The five-step disability evaluation process for SSDI claims

On behalf of Mike Wagner at Wagner & Wagner Attorneys at Law

The definition of disability for SSDI is unique among benefit programs.

It seems that whether someone is disabled should be an easy question when his or her medical condition prevents work. But for purposes of Social Security Disability Insurance eligibility, the definition of disability is complex and distinct. The Social Security Administration has developed a five-step evaluation process to answer the question for every application.

It is important to understand that being disabled for SSDI purposes is not the same as it might be for a state workers' compensation benefit, which might allow benefits for partial or temporary disability, or for a private disability insurance program with its own definitions.

Social Security law says that a claimant is disabled if he or she has a severe physical or mental medically determinable impairment or combination of impairments expected to last at least one year or result in death that prevents him or her from engaging in substantially gainful employment.

Again, at first glance this may seem like a reasonably simple question, but the governing law is complicated and the need for extensive medical evidence significant, so engaging an attorney to assist with an application or appeal of a denied application can make all the difference.

The agency uses a five-step evaluation process to determine whether an applicant is disabled for purposes of SSDI eligibility.

At the first step, the SSA asks whether the claimant is engaging in substantial gainful activity, known as SGA. For 2016 for a nonblind individual, monthly SGA is $1130, so a claimant making less than this monthly on average is not considered to be working for SSDI purposes. If yes, the claimant is not disabled. If no, the second step is considered.

At the second step, the SSA asks whether the claimant's impairment is severe, meaning that it negatively impacts basic work activities (lifting, standing, sitting, understanding and following simple instructions, responding appropriately to managers and colleagues and so on) and is expected to last at least one year or result in death. If no, the claimant is not disabled. If yes, the third step is considered.

At the third step, the SSA asks whether the claimant's impairment meets or equals a listed impairment from a list of medical conditions that the SSA considers so severe that meeting or equaling one of them automatically means the claimant is disabled. If yes, the claimant is disabled. If no, the fourth step is considered.

At the fourth step, the SSA considers the claimant's residual functional capacity, called the RFC, which assesses the claimant's remaining ability to do sustained work activity after accounting for the restrictions and limitations caused by his or her impairment. The question is whether, considering the claimant's RFC, he or she can perform any past relevant work or PRW, meaning SGA in the previous 15 years done long enough to reach an average level of performance in the job. If yes, then the claimant is not disabled. If no, the fifth step is considered.

At the fifth step, the SSA considers whether other jobs exist in significant numbers in the national economy that the claimant could do after considering his or her impairment, age, work experience and education. If yes, the claimant is not disabled. If no, the application for SSDI will be approved.

The Chattanooga, Tennessee, lawyers at Wagner & Wagner Attorneys at Law advocate for SSDI applicants in Tennessee and Georgia at every stage of the application and appeal process.

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