How Does Social Security Decide if Someone is Disabled?

While many of us spend a great deal of time working to succeed in our jobs and careers, few of us think about what we would do if we become too ill or have an injury that keeps us from working. The Social Security Administration estimates that just over 1 in 4 of today’s 20 year-olds will become disabled before reaching age 67.https://www.ssa.gov/planners/disability/

For those already facing this dilemma, it is likely confusing as to why their cases are being denied by Social Security. So, how does Social Security decide if a person is disabled and entitled to disability benefits?

Whether a claim is being decided at the initial application level, the reconsideration level, or the hearing level, the process is always the same. All claims undergo a sequential evaluation that has 5 steps. The following provides some information about what Social Security will consider at each step.

Step 1. Are you working or have you worked during any time period for which you are claiming disability?

This sounds simple enough, right? Unfortunately, it’s only simple if your answer is “No”. With a “No” answer, you can move on to Step 2.

If your answer is “Yes”, then Social Security needs to take a look at the amount of money you were able to earn or are earning at present to decide if your work activity precludes you from receiving disability benefits. Most people I speak with are surprised that someone can have part-time work and still be eligible for disability benefits. However, Social Security recognizes a person may have some residual ability to work, but may not be able to sustain work activity required for full-time employment. For those involved in part-time work, the key factor is how much one is able to earn for the work they can perform. For the year 2016, if your work activity has resulted in earnings more than $1,130 a month gross, you generally cannot be considered disabled and will not advance to Step 2 in the analysis. If your earnings are less than $1,130 per month, then the analysis continues.

Step 2. Do you have a severe impairment?

You must have a condition or illness that interferes with basic work-related activities for your claim to be considered. Work related activities include (but are not limited to) walking, sitting, standing, lifting/carrying, ability to concentrate or interact appropriately with others, etc. If you cannot identify to some type of problem that your condition causes with your ability to work any job, then the condition may be considered by Social Security to be non-severe and you cannot get disability benefits. Once at least one work related activity is shown to be impacted by your condition, it is time to move on to Step 3.

Step 3. Does you condition meet a Listing Level Impairment?

For each of the major body systems (and there are 14 major body systems recognized by Social Security – Musculoskeletal, Special Senses/Speech, Respiratory, Cardiovascular, Digestive, Genitourinary, Hemotological, Skin, Endocrine, Congenital Conditions, Neurological, Mental Illness, Cancer/Neoplastic, and Immune System), Social Security maintain a list of medical conditions that are so severe they automatically mean that you are disabled. So, if your condition meets or is equivalent to “Listed” condition, you qualify for disability without having to go on to Steps 4 and 5.

Step 4. Can you still do the type of work you did previously at a full-time schedule?

If your condition is considered severe at Step 2, but not at the same or equal level of severity as a medical condition on the list in Step 3, then Social Security will next determine if your condition interferes with your ability to do the type of jobs you have done in the past 15 years. Any work performed more than 15 years ago is considered out of the relevant time period since it is likely that the way the job is performed is likely to have changed or perhaps no longer even be a job that is available due to technological or other changes in the work place. If your condition is severe, but it does not preclude you from doing your past work,your claim will be denied. If it does, then your claim proceeds to Step 5, the final step.

Step 5. Can you do any other type of full-time job that exists in sufficient numbers?

If you cannot do the work you did in the past, Social Security will look to see if your medical condition prevents you from doing any other type of work. This analysis takes into account not only your medical condition, but your age, education, past work experience and any transferable skills you may have. If Social Security finds that due to all of these factors you cannot adjust to other work that exists in the economy, your claim will be approved. If you can still perform full-time work of any kind, your claim will be denied. This is true regardless of what the job may pay. For instance, we represented a registered surgical nurse that was 40 years old and making over $60,000 when she developed a disabling condition that did not allow her to stand or walk longer distances. She was limited to a sit-down type job. Because she could perform the job of a receptionist or hotel desk clerk that generally makes less than $25,000, she was denied disability benefits. The wage or salary of the job is not taken into consideration by Social Security when analyzing disability.

Most denied claims for disability happen at Step 5. If medical records are not clear about your ability to do exertional activities such as standing/walking/sitting/lifting/carrying, Social Security will rely on the opinions of contracted doctors they use to review your records or do exams. These doctors will rarely ever opine that someone is limited enough to be disabled. Thus, a denial would be in your cards.

Having an experienced attorney to help put together the right kind of evidence to support your claim for disability is very important. The disability attorneys with Syfrett, Dykes & Furr have handled thousands of disability cases involving a wide variety of disabling conditions. We have developed relationships with many of the doctors in our area which is important when it comes time to get extra information about your condition and why it may be disabling. And, we only get paid for our work when you win your claim. Because of the legal complexities in proving disability and because there seems to be this growing atmosphere of denial in Social Security, having an attorney to help navigate the system is a must.

If you have questions about your Social Security disability claim, contact the experienced disability attorneys with Syfrett, Dykes & Furr. (850) 795-4979.