When Does a Health Problem Become “Enough” for Social Security to Consider it a Disability?

Social Security Disability Evaluation

I often receive phone calls from prospective clients wondering if their condition(s) would qualify them for Social Security Disability. Unfortunately, disability is a “squishy” term and there is no straightforward answer to this question.

Social Security does use a Five Step Sequential Evaluation Process (listed below) to guide in the evaluation of Disability claims that can help shed some light on what is “enough” to consider someone disabled.

Step 1: Work Activity
Step 2: Medical Severity of Impairments – Duration of Disability
Step 3: Medical Severity of Impairments – Listings
Step 4: Ability to Perform Past Work
Step 5: Ability to Perform Any Other Work

The first step is to determine if the Claimant, or person who has filed for Disability, is working. If not, Social Security moves on to Step 2. If the Claimant is working, Social Security must decide if the work qualifies as Substantially Gainful Activity, or SGA. Social Security’s rules explain that in most situations if a person is working and his or her gross earnings (before taxes) are roughly $1,000 per month, it is SGA and that person will be denied almost immediately. In this instance, Social Security will not evaluate if the Claimant meets the medical requirements for Disability.

At the second step, Social Security will determine if the impairment has lasted at least one year or could be expected to last at least one year. If the condition(s) do not meet this requirement, the claim will be denied. If the condition(s) do meet the duration requirement, Social Security moves on to Step 3.

Step 3 is where the medical records and doctor opinions are thoroughly evaluated.  The Disability Determine Service or Bureau (DDS or DDB) will collect the medical records from all of the treating doctors to see if the condition meets the requirements of the Listings. Listings outline conditions or symptoms that automatically qualify someone for Disability. It is quite difficult to meet the Listing requirements, so I generally argue that a combination of a Claimant’s symptoms and impairments meet the disability threshold set forth by the Listings. If a Claimant meets the Listing criteria, it will result in an award for benefits. If not, Social Security will look at all of the medical evidence and move on to Step 4.

Once moving to Step 4, Social Security considers whether or not the condition(s) prevent the Claimant from doing any job he or she may have performed in the past 15 years.

Finally, Step 5 is when Social Security considers if there is any other work in the national economy that the Claimant could perform. This step often proves to be the most difficult in Disability cases.

The Five Step Sequential Evaluation is a good place to start when thinking about Disability but Social Security also looks at a Claimant’s age and education level, making the determination even more complicated. Because each person’s situation is so unique, and the high odds that a Claimant will be denied by Social Security, it is best to consult a lawyer to work through the intricacies of the law.