In order to make a determination on disability applications the Social Security Administration (SSA) has created an evaluation process to assess claims.
The SSA considers a person disabled when they meet the qualifications of the medical listings, they cannot perform the work they did before and they cannot transition to another type of gainful employment. Disability determinations are not made on a temporary basis and the condition must have lasted, or be expected to last for at least 12 months.
Understanding sequential evaluation
When a SSA examiner reviews a case for disability they follow a five step sequential evaluation process. Each step asks a question about the applicant’s work history and claimed disability to determine if the applicant meets the SSA’s qualifications for disability eligibility. The steps are completed in a set order and if the examiner finds an individual disabled or not disabled at any of the steps the evaluation ends.
Steps four and five of the evaluation consider an applicant’s Residual Functional Capacity (RFC). The RFC is an assessment of an individual’s ability to perform sustained work activities despite limitations resulting from their impairment. The SSA considers eight hours per day for five days a week as the standard for performing sustained work-related activities.
Five step evaluation process
To determine disability eligibility, the SSA examiner will ask the following questions in order, only moving on to the next question if the determination cannot be made at the current step.
- Is the individual engaging in substantial gainful activity? An applicant’s total earnings must be less than the SSA maximums, which change annually. If an applicant is not working or their income averages less that the SGA limit the evaluation continues.
- Is the applicant’s condition medically severe? The condition, whether mental or physical, must be severe enough to interfere with work related activities and meet the 12 month duration requirement.
- Does the applicant’s impairment meet a SSA listing? The condition must be listed in the SSA listing of conditions or be medically equivalent to a condition.
- Does the applicant’s impairment prevent him or her from performing Past Relevant Work (PRW)? The applicant’s RFC must prevent him or her from performing PWR as they used to when previously working. The applicant’s RFC must also prevent him or her from performing the work however it is performed by other workers in the national economy.
- Is the applicant able to transition to another type of work? The examiner will consider the applicants age, education and work experience to determine if the applicant is able to transition to another type of work.
Disability is based on an individual’s inability to work, which is determined by an examiner during the sequential evaluation. The cornerstone of any disability application is based on a comprehensive medical record which proves an applicant’s impairment. If an application for disability is denied by the SSA examiner, the applicant can request an appeal.