How Does the Social Security Administration Evaluate Disability?
The Social Security Administration has specific requirements for finding a claimant “disabled.” Every case (both Disability Insurance benefit and SSI claims) is evaluated using a step-by-step process called the 5-Step Sequential Evaluation.
Step 1: A claimant must not be engaged in performing “substantial gainful activity,” which is usually determined by the amount of one’s gross earnings, if any. The amount is adjusted yearly. Special rules apply for self-employment.
Step 2: A claimant must have a medically determinable impairment. A medically determinable impairment is a physical or mental impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.
Duration. The impairment must be expected to result in the claimant’s death or it must have already lasted or can be expected to last for a continuous period of not less than 12 months.
Step 3: Does one of the claimant’s specific impairment meets or medically equal one set of the medical symptoms and finding that are itemized in the SSA Listing of Impairments?
If the claimant’s impairment is in the Listing of Impairments, it is determined whether it meets the severity described in the rule for that condition. The Listing requirements are often quite complex. If an impairment does not exactly match the requirements of the Listing, it may medically “equal” the severity of the listed impairment.
If a claimant meets or equals a listed impairment, a finding of “disabled” is automatic and the evaluation is concluded. If not, the evaluation proceeds to the final two steps.
Step 4: Social Security must first determine the claimant’s “residual functional capacity,” which is the “most you can do despite your limitations.” This is compared to the claimant’s “past relevant work.”
Past Relevant Work. The impairment must prevent the claimant from performing any past relevant work. Generally, work is “relevant” if it was performed in the last 15 years, was performed full-time (or nearly so), and was performed long enough for the claimant to have learned the job.
If the claimant can still perform one or more of his or her past jobs, a finding of “not disabled” is made, and the evaluation is concluded. If not, the evaluation proceeds to the final step.
Step 5: In addition to residual functional capacity, the claimant’s age, education and work experience is taken into account in determining the potential for performing other full-time jobs that exist in the economy in significant numbers. Special rules apply in age categories starting at age 50 that factor in age as a vocational adversity.
NOTE: The Social Security Act expressly states that a claimant is not disabled if drug addiction or alcoholism is a material contributing factor to the individual’s impairment.