Whether you are applying for SSD or SSI benefits, the SSA uses the same five step process to determine whether or not an adult person is medically disabled under their rules. This process is known as the “Five Step Sequential Evaluation”. We have created a very basic summary of this process, however it is by no means inclusive of all issues faced at each step, and it is rather a brief overview to give you an idea of the general process utilized.
At Step 1, the SSA begins by looking into whether or not an individual is working or performing what they call substantial gainful activity (SGA). Generally speaking, if a person is working at or over the SGA limit, they are denied disability at this step. The SSA sets a yearly income limit and if a person earns over that limit for that year, they are deemed to be performing substantial gainful activity. Of important note, however, is that there are exceptions to this rule. If a person’s employer is providing special accommodations or a certain amount of money is being spent on impairment related work expenses, then the SSA will look into the specifics of the job and make their determination in consideration of all of these factors.
If the SSA determines that an individual is not performing substantial gainful activity, then their claim progresses to Step 2. At Step 2, the SSA looks at your disabilities and determines whether or not they are severe. To be considered severe, the SSA requires that an individual’s disabilities interfere with basic work activities (physical and mental). They also require that the disabilities will last for at least 12 months or will result in death.
If an individual’s disabilities meet the requirements of Step 2, then the SSA proceeds to Step 3 of their evaluation. At Step 3, the SSA looks at what are called the “Listing of Impairments”. Within the “Listing of Impairments” for adults, the SSA has created fourteen main categories as follows: Musculoskeletal System, Special Senses and Speech, Respiratory Disorders, Cardiovascular System, Digestive System, Genitourinary Disorders, Hematological Disorders, Skin Disorders, Endocrine Disorders, Congenital Disorders that Affect Multiple Body Systems, Neurological Disorders, Mental Disorders, Cancer (Malignant Neoplastic Diseases) and Immune System Disorders. Within each of these sections, the SSA provides medical criteria that apply to the evaluation of disability under each of these categories. At this step, the SSA will determine what sections apply to your particular disabilities and then determine whether or not your disabilities meet or equal the severity of the requirements of each listing.
If the SSA determines that your disabilities meet or equal that of a listing, you are found medical disabled at Step 3 and the analysis is discontinued. If however, you are found not disabled at this Step, the SSA will proceed to Step 4 of the analysis.
At Step 4, the SSA will evaluate your residual functional capacity (RFC). Your RFC is essentially an assessment of an individual’s functional abilities to sustain physical and mental work related activities on an ongoing, sustained basis despite the limitations imposed by his/her disabilities. Once your RFC is established, the SSA will utilize it at this step to determine your ability to return to your past relevant work. Past relevant work is any work that you performed within the last 15 years that you actually learned and carried out for a sufficient amount of time. If the SSA feels that an individual retains the physical and mental abilities to perform his/her past relevant work, then he/she is determined not medical disabled at this step. If the SSA determines that an individual does not retain the RFC to return to his/her past relevant work, then the analysis continues on to the final step, Step 5.
At Step 5, the SSA will determine whether or not sufficient work exists in the national economy that the individual could perform with his/her disabilities. In making this determination, the SSA will consider the individual’s age, educational background, work experience along with his/her disabilities. This analysis will also take into consideration what adjustments the individual could make to other work considering the transferability of skills obtained while in the workforce. At this step, the SSA will consider what is called the Medical-Vocational Guidelines or the “Grids”. These are tables broken into RFC exertional levels. The individuals RFC is considered along with a gridded list of age groups, educational levels and work experience levels to yield a determination of disabled or not disabled. This step is very complicated and involves far too much to fully explain in a blog article. However, the main point here is that the SSA looks to determine whether or not an individual is employable with consideration to the factors discussed above and sometimes consideration to certain special medical-vocational profiles. If the SSA determines that you meet a GRID rule, a special medical vocational profile or that enough jobs are not widely available in the national economy in consideration of the impairments imposed by your disability, then an individual is found to be disabled at this step.