What are the steps to get approval for disability benefits?
That is the question everyone asks when considering applying for SSDI.
Social Security disability claims can be lengthy and complex.
However, the process of how the SSA reviews a claim is usually the same, and it consists of 5 steps.
In this article, Pinyerd Law, a seasoned disability law firm, will share how the SSA’s 5-step evaluation process works. You’ll learn what you’ll be assessed for when applying for Social Security disability benefits.
What Is The SSA’s 5-Step Sequential Evaluation Process?
When the Social Security Administration (SSA) receives a claim, they use a 5-step sequential evaluation to determine whether the claimant is eligible for benefits.
The 5-step evaluation involves a series of questions that address medical and vocational factors. This approach assesses each case with a level of precision that leaves no room for ambiguity.
This process is the same when applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
5 Steps Social Security Uses To Determine Your Eligibility
Each step of the evaluation process is presented in a question format by the SSA’s adjudicator or decision-maker. If they find the claimant is eligible, they move on to the next step, and so on, until the last one:
Step 1: Financial Eligibility – Are You Working?
First and foremost, the SSA will check if you are currently working.
As you might know, to be eligible for Social Security disability benefits, your impairment must prevent you from working.
A disability that doesn’t hinder your work capacity will be immediately rejected.
However, you may still be able to do some work. Let’s explain this further.
The SSA uses Substantial Gainful Activity (SGA) to measure your work activity and earnings level.
As of 2024, this is the monthly SGA you can earn to receive disability benefits:
- Non-blind individuals: $1,550 per month
- Bling individuals: $2,590 per month
What happens if you secure disability benefits and then start working? If you surpass the SGA cap, your benefits will end.
Step 2: Impairment Severity – Do You Have A “Severe” Medical Condition?
As mentioned above, your disability must stop you from performing your job. Additionally, your disability must be expected to last for at least 12 months.
A health condition that’s not severe enough to negatively impact your work ability and daily life tasks is unlikely to grant you disability benefits.
Some people have severe impairments but are still able to perform their job duties without restriction. For example, suppose someone has severe diabetes but controls it by taking medication; their impairment will be considered “not severe.”
The SSA employees will review every piece of medical evidence you provide to decide whether you have a qualifying condition.
It’s essential you submit relevant and up-to-date medical proof to support your claim.
A disability attorney can review your case, find and improve weak spots, and help you gather medical records to enhance your case.
Step 3: Impairment Criteria – Does Your Disability Meet The SSA Definition?
The SSA has its own definition of disability to review SSDI and SSI cases.
Your impairment must match one of the many conditions included in the Listing of Impairments. Even if your health condition isn’t listed, you can still qualify through an equivalent disability.
The impairment listing has 14 categories. Depending on your ailment type, the SSA will review it under a specific category.
For example, if a claimant has a breathing-related disability, it will be evaluated under Listing 3.00, Respiratory System. However, an individual with an immunological impairment will be reviewed under Listing 14.00 Immune System Disorders.
Again, to prove your disability meets the listing criteria, you must submit strong medical evidence.
Step 4: Previous Employment – Can You Perform Your Past Work?
The SSA will ask, “Can you perform your previous job?”
If the answer is “yes,” you won’t be granted disability benefits.
At this step, the claimant must showcase that they cannot perform their old job due to their impairment.
A doctor will perform a function-by-function and residual functional capacity (RFC) assessment to measure your ability to sit, stand, lift, communicate, and complete diverse on-the-job tasks.
If the doctor’s diagnosis says you have the physical and mental capacity to do your old job, the SSA won’t consider you disabled.
Step 5: Work Capacity – Can You Perform A New Work?
Did the doctor determine you can go back to your previous job?
In this last step, the SSA will try to find a new line of work you can perform.
A final medical-vocational examination will estimate your ability to get a new job based on age, career experience, skills, and educational level.
If the adjudicator decides you can do other types of work, you won’t receive benefits. However, if they resolve that you cannot perform other jobs, you’ll get approval for disability benefits.
Need Help To Win Social Security Disability Benefits?
The SSA’s 5-step sequential evaluation process is stringent and complex.
To win your claim, you must gather enough medical evidence that showcases that you can no longer work due to your health impairment. You must also prove your disability hinders your ability to secure a new job.
An experienced disability lawyer can help you build a strong case and go through each one of the 5 steps of the process smoothly. The better prepared you are, the more chances you have of securing Social Security benefits.
