For every adult disability, SSI, widow’s or widower’s benefit claim, the five step sequential evaluation process must be followed to determine whether or not the claimant is disabled. The steps must be followed in a set order. If SSA finds that a claimant is or is not disabled at a step, the evaluation process ends. If they cannot find the claimant either disabled or not disabled at a step, the process then proceeds to the next step. Before SSA can go from step three to step four, however, the claimant’s residual functional capacity must be assessed. This assessment is then used at both steps four and five.
Step 1: Are You Engaged in Substantial Gainful Activity?
Just because a person is working does not automatically disqualify them from pursuing disability. However, the work activity must fall below Substantial Gainful Activity (SGA). Engaging in SGA basically means you are making reasonably enough income to live based on the cost of living, therefore you cannot be considered disabled and in need of the financial help disability benefits provide. The current SGA amount for 2020 is $1,260. If your earnings fall below SGA, or you have no income at all, your claim proceeds to step two.
Step 2: Are Your Impairments Severe?
A severe medical impairment significantly interferes with an individuals either physical or mental ability to do basic work activities. If your impairment is found to only mildly interfere with basic work activity, you will not be found disabled. This can be a single, severe impairment or a combination of impairments that is severe, and is expected to last at least twelve consecutive months. If your impairment or combination of same is found to be severe by SSA, proceed to step three.
Step 3: Do Your Impairments Meet or Equal a Listing?
At this step, the severity of your impairment or combination of same is also considered. If they meet or equal one of SSA’s listings, you will be found disabled. The complete list can be found here: http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm. Once this is determined, proceed to step four.
Step 4: Are You Able to Return to Your Past Relevant Work?
At this step, your residual functional capacity (RFC) is assessed to determine whether or not you are able to return to your past relevant work (PRW). Past relevant work is the work you did within the last fifteen years, that was SGA, and that you performed long enough to learn how to do it. Ideally, your doctor would test your abilities (such as how much you can crouch, stoop, handle objects, walk, sit, etc.) and complete a RFC form that outlines your limitations. One of the benefits of hiring an experienced disability representative is that he or she will work with your doctor to get this information for SSA. If your limitations are as such that you cannot perform your past work duties, proceed to step five.
Step 5: Can you Adjust to Other Work?
If you cannot go back to your past relevant work, SSA then considers your age, education and work experience to determine whether you can perform other work. If you previously performed work that was considered “heavy,” you may be able to adjust to other work that is considered “medium” or “light.” If you can perform other work, you will not be found disabled. SSA utilizes the Medical-Vocational Guidelines, also known as the “grids,” to help make this determination. The guidelines take into account your impairment(s), age, education and work experience. However, the grids only address exertional limitations.
Because individuals are not always found disabled by the grids alone, other factors are considered by SSA. Other factors can include mental impairments, postural, manipulative, communicative and environmental limitations, as well as side effects from medication, pain, and fatigue levels. In cases such as these, vocational testimony is vital in order to determine whether someone can adjust to other work. If you cannot adjust to other work, you will be found disabled by SSA and the process ends.
Summary of Five Step Sequential Evaluation Process
This is a brief summary of how the five step sequential evaluation process works. Of course there are exceptions to this process, as well as slightly different rules for individuals already receiving benefits. This is why it’s advisable to consult an attorney who specializes in disability to help you understand this process better.