5 Step Evaluation

Social security disability can be a complicated process, requiring several steps to proving you are disabled. The complication ultimately begins with how social security defines disability. Social security defines 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.” To prove you are disabled under this definition, social security will evaluate your disability using a five-step sequential evaluation process. That is a fancy way of saying they will review your claim using 5 steps. Part of that process requires you to first submit an application for benefits. Simply put, you must apply for the benefits so that social security can then determine if you are disabled or not. An application can be done online, in person, or over the phone. We recommend completing your application online for two reasons. First, it gives you the opportunity to start and stop the application at your leisure. Second, and more importantly, when you submit the application online you receive a receipt showing that you applied for the benefits at a certain date and time. You would be surprised, or maybe you wouldn’t, how often social security misplaces an individual’s application for benefits. Having a receipt of the application makes proving the date you filed all the easier. In some cases, the filing date can mean the difference of when your Medicare health insurance starts or the amount of back pay you would receive. All very important things.

 

Once an application has been submitted, social security will then begin the five-step evaluation process. The first step in the process is to determining if you are performing “substantial gainful activity”, as termed in the definition. Substantial gainful activity is generally the work you are performing where your earnings exceed a set monthly amount. That set monthly amount changes from year to year. In 2021, the monthly SGA amount is $1,310. If you are working and earning more than $1,310 per month in gross earnings, you are technically ineligible to receive disability benefits as the definition requires an individual to be unable to engage in substantial gainful activity. It should be noted, if you are earning less than SGA, that must be due to a medical condition, not your own volition. We will discuss further in step 2.

 

Step 2 of the five-step process requires proof that your income is limited due to a severe physical and or mental impairment. If your inability to work is related to anything but a medical condition, then you will be denied at step 2 of the evaluation process. For your claim for disability benefits to continue you must show you suffer from a severe physical or mental condition that poses more than a minimal impact upon your ability to engage in substantial gainful activity. The severity of your condition is proven through the use of medical records. Social security will need medical proof not only of a medical diagnosis but also treatment notes documenting how your diagnosis limits you or what symptoms your condition causes you. It is not enough to just be diagnosed with a medical condition. That medical diagnosis must impact your ability to work in some way.

 

If you are found not to be engaging in substantial gainful activity and your medical conditions are deemed severe, then social security will review your claim under step three to determine if you meet or equal a listed condition. The social security listings, generally speaking, are a list of conditions in which social security have deemed so severe that if you have the medical evidence to support the listing you will be found disabled at step three of the evaluation process. The Listings comprise a number of medical conditions and are broken down by category such as musculoskeletal, respiratory, cardiovascular system, mental disorders, etc. There are a total of 14 categories of listings containing hundreds of conditions. It is quite difficult to prove you meet or equal a listing. In fact, most people are not found disabled based upon a listing but at steps four and five of the process.

 

If you are not found disabled based upon a listed condition, social security will then determine your residual functional capacity before reviewing your claim under steps four and five of the process. In determinizing your residual functional capacity, social security will review your medical records to evaluate your physical and mental capabilities. Essentially determine what you are functionally capable of doing in spite of your medical conditions. Once your residual functional capacity is determined, social security will then determine if you are capable of performing your past relevant work under step four of the process.

 

Not all work qualifies as past relevant work. For your work to qualify as past relevant work you must have worked the position long enough to learn it, earned SGA level earnings, and the work must have been performed within the past fifteen years. If your past work does not meet all of these criteria then social security will not consider if your residual functional capacity allows you to perform that work.

 

Assuming social security determines your residual functional capacity precludes you from performing your past relevant work, they will then evaluate your case to see if there is any other work you may be able to perform in the national economy that exists in significant numbers. Social security has not specifically defined what counts as “significant numbers.” The general rules are that if there are more than 12,000 that may be performed with your functional abilities then you will be found disabled. Of course, there are always exceptions to every rule. One of the main exceptions at step five of the process has to do with your age. If you are over a certain age, social security will use the medical vocational guidelines to assess your ability to perform other work.

 

If all of this sounds confusing that is because it is. While social security’s intent was not to create a complicated convoluted process, the application process is certainly not easy. At the LaBovick Law Group we know exactly how to navigate the application process so as to put forth the best legal argument to win you disability benefits. Call us today at (561) 625-8400 for a free consultation.

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