How Social Security Decides Disability: The Five Questions That Determine Every Social Security Disability Claim The Sequential Process

How Social Security Decides Disability: The Five Questions That Determine Every Social Security Disability Claim

Part One of Powell & Denny’s Guide to Social Security Disability Benefits

“I have serious medical problems. My doctor says I can’t work anymore. Why did Social Security deny my disability claim?”

It is one of the most common questions we hear from prospective clients.  Many people believe that qualifying for Social Security Disability benefits should be relatively simple in this situation. If they have undergone surgery, receive regular medical treatment, take prescription medication, and can no longer perform the work they have done for years, they naturally assume they qualify for disability benefits.

Unfortunately, that is not how the Social Security Administration (“SSA”) decides disability claims.

Social Security does not simply ask whether you have a diagnosis. It does not automatically approve a claim because your physician believes you cannot work. Nor does it deny a claim simply because your MRI or X-rays do not look as serious as someone else’s.

Instead, every adult disability claim follows the same legal process. Whether you suffer from chronic back pain, heart disease, diabetes, depression, anxiety, cancer, multiple sclerosis, arthritis, or another medical condition, Social Security asks the same five questions—in the same order—before deciding whether you qualify for disability benefits.

Understanding those five questions may be one of the most important things you can do before filing a disability claim or appealing a denial.

How Social Security Decides Disability

Step One:
Can You Work and Still Receive Disability?

Step Two:
What Is a Severe Impairment?

Step Three:
Do You Meet a Listing?

Step Four:
Residual Functional Capacity (RFC)

Step Five:
Can You Perform Other Work?

Chronic Pain and Disability Claims

Who Has the Burden of Proof?

Every Disability Claim Follows the Same Roadmap

Imagine taking a road trip across Alabama.  Whether you begin in Mobile, Huntsville, Birmingham, Dothan, or Florence, you eventually travel the same highways to reach your destination.

Social Security Disability claims work much the same way.

Every disability claim follows the same roadmap established by Congress and implemented through regulations adopted by the Social Security Administration. Administrative Law Judges do not create their own tests, nor may they simply decide whether someone “looks disabled.”

Instead, federal law requires the Administration to evaluate every disability claim using what is known as the Five-Step Sequential Evaluation Process.

Simply put, Social Security asks five questions, and the answer to each question determines whether your claim continues or ends.

In this article, we’ll introduce each step. In the articles that follow, we’ll examine each one in much greater detail.

Step One: Are You Working?

Surprisingly, the first question Social Security asks has nothing to do with your medical condition.  Instead, the Administration asks Are you currently engaging in Substantial Gainful Activity (SGA)?

In other words-Are you working too much to qualify for disability benefits?

If the answer is yes, your claim will usually end there.  If the answer is no, Social Security proceeds to Step Two.

Notice what has not happened yet.  Social Security has not reviewed your MRI.  They have not evaluated your pain.  SSA has not determined whether your physician believes you are disabled.

Those questions come later.

Why This Matters

Many people believe being able to return to your job automatically qualifies them for disability benefits, while some believe they can never work while applying for disability.

Neither assumption is necessarily correct.

Understanding Social Security’s work rules before filing a disability claim can prevent costly mistakes.

Related Powell & Denny Articles

• Can You Work and Still Receive Social Security Disability Benefits? (Part Two of this Series)

Isn’t my Diagnosis Enough?

What does Substantial Gainful Employment Mean?

What if I cannot Return to my Old Job?

Step Two: Do You Have a Severe Impairment?

The word “severe” often creates confusion.  Many people believe Social Security is deciding whether they are permanently disabled.

It isn’t.

Instead, the Administration asks a much narrower question: Does your medical condition significantly limit your ability to perform basic work activities?

The impairment must also be expected to last at least twelve consecutive months, or be expected to result in death.

Importantly, Social Security evaluates all medically determinable impairments—not simply the diagnosis you believe is your most serious problem.

For example, an individual may suffer from:

• degenerative disc disease;
• diabetes;
• obesity;
• depression; and
• anxiety.

Standing alone, each condition may appear manageable.  Together, however, they may significantly limit the person’s ability to sustain competitive employment.

Social Security must consider those impairments together.

