Social Security Disability 5-Step Qualification Process
Philadelphia Area Social Security Disability Qualification Criteria
When meeting with clients seeking Social Security Disability benefits, the Philadelphia Area Disability attorneys at Silver & Silver are frequently asked how the Social Security Administration will determine if they are “disabled” for the purpose of qualifying for Disability benefits. The qualification review process is a Five-Step process, addressing five basic issues. We walk our clients through the process to determine if they are eligible for benefits.
Step 1 – Is the applicant “working”?
The determination of whether or not an applicant is “working” is not as obvious as it may seem. According to the Social Security Administration (SSA), generally, an applicant is determined to be “working” if they are engaged in what is referred to as a “substantial gainful activity” (SGA). The SSA defines SGA as work that involves significant and productive duties and pays more than the current monthly income limit set by the SSA. (In 2015, the monthly earning limit for non-blind individuals is $1,090). Substantial gainful activity includes part-time work paying less than an applicant’s regular employment, and/or work with less responsibility. Work that is not paid is not considered “gainful” employment; however, if it is “substantial” in scope or responsibility, the SSA may conclude that an applicant is able to “work” and therefore is not eligible for benefits.
The “substantial” component of the activity applies to the actions and steps one takes in the process of completing their job. This can mean that physical and/or mental activity is required to complete such tasks and suitably perform the job. Most full-time jobs fall into the category of substantial gainful activity. Part-time work or brief periods of sporadic work may or may not be considered substantial gainful activity; therefore, a consultation with a Social Security Disability attorney can be helpful to determine an applicant’s work status under Social Security rules and regulations.
To determine if an activity is gainful, Social Security considers different factors for different employment scenarios. For example, if an applicant is working for someone else (an employer), then the applicant has to earn a certain amount per month to be considered “working”. The amount varies from year to year. In 2015, to be considered working for an “employer”, an applicant must be earning more than $1,090/month. If the applicant is earning less than that amount working for someone else, then he or she is not considered to be working.
If the applicant is self-employed, it becomes more complicated. It may not matter if the applicant’s work is earning a profit or realizing income. The mere fact that the applicant is engaging in substantial gainful activity that will in the future realize a profit or that it is in furtherance of a job or action in an attempt to earn a profit may be enough for Social Security to deem that the applicant is working and thus not eligible for Social Security benefits. A Social Security Disability attorney can be vital to guiding the applicant through this somewhat confusing process.
Step 2 – Does the applicant have a “severe” condition?
The Social Security Administration determines whether the applicant’s condition is considered “severe” based on whether their condition interferes with basic work-related activities. The term “severe” should not discourage an applicant from moving forward with their claim for Social Security benefits since the SSA tends to apply a relatively low standard of what is considered “severe”.
Generally, if an applicant’s medical or mental condition is significantly interfering with basic work-related activities, then the applicant’s condition is considered “severe”. If an applicant’s condition does not significantly limit their work activities, the impairment will be considered “not severe”. Since medical conditions cover the range of severity from “not severe” to “incapacitating”, it is the cumulative effect of the applicant’s condition(s) on his or her ability to function mentally or physically that is important, not just the presence of diagnosed medical conditions. A Social Security Disability attorney can advise an applicant of what needs to be proven for Social Security to find that his or her condition is “severe” under the Social Security Administration’s guidelines.
Step 3 – Is an applicant’s condition on the “list of disabling conditions”?
If an applicant’s condition is on the “list of disabling conditions” as set forth by the Social Security Administration, then the applicant will be considered disabled by Social Security and therefore eligible to receive Social Security benefits.
The list of disabling conditions includes many conditions, both physical and mental. The listings include conditions related to muscular/skeletal problems, respiratory problems, problems with a person’s speech or other senses, cardiovascular/heart conditions, digestive problems, neurological disorders, mental disorders, immune system disorders, and numerous other types of conditions.
Even if an applicant’s condition is not on this list, he or she may be found to be disabled and entitled to Social Security Disability benefits if the applicant can successfully demonstrate that the condition is of equal severity to a condition that is on the list. An experienced Social Security Disability attorney can be very helpful in proving that an applicant’s impairment is as debilitating as the conditions on the list and interferes with the applicant’s work-related activities to the same extent.
Step 4 – Can the applicant do work they previously performed?
Next, a determination has to be made as to whether an applicant can do work previously performed. If it is found that an applicant can perform their previous work, then they will not be considered disabled and will not be granted disability benefits. When making this determination, the SSA will look at the activities and requirements of an applicant’s past work and compare it to the limitations caused by the applicant’s condition. The SSA will consider “past relevant work” as any work an applicant has performed in the last fifteen years. Whether the applicant’s position is still available is not a relevant issue for Social Security Disability eligibility purposes. Instead, the relevant issue is whether or not the applicant is physