Application & Eligibility

How the Social Security Administration Determines if you are Disabled

The Social Security Administration (SSA) offers 2 disability programs: the Social Security disability program and the Supplemental Security Income (SSI) program. A 5-step evaluation process is applied in each case regardless of what types of benefits you are seeking. Although the SSA’s evaluation process consists of 5 steps, not all the steps are necessarily reached if the SSA determined that you are – or are not – disabled at an earlier stage in the process. The SSA proceeds sequentially and if it determines that you are disabled at Step 3, for example, it will not proceed on to Steps 4 and 5.

The 5-step sequential evaluation consists of the following steps:

  1. Determining that you are not engaged in “substantial gainful activity” (SGA); and
  2. Determining that you have a “severe” impairment; and
  3. Determining that your impairment is listed in the regulations or is equivalent to one of the impairments on the “Listing of Impairments;” or
  4. Determining that you are incapable of performing your “past relevant work” (“PRW) in light of your “residual functioning capacity;” (RFC) and
  5. Determining that in light of your age, education, work history, and RFC, you are unable to perform other jobs that are available in significant numbers.

Note the numerous quotations marks around certain legally significant terms and the liberal use of abbreviations. These terms, commonly referred to as “defined” terms, have a precise meaning within the context of the regulations. An experienced Vancouver disability lawyer will be able to explain what these terms mean, which is important because they often have obscure meanings.

After engaging in the 5-step sequential evaluation, the SSA will decide whether you meet the “duration requirement.” That is, you must be disabled for at least 12 complete months.

In a nutshell, there are 2 routes to a disability determination. Under the first route, the SSA engages in the sequential evaluation process and stops at Step 3, determining that your impairment is a listed impairment or the equivalent of a listed impairment. Under the second route, the SSA engages in the evaluation process, determining at the end of Step 5 that you are impaired within the meaning of the regulations.

On the flip side, there are six routes to a determination that you are not disabled within the meaning of the regulations. From the SSA’s perspective you are not disabled if you:

  • are engaging in SGA
  • do not have a severe medically determinable impairment
  • have a medically determinable impairment, but it is not severe enough to significantly limit your physical or mental ability to perform basic work functions
  • can perform past relevant work
  • are capable of other work
  • fail to satisfy the 12-month duration requirement.

Consult a Vancouver disability Lawyer at Marla Heikkala & Associates. The SSI program has additional requirements as well, relating to both your assets and income.

 

The five steps that the Social Security Administration uses to evaluate disability claims

When our Oregon and Washington Social Security clients with disability claims ask whether or not their claim will be accepted by the Social Security Administration we explain the five-step system that the Social Security Administration uses to evaluate disability claims.

The Social Security Administration’s sequential evaluation process

The regulations that govern the Social Security Administration establish a five-step sequential disability evaluation process.

Briefly summarized, the steps that the Social Security Administration takes are to consider:
1. Whether you are currently working.
2. Whether you have a severe impairment, and have had it or expect to have it for a full year.
3. Whether your impairment meets or equals an impairment in a Listing of Impairments.
4. Whether you can still do any job that you have had in the last 15 years.
5. Whether you can do any other work.

Even though the regulations establish five steps, there are really two different ways that the Social Security Administration may conclude that you are disabled.

One way is to decide at step three that your impairment meets or equals one of the impairments in the Listing of Impairments. At that point the Social Security concludes that you are eligible for disability benefits, and there is no need to go to steps four and five.

The other way is to fail to establish disability at step three, but then at steps four and five the Social Security Administration can conclude that you are unable work and therefore need disability benefits.

 

Can I Work and Still Receive Social Security Disability Benefits?

You can still receive your full Social Security disability benefits only if you earn no more than the “substantial gainful activity” amount each month. For 2014 is $1,070 per month for non-blind individuals and $1,800 per month for blind individuals. This amount is set in stone. If you earn even a dollar more than the substantial gainful activity amount, you can no longer receive your Social Security disability benefits after your nine-month trial work period (and three-month grace period) expires, even if you are extremely disabled. Your Vancouver disability lawyer can give you the best advice about your particular situation.