Powell & Denny Practice Tip

One of the biggest mistakes we see is applicants focusing exclusively on one diagnosis.

Many successful disability claims involve several medical conditions that, when considered together, prevent a person from maintaining full-time employment.

Related Powell & Denny Articles

• What Does Social Security Mean by a Severe Impairment? (Part Three of this Series)

Step Three: Do You Meet One of Social Security’s Listings?

Many people have heard of Social Security’s “Blue Book.”  Officially known as the Listing of Impairments, it identifies medical conditions that may qualify for disability benefits if the claimant satisfies very specific medical criteria.

Some applicants assume that failing to meet a Listing means they have lost their disability claim.  Fortunately, that is not true.  Many successful disability claims never satisfy a Listing, as medically meeting or equaling a Listing is difficult.

Instead, they are approved because the evidence demonstrates the claimant cannot sustain full-time work despite not meeting every requirement of a Listing.

Why This Matters

Meeting a Listing is only one way to qualify for disability benefits.  For many claimants, the most important part of the disability evaluation has not yet begun.

Related Powell & Denny Articles

• Do You Have to Meet a Listing to Win Your Disability Claim? (Part Four of this Series)

Where Most Disability Cases Are Actually Decided

Most disability claims receive their most detailed evaluation during Steps Four and Five, when SSA evaluates functional limitations and the ability to perform work.

That evaluation occurs during Steps Four and Five.

Step Four: Can You Perform Your Past Relevant Work?

Step Four introduces one of the most important concepts in Social Security Disability law—Residual Functional Capacity, commonly referred to as RFC.

Think of your RFC as a description of what you can still do despite your medical conditions.  Social Security considers questions such as:

• How long can you sit?
• How long can you stand?
• How much weight can you lift?
• Can you use your hands throughout the workday?
• Can you maintain concentration?
• Would pain interfere with your ability to stay on task?
• Would medication side effects affect your attendance or productivity?

These questions often determine whether a claimant can return to his or her past work.

If not, the claim proceeds to the final step.

Why This Matters

Your diagnosis is important.

However, Social Security is usually more interested in how your medical conditions affect your ability to perform work-related activities than in the diagnosis itself.

That is why two people with the same diagnosis may receive very different decisions.

Recommended Reading

Federal Regulations

• 20 C.F.R. §§ 404.1545 & 416.945

Related Powell & Denny Articles

• Residual Functional Capacity (RFC): Where Most Disability Cases Are Won or Lost (Part Five of this Series)
• Can Chronic Pain Qualify You for Social Security Disability Benefits? (Part Seven of this Series)

Why your Restrictions Matter More than your Diagnosis

Step Five: Can You Perform Other Work?

If Social Security determines you cannot return to your previous work, one final question remains.  Can you perform any other work that exists in significant numbers in the national economy?

To answer that question, Social Security considers your:

• age;
• education;
• work experience;
• transferable job skills; and
• Residual Functional Capacity.

Vocational experts frequently testify during disability hearings regarding these issues.

Interestingly, this is also the point where the burden of proof changes—a subject we’ll discuss later in this series.

Related Powell & Denny Articles

• What does “Jobs Existing in Substantial Numbers Mean?
• Can You Perform Other Work? (Part Six of this Series)
• Who Has the Burden of Proof in a Social Security Disability Claim? (Part Eight of this Series)

The Bottom Line

Many people approach a disability claim believing the most important question is:

“What medical condition do I have?”  Social Security asks a different question: “Considering all of your medical conditions, are you still capable of performing substantial work on a regular and continuing basis?”

The answer often lies not in the diagnosis itself, but in how the evidence fits within Social Security’s five-step sequential evaluation process.

Coming Next

Can You Work and Still Receive Social Security Disability Benefits?

Many people believe the answer is obvious.

It isn’t.

In the next article, we’ll examine Substantial Gainful Activity (SGA) and explain:

• Can you work part-time and still qualify for disability benefits?
• How much can you earn before it affects your claim?
• What is an unsuccessful work attempt?
• Does quitting your job improve your chances of being approved?
• What mistakes should you avoid before filing a disability claim?

Understanding Step One is critical because every Social Security Disability claim begins there.