How to Qualify for Disability

January 10, 2018 in

When applying for Social Security Disability you will be asked several questions to make sure you qualify for the program. There are two parts to this qualification. First, you need to have disability insurance coverage. Second, your condition must meet Social Security’s definition of disability. When an individual works, they are required by the Federal Government to pay taxes on their working income. Part of those taxes goes towards the Social Security System. Social Security provides benefits for retirement, disability, and Medicare. When you pay taxes on your income into the Social Security system you are not only paying money into your individual retirement fund, but you are also paying money towards disability insurance coverage. This is similar to a premium you might pay for other types of private insurance. Unlike private insurance, the Social Security Disability Insurance program is mandatory. You do not have an option to not pay taxes into this program.

To obtain the disability insurance coverage you must have worked and paid taxes for the past 5 out of 10 years. Or, you must have obtained 20 quarters of earnings out of the past 40 quarters. One-quarter of coverage represents $1,300 in earnings for 2017. You are eligible to earn up to 4 quarters of coverage per year. What this means is that in 2017 as long as you earned approximately $5,200 you will have maxed out your earnings for that year. If you earn 4 quarters of coverage for the past 5 out of 10 years you will be eligible for coverage under the Social Security Disability Insurance program. One thing to keep in mind is that while you may have coverage, that coverage will not last forever. Generally, you have five years from the date you stop paying income taxes to keep your disability coverage. All this means is that you would need to prove your disability began prior to your disability insurance coverage expires.

To prove you are disabled, you must show you meet Social Security’s definition of disability. Social Security defines disability as suffering from a severe physical and/or mental impairment that prevents you from earning substantial gainful activity for a twelve-month time frame. One exception to the 12-month duration requirement is if you are diagnosed with a terminal condition. In this situation, you will not be required to show your condition is going to last 12 months as may not survive that long.

Step 1

When determining if you meet the definition of disability, Social Security will perform a 5 step analysis of your claim. First, they will determine if you are currently working. If you are working and earning over substantial gainful activity then you will automatically be disqualified from the program. Substantial gainful activity is a monthly monetary amount that SSA has determined to be large enough to preclude you from the program. This amount changes on a yearly basis. In 2017, SGA was $1,170. So, if you were grossing over $1,170 per month you would not be eligible for the disability program. Of course, there are always exceptions to every rule. In this instance, if you are working but are only able to earn over SGA for 3 months due to your medical condition this may be classified as an unsuccessful work attempt, thus still being eligible to apply for the disability program. The work requirements can be quite tricky for the disability program. If you’re working but you think you may meet the qualifications of disability, I recommend you seek counsel from an experienced disability attorney. They will be able to tell you quickly if you are automatically disqualified from the program or if you are able to progress to Step 2 in the disability analysis.

Step 2

The second step in the analysis considers whether your medical conditions pose a severe impairment for you. Severity is generally a low threshold. As long as the condition poses more than a minimal effect upon your ability to work then your condition will be deemed severe. Conditions that are noted to be controlled or stable, will most likely not be considered severe. But as longs as your condition poses limitations to your physical or mental capabilities then you will be able to progress to Step 3.

Step 3

Step 3 in the analysis considers whether you meet one of Social Security’s Listing. The Social Security Listings are medical conditions that most obviously meet the definition of disability. If you are found to meet a listing then the analysis will stop right here, with approval at Step 3. To prove you meet a Listing you must have sufficient medical evidence to document each of the required symptoms or limitations for the conditions. These symptoms and limitations are set forth by the Social Security Administration. For example, if you suffer from back pain, SSA will most likely consider whether you meet Listing 1.04. This Listing requires a diagnosis of a disorder of the spine resulting in a compromise of a nerve root or the spinal cord with evidence of nerve root compression or spinal arachnoiditis. Or, if you are diagnosed with lumbar stenosis which results in an inability to ambulate effectively. To prove you meet this Listing you will likely need imaging reports such as MRIs or X-Rays to document the condition, as well as treatment notes documenting your ability to ambulate. It is quite difficult to prove you meet one of Social Security’s Disability Listings. If you are not found to meet a Listing do not be discouraged. There are still steps 4 and 5 to consider.

Before considering Steps 4 and 5, SSA will determine what your maximum functional capacity is. This is done by determining what you are physically and mentally capable of doing in spite of your conditions. This determination considers not only what you are physically able to do but also what you are mentally able to do. Once your functional capacity is determined, SSA will then move on to Step 4.

Step 4

At Step 4, SSA will consider whether your functional capacity precludes your ability to perform past work. Past relevant work is defined as any work you have performed within the past 15 years that was performed at the SGA level. SSA will not consider the jobs you did 30 years ago. They will only look at the most recent past, that being 15 years. IF any of the jobs you performed in the past 15 years did not rise to SGA level activity those jobs will not be considered at Step 4. If SSA determines your limitations do not preclude your past work then you will not be found disabled. However, if your past work is precluded with the limitations then SSA will move on to Step 5.

Step 5

Step 5 considers whether there are jobs available that you could perform in spite of your residual functional capacity. If there are jobs available, no matter if you have performed them previously or not, you will not be found disabled. This is one area of great confusion for most people. Social Security disability is not a private disability program. This program, unlike private disability, requires an inability to not only being able to perform your past work but other work in the national economy as well. IF you are found to not be able to perform any other work then SSA will find you meet the definition of disability.