activity?

To be found disabled under the Social Security rules you cannot be earning, on average, more than $1,220 gross income per month. If your average monthly gross earnings are $1,220 or more, Social Security will find that you are performing substantial gainful activity.  There are special rules that apply for determining your gross income if you are self-employed.  There are also separate earning allowances if you are legally blind. 

STEP TWO:  Do You Have a Condition(s) That SSA Will Consider Severe?

If you are earning less than $1,220 gross income per month, SSA will then ask if you have a “severe” impairment.  SSA will find your impairment is severe if it significantly interferes with your basic work-related activities.  If your impairment is severe you move to Step 3. 

STEP THREE.  Is Your Condition on The SSA “Listing of Impairments”? 

You have an opportunity to be found disabled at step three.  If you are not earning $1,220 or more gross per month (Step 1) and your condition is severe (Step 2), you will be found disabled if your condition meets or equals the requirements of what is called a listing.  A listing is a set of specific diagnostic criteria set forth by SSA for different medical conditions. 

To view the listing for adults, go to:  www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

Even if your condition does not meet or equal a listing, you can still be found disabled.  SSA will move to Step 4.

STEP FOUR.  Can You Perform Your Past Relevant Work?

SSA will determine whether your impairment(s) prevents you from doing what is called your “past relevant work.”  Past relevant work is defined by SSA as the work you have done in the 15 years prior to you becoming disabled.  If SSA determines that your impairment(s) prevents you from performing your past jobs, then they will move to Step 5. 

STEP FIVE.  Can You Do Any Other Type of Work?

During this final step, SSA will evaluate your physical and/or mental condition(s), age, education, work experience and skills you have acquired that could be transferred to other jobs.  Given all of these factors, if Social Security determines you cannot do other types of jobs that exist in significant number in the national economy, Social Security will make a determination of disability. 

 

Substantial Gainful Activity

Generally speaking, a Social Security Disability claim is about whether or not you are able to work at substantial gainful levels.

  • Substantial gainful activity (SGA) is work that brings in over a certain gross dollar amount per month. In 2019, that amount is $1,220 for non-blind wage earners and $2,040 for blind wage earners. The SGA limit does not apply to blind claimants applying for SSI. If you are making more than that amount per month, then the Social Security Administration presumes that you must not be disabled. In their words, they believe you “are able to engage in competitive employment”.

High earnings do not necessarily mean you are doing SGA, if you work under special conditions. Claimants can argue that their income would have been lower but for the fact that there were one or more special circumstances:

  1. The claimant required special assistance from other employees in performing the work
  2. The claimant was allowed to work irregular hours or take frequent rest breaks
  3. The claimant was provided with special equipment or assigned work especially suited to his or her impairment
  4. The claimant was able to work only because of specially arranged circumstances (for example, other people helped the claimant get to and from work)
  5. The claimant was permitted to work at a lower standard of productivity or efficiency than other employees
  6. The claimant was given the opportunity to work despite his or her impairment because of a family relationship, past association with the employer, or the employer’s concern for the claimant’s welfare

Individuals who work and earn a gross monthly income exceeding the SGA threshold are not considered disabled and are ineligible to receive benefits unless they were working under one of special circumstances discussed above.

How much you earn is one of the first things SSA looks at. Generally, if you are making over $1,220 when you apply, your claim will be denied almost immediately without a medical review. Your medical records will not even be requested or evaluated because you will be considered ineligible for benefits for non-medical reasons.

If you are self-employed, SSA recognizes that whether a small business’s net profit is over $1,220 per month is not always a good indicator of whether the business owner is doing substantial gainful activity. If you are self-employed and you are not applying for disability for blindness or low vision, then SSA will try to look more closely at what you are doing for the company. SSA will apply what it calls “The Three Tests” to determine if your business activity is SGA. Your business activity will be considered SGA if any of the following are true:

 

Severe Impairment

When claimants apply for Social Security Disability benefits, they must be able to prove that they have a severe impairment that leaves them unable to perform substantial gainful work activity (See SGA – https://www.ssa.gov/oact/cola/sga.html)

The Social Security Administration defines a severe impairment as one or a combination of impairments that significantly limits the individual’s physical or mental abilities, and, as a result, interfere with the individual’s ability to perform basic work activities. If an impairment or combination of impairments does not significantly limit the individual’s ability to work, SSA will determine that the individual is not suffering from a severe impairment and will not receive Social Security Disability benefits.

