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The Five Steps in Determining Disability

The Social Security Administration (SSA) defines disability as the inability to do any substantial gainful activity, because of any medically determinable physical or mental impairment, which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least 12 months.

The SSA follows five steps to determine whether a claimant is disabled under their regulations. Disability must be determined in this order:

STEP 1: Are you performing Substantial Gainful Activity (SGA)?

Substantial gainful activity is defined by SSA regulations as work involving significant and productive physical and/or mental duties for pay or profit. The Social Security Administration will automatically presume that you are performing Substantial Gainful Activity if you make a certain amount of money (currently, $980 per month if you are not blind, or $1640 a month if you are blind. The reason the amount is higher if you are blind is so that the application won’t be automatically rejected).

If you are performing Substantial Gainful Activity, you are not disabled, regardless of your medical condition or your age, education and work experience. If you are not performing Substantial Gainful Activity, SSA will go on to the next step.

STEP 2: Is your impairment severe?

Severity of impairment is defined as having more than minimal impact on a person’s functioning. It must significantly limit your physical or mental ability to do basic work activities. If the Social Security Administration finds that your impairment is severe, they will go on to the next step. If not, they will find that you are not disabled.

STEP 3: Does the impairment meet or equal a listing?

SSA regulations contain specific categories of physical and mental impairments, which are designed to include every part of the body. If your impairment meets or equals specific symptoms and signs, and is documented by the required medical proof, SSA must find you disabled at this level. If not, SSA will go on to the next step. (Note that at this step, many conditions will result in a finding that you are disabled only if they fail to respond to treatment. In all cases we strongly recommend you continue to receive medical treatment for your condition as long as you can afford to do so.)

STEP 4: Does your severe impairment prevent you from performing Past Relevant Work (PRW) (if you have a work history), or any work (if you have no work history)?

Past Relevant Work (PRW) is defined by SSA as work that you performed in the last 15 years, lasted long enough for you to learn to do the job, and amounted to Substantial Gainful Activity. They look at your Residual Functional Capacity (RFC – what you can still do despite your disability) and the physical and mental demand of the work you have done in the past. If SSA does not find that your impairment prevents performance of past relevant work, they will not find you disabled. If they find that it does, they will go on to the next step.

STEP 5: Does your severe impairment prevent performance of any other work?

If SSA finds that you cannot do any of your past work because of your severe impairment, they will consider your Residual Functional Capacity and your age, education and past work experience to see if you can do other work. If you are unable to perform other work under these considerations, they will approve your claim.

The Five Step Process

The entire process can take anywhere from a month to over a year, depending on the claim, the medical records and any other evidence provided. Furthermore, at each stage of decision, the five-step process is repeated.

Although this can also become very discouraging to you at times, we cannot control the delay or speed up the process, except under circumstances defined by the Social Security Administration. We periodically check the status of our client’s claims to make sure SSA does not forget the claim and that SSA continues to process it. The process for obtaining any of the benefits Social Security potentially offers is confusing and difficult. The sooner you obtain an attorney the better. The more time we have to work on your claim, the better chance you have of a positive outcome. Attorney fees are paid only if you are awarded benefits. Nothing comes out of your continuing monthly benefits. You will, however, also be responsible for paying any costs, such as medical record expenses and gross receipts tax in addition to the attorney fees.