Five Step Process

The five steps of adult sequential evaluation of disability. The decision on whether an adult is disabled is based on a five-step sequential evaluation process. All SSA adjudicators follow this process. If the claimant is not disabled at a given step, the sequential evaluation ends.

Step #1. Are you working?
To be eligible for disability benefits, a person must be unable to engage in substantial gainful activity (SGA). SGA is a monthly income amount that the SSA sets. This amount changes every year. For 2018, the SGA amount is $1,180.

If you are not working, we will send your application to the Disability Determination Services (DDS) office that will make the decision about your medical condition. The DDS uses Steps 2-5 below to make the decision.

Step #2. Is your condition “severe”?
Is to consider whether you suffer from a severe physical and/or mental condition? This threshold is fairly low, requiring a showing of more than a minimal impact upon your ability to work. In other words, the claimant must prove you suffer from a medical condition that poses an impact upon your working ability.

Step #3. Is your condition found in the list of disabling conditions?
For each of the major body systems, we maintain a list of medical conditions that we consider so severe that it prevents a person from completing substantial gainful activity. If your condition is not on the list, we have to decide if it is as severe as a medical condition that is on the list.

Compassionate Allowances plan. In addition, SSA has two fast-track processes, Quick Disability Determinations (QDD) and Compassionate Allowances (CAL). Given the applicant’s medical conditions, QDD use a computer-based program to screen initial applications where a disability determination is highly likely. Example includes acute leukemia, amyotrophic lateral sclerosis [ALS], and pancreatic cancer.  The model allows these high-likelihood claims to receive priority and be expedited in cases involving more serious impairments.

Step #4. Can you do the work you did previously?
An individual’s residual functional capacity (RFC) is the most they can physically or mentally do in spite of their medical condition. This is not the average they can do, but the absolute most they can do. To determine RFC, the SSA will review an individual’s medical records for a list of their conditions, treatment, symptoms, and limitations. The SSA will then take that information and determine your functional capacity, both physically and mentally. Once the SSA has determined what you are physically and mentally capable of, the organization will determine when your limitations prevented you from performing your past relevant work. Past relevant work is any work you have performed in the past fifteen years in which you earned SGA, while performing the job long enough to learn it. This can be very important to your claim depending upon your age and your RFC. This analysis is where things start to become very tricky, and where age becomes a huge factor.

Step #5. Can you do any other type of work?
If you can’t do the work you did in the past, we look to see if there is other work you could do despite your impairment(s). We consider your medical conditions, your age, education, past work experience, and any transferable skills you may have.

The general concept is that if you are age 50 to 54 and found to have a sedentary RFC, with an inability to perform the work you have done in the past fifteen years, you will be found disabled. This effectively means you can be found eligible for disability benefits, even though there are jobs available to you at the sit-down level. Once an individual reaches age of 50 it would be too difficult to retrain you to perform a sit-down type of position. And as one continues to age, the rules continue to become even more relaxed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(6) above chart prepared by ssa.gov.

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citations:
(1) Code of Federal Regulations (CFR) in appendix 1 to subpart P of part 404
(2) ssa.gov/disability/professionals/bluebook
(3) DI 22001.001
(4) 20 CFR 404.1520 and 416.920
(5) Physical Residual Functional Capacity Assessment (RFC), SSA-4734
(6) 5 step process chart: ssa.gov
(7) Disability Benefits, Publication No. 05-10029

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