There are different ways in which a person can prove that he or she is suffering from a severe impairment in order to qualify for Social Security Disability benefits. In order to qualify, claimants must have sufficient objective medical evidence that shows that they suffer from one or more impairments that result in an inability to work. Even if the impairments when taken alone do not qualify the individual for Social Security Disability benefits, claimants may still qualify for benefits if the condition is severe when all their impairments are considered altogether.

 

Do You Meet a Listing 

Social Security’s Listing of Impairments are detailed requirements that SSA uses to determine if a medical condition is automatically disabling. The Listing of Impairments contain the most common medical conditions considered to be severe enough to keep an individual from working.

There are separate listings for adults and for children.

The major body systems and disorders addressed within the Social Security Disability listings are as follows: Musculoskeletal System, Special Senses (Vision and Hearing), Respiratory System, Cardiovascular System, Digestive System, Genitourinary System, Hematological Disorders, Skin Disorders, Endocrine Disorders, Multiple Body Systems, Neurological Disorders, Mental Disorders, Neoplastic Diseases (Cancer), and Immune System Disorders.

Because illnesses and injuries have varying degrees of severity, the listings set out the requirements for the severity of the symptoms and the availability of clinical findings and laboratory tests for a particular impairment in order to receive an automatic approval. (If your condition does not match a listing, then SSA goes through a longer determination process to see if are disabled. But if you can match a listing, then the process stops there, and you will be found disabled.)

If your impairment do not match the requirements of their listings, SSA will consider if your impairments can be considered equivalent to a similar listing in terms of severity. SSA allows you to “equal” a listing because it cannot include every form or variant of a severe disability in its listings. SSA also recognizes that there are various ways to diagnose and document the same illness.

Another way to equal a listing is by having a combination of impairments that may not be severe enough to meet a specific listing when considered individually, but when considered together are severe enough to equal a listed impairment.  If SSA says you equal a listing, you will be found disabled.

You can get disability for a condition not founds in SSA’s listings if you can prove the condition limits your functioning too much for you to work.

You can find the SSA Listings on SSA’s website at

(Adults): https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

(Children): https://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm

 

Can You Perform Your Past Relevant Work

When an individual applies for Social Security Disability benefits, the Social Security Administration considers a number of factors in determining whether or not that individual is capable of performing any type of work activity. One of the considerations taken is the applicant’s past relevant work experience.

  • Generally, past relevant work is any type of work that the individual has performed in the past fifteen years. This work must have been performed for three months or more at a full time capacity in exchange for wages or other compensation.

When you are filling out your Social Security Disability application, it is important that you clearly define your past work experience. If you do this incorrectly when filling out this part of the disability paperwork, it may hurt your chances of being approved for disability benefits.

The Social Security Administration looks closely at your past relevant work and the jobs that you held for the past fifteen years. If the Social Security Administration determines that you can return to the type of work that you have done in the past, then your application for Social Security Disability benefits will be denied.

When filling out your disability application, be clear and straightforward when describing your previous jobs. Be honest, and do not embellish your work history. Remember: this is not a resume; it is an application for disability benefits. If you embellish your past work experience, it may hurt your chances of being awarded disability benefits.

 

Can You Do Other Work

Can you do any other type of work? SSA calls the work you did in the last 15 years your “past relevant work” (LINK PRW E&E SITE). If you cannot perform your past relevant work, then SSA looks to see if you can do any other type of work.

SSA will consider your age, education, past work experience, and transferable skills. They cross-check this with the job demands of occupations that are determined by the Department of Labor in a Dictionary of Occupational Titles.

  • If you cannot do any other kind of work, your claim will be approved.

Social Security has to review the reports from all of the doctors, hospitals, and clinics that have treated you. Information about any medication you are taking is also important. The law requires Social Security to consider all of the evidence and all of your impairments when makes a decision about your disability. Social Security must look at the combined effects of every impairment.