How Disability Claims are Evaluated

Step-by-Step Guide to Disability Claim Evaluation

The Definition of Disability

The definition of disability for adult claimants is the same under all programs, though eligibility and program features differ. Adult disability is defined through a 5-step sequential evaluation. Each claim must proceed through each step until a finding about disability can be made.

Step 1

Is the claimant engaging in Substantial Gainful Work Activity (SGA)?

Many people believe that they must not be working at all in order to be eligible for disability benefits through the Social Security Administration. This is not true. An individual may be capable of performing part-time work and still meet the regulatory definition of disability. At this step, the question is whether the individual is engaging in full-time work, or engaging in work activity that results in substantial earnings. The answer must be “no” in order to proceed.

Our team will help you determine whether you may be eligible for disability benefits notwithstanding current work activity or earnings. Contact us today.

Step 2

Does the claimant have one or more severe, medically provable impairments?

SSA defines “severe impairment” as any medically documented physical or mental impairment that

  1. Has significantly impacted, or is likely to significantly impact, an individual’s ability to perform basic work functions (e.g., Sit/Stand, Push/Pull, Understand/Remember, etc.)
  2. Has lasted, or is likely to last, 12-months or more.

The threshold is low at this step and it is typically easy to prove that you have a severe impairment. You must have one or more severe impairments for your claim to proceed.

If you are unsure about whether you have a mental or physical disability that qualifies, our team will be able to provide analysis of your claim at no cost. Contact us today.

Step 3

Does the claimant have a severe impairment that meets or equals a Listing?

SSA created a handbook that breaks down all common impairments into fourteen categories. Everything from musculoskeletal to mental impairments are classified. This handbook is available to the public. Within each of the fourteen categories are sub-categories that provide specific medical criteria. If a claimant’s medical records demonstrate that all criteria of a Listing are met, the evaluation ends and the claimant is found disabled at Step 3. The bar for meeting all of the criteria of these Listings is quite high. As such, few claims are granted at this step. Even if your impairments do not meet a listing, you may still be found disabled. Most claims are granted after Step 3. If an impairment does not quite rise to the listing level, the evaluation proceeds to the next step.

Our team checks these Listings for every claim and will determine whether a claimant’s medical impairments meet or equal a listed impairment. Contact us today.

Step 4

Do the claimant’s severe impairments prevent them from performing their Past Relevant Work (PRW)?

If a determination of “disabled” cannot be made, the claim must proceed through the remainder of the steps. At this step, the evidence must demonstrate that the claimant’s impairments result in limitations that prevent them from being able to perform any of their past relevant jobs, any significant work activity (SGA) they performed in the last 15 years. Evidence must demonstrate that you are unable to perform all past relevant jobs in order for you to win your claim. This step becomes even more significant for claimants 50 years of age and older and it is possible to be granted disability at this step if you are an older individual.

Our team will evaluate your claim and take the time to explain how your age and past relevant work will be considered and addressed by SSA. Contact us today.

Step 5

Are there other jobs in the national economy that the claimant would be able to perform full time?

As noted at Step 1, SSA is not concerned with your ability to perform part-time or accommodated work activity. At this final step, the Agency has the burden of identifying other full-time jobs that a claimant would be capable of performing even if their limitations prevent them from performing their past work. If SSA can identify a significant number of full-time jobs that exist in the country, that you could perform long-term and despite your physical and mental limitations, your claim will be denied.

Our team will fully develop the necessary evidence in your claim with the goal of demonstrating you meet the definition of disability at each relevant step of the evaluation process. Contact us today.