If you are planning on getting a part-time job, the best strategy is to earn no more than the “trial work period services” amount, which for 2014 is $770 per month. SSA offers a limited number of trial work period months in which a beneficiary may test his or her ability to work and still be considered disabled. By earning no more than this amount, you will keep your allotment of trial work period months. You can save them for a later time when you may want to go back to work on a full-time basis.

Note that the substantial gainful activity amount rules and the trial work period rules do not apply to SSI benefits.

For the best advice about your disability claim, contact a Vancouver disability lawyer.

 

9 Tips for Applying for Social Security Disability Benefits

1. Likelihood of success. If (a) your physical or mental disability is severe, (b) your condition limits your activities of daily living, (c) your medical impairment will last or has lasted longer than 12 months, and (d) your doctor agrees with this assessment, you should apply for Social Security disability.

2. Irrelevant evaluation factors. SSA has a strict definition of disability that ignores many real-life aspects of the job market. Difficulty finding a job, thinking that no one will hire you with your condition, believing you could not pass a job-required physical, or even knowing that the pay you would receive for the work you can do is too little to live on … all of these important real-world considerations do not matter to the Social Security Administration (SSA) when evaluating your claim for benefits.

Proof from doctors

3. Medical evidence. As is the case with most legal claims, what counts in disability evaluations is what you can prove. If no medical records exist to support your claim of disability, you are unlikely to be successful. SSA figures that if your medical condition is severe enough to keep you from working, then it should justify doctor visits, tests, diagnosis, and treatment.

4. Failure to follow treatment. SSA expects you to try to get better. That means doing what your doctor prescribes. If you do not believe that your doctor’s recommended treatment will help, then be sure your doctor documents the treatment’s odds of success or failure.

5. Keep good records. Conversely, if you do follow your doctor’s prescribed treatment, document your efforts. Without records, you are unlikely to remember the date of every doctor visit, lab test, medicine taken, and therapy received. Obtain the business cards of every doctor you see and file them. Save your pill bottles. Keep notes of your pain and other medical events.

Evidence from you

6. Symptoms vs. diagnosis. SSA does not expect you to be an expert on medical conditions. Even if you are, SSA would rather learn about your impairment from your doctor and your medical records. What SSA wants to receive from you are details about your symptoms. For example, how severe is your pain? Is it constant or intermittent? What aggravates your pain? What reduces it? Do you suffer from shortness of breath or fatigue? No one knows your symptoms better than you. Do your best to explain them in detail without exaggerating or minimizing. Do not omit or gloss over any lesser conditions just because you have one severe condition and several minor ones.

7. Physical restrictions. What can’t you do? Sit for lengthy periods? Stand and walk? Lift and carry? Bend, twist, kneel, and stoop? Manipulate objects with your hands? Social Security disability is a functional program. SSA will focus on your limitations rather than your diagnosis.

8. Effect of symptoms and restrictions. How does your medical condition affect your daily activities? Tell SSA about the impact on your personal care (hygiene, dressing, bathing), errands and housework (driving, shopping, cleaning), and social functioning (hobbies, sports, interaction with friends and family).

Final point

9. Consistency, accuracy, and honesty. Contradictions, errors, memory lapses, and discrepancies all work to erode your credibility, and nothing will sink your claim faster than questions about your truthfulness.

 

An experienced Vancouver Social Security disability lawyer can help you with your Social Security disability claim

The Social Security Administration has a lot of complex regulations. Pursuing a disability claim on your own can be confusing and frustrating, and you may want an experienced Vancouver Social Security disability lawyer to help you through the process.

If you are not already represented by an Oregon or Washington Social Security disability lawyer, consider getting an evaluation from us about your claim. Give us a brief description of your claim using the form to the right, or call our office at (360)699-5405.

Marla Heikkala & Associates
Vancouver Washington Social Security disability lawyers

Street address:
6529 N.E. Hwy 99
Vancouver, WA 98665

Mailing address:
P.O. Box 61749
Vancouver, WA 98666