Social Security Disability Determination Process

Share

INTRODUCTION TO THE SOCIAL SECURITY DISABILITY DETERMINATION PROCESS

(IMPORTANT: This section is meant to provide a brief overview of the disability determination process, particularly during an SSD hearing. It is provided here for basic informational and educational purposes only. It is not a complete or exhaustive description of the entire disability determination process.)

For a more detailed analysis of your specific case, please call AJM Disability Advocates at 586-929-0654 to schedule a FREE consultation.

Process For a Disabled Adult–Claims by disabled workers, disabled widows/widowers, and disabled adult children.

The Social Security Act defines adult disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. (20 CFR 404.1505(a) and 416.905(a))

The adjudicator must follow a specific sequential order of steps in evaluating each claim for disability. This 5 Step Process can be stopped at any step at which a finding of disabled or NOT disabled can be made.

PERFORMING SUBSTANTIAL WORK FOR PROFIT

STEP 1: Is the individual engaged in substantial gainful activity (SGA)?

–Is the individual performing substantial work for profit or the type of work that generally results in pay or profit? (Part-time work and even illegal activities can be considered here.)

*AJM Advocates can evaluate your work history and earnings record to appropriately argue whether or not your work reaches SGA levels.

IF THE INDIVIDUAL IS NOT FOUND TO BE ENGAGED IN SGA, PROCEED TO:

MEDICAL EVIDENCE STEPS

STEP 2: Does the individual have a severe medically determinable impairment?

–To have a severe impairment that impairment or combination of impairments must be medically determinable, significantly limit the individuals mental or physical ability to perform basic work, and meet a durational requirement.

*AJM Advocates can evaluate your medical records and consult with you (as well as your medical doctors) to appropriately argue whether you have a severe medically determinable impairment.

IF THE INDIVIDUAL IS FOUND TO HAVE A SEVERE MEDICALLY DETERMINABLE IMPAIRMENT, PROCEED TO:

STEP 3:  Does the individual have an impairment(s) that meet or equals the criteria of a listed impairment?

–The Listing of Impairments is a large Appendix that describes medical conditions which have been deemed severe enough to prevent an individual from performing SGA. As the Listing consists of extremely specific medical criteria, most claimants will not meet a Listing. (20 CFR Part 404, Subpart P, Appendix 1)

*AJM Advocates can compare your medical records to the Listing, which is organized by body system and mostly consists of impairments that are permanent. We understand how Social Security will compare your disability to their Listing criteria!

IF THE INDIVIDUAL DOES NOT MEET THE LISTING CRITERIA, PROCEED TO:

RFC: THE SPECIAL HALF-STEP

STEP 3 & ½: Assessing an individual’s residual functional capacity (RFC)!

–Perhaps the most important step in any Social Security claim/hearing. In order to proceed to Steps 4 and 5, the Administrative Law Judge (ALJ) is responsible for assessing the individual’s RFC.

An RFC is defined as the most an individual can do on a sustained (full-time) basis despite the limitations caused by their medically determinable impairment.

For example, the ALJ may find in his/her RFC assessment that: The claimant is capable of light work with occasional postural activities and no exposure to environmental hazards such as moving machinery, respiratory irritants, or work performed at dangerous heights.

*Proper evaluation of your medical records, asking the right questions at your hearing, and putting forth legal arguments based on your established medical evidence record is an essential part of most RFC assessments. Let AJM Advocates put our knowledge and experience to work for you!

PROCEED TO:

VOCATIONAL STEPS

STEP 4: Does the individual’s medically determinable impairments prevent the performance of his/her past relevant work (PRW)?

Typically, your PRW is classified by a vocational expert (VE) and a determination is then made by the judge whether the individual can still perform his/her PRW despite their limitations. If the individual can still perform their past relevant work, they are considered NOT DISABLED and the evaluation ends without proceeding to final step.

*During this step, a VE is not typically given earnings records for the claimant’s past jobs. Let AJM Disability Advocates evaluate your work history and earnings records to make certain the VE properly classifies all of your past work.

IF THE INDIVIDUAL’S LIMITATIONS PREVENT THEM FROM PERFORMING ALL OF THEIR PRW, THEN PROCEED TO:

STEP 5: Does the individual’s impairments prevent him or her from adjusting to other work which exists in significant numbers in the national (and/or regional) economy?

–At this final step, the ALJ must consider all vocational factors (including age, education, and work experience) in conjunction with the RFC to determine if the individual can adjust to other SGA work that exists in significant numbers in the national economy.

In claims involving physical impairments, the ALJ will also look at another Appendix, the Medical-Vocational Guidelines (or GRID rules) to determine if the claimant’s Vocational Profile directs a finding of disability (SEE: Appendix 2, Subpart P, 20 CFR 404)

However, when “other work” testimony is taken from the VE, it will often include the number of jobs in the national and regional economy.

For example, “other work” testimony put forth by the VE may hypothetically assert that: The claimant can perform the job of clerical sorter, which is unskilled work; performed and the sedentary level. (25,000 jobs in Southeast MI and 100,000 jobs nationally).

This fairly common VE testimony can be confusing for claimants during the hearing. Here, the VE is NOT saying that the individual has worked as a clerical sorter. Furthermore, the VE is NOT saying that there are 25,000 people ready to hire the individual in Southeast MI to perform the work of a clerical sorter. NOTE: Social Security is evaluating whether this individual COULD hypothetically do this job; not whether an employer is actually willing to hire him/her for such work or asserting they have done clerical sorting work before.

*Let AJM Disability Advocates argue your Vocational profile and appropriately question the VE as to their “other work” testimony. During the final step of the disability evaluation process, it is crucial that your representative understands VE testimony and knows how to ask the right questions!

If other work exists in significant numbers in the national (regional) economy that the individual is capable of performing on a sustained basis (full-time), a finding of NOT disabled is appropriate.

IF SUCH OTHER WORK DOES NOT EXIST, A FINDING OF DISABILITY IS APPROPRIATE! 

CONTACT US TODAY FOR A PERSONAL CASE REVIEW – THERE IS NO FEE UNLESS YOU WIN!

Your Name (required)

Your Phone (required)

Your Email (optional)

Subject

Your Message

Privacy: We care about your privacy. We do not sell, share, or rent our data. Your information is used exclusively by AJM Disability Advocates to contact you about Social Security Disability Legal Representation. If we are unable to service you, we may refer you to a trusted attorney in your area with your permission. Submission of this contact form does not create an attorney/client relationship.

(Revised 2/4/2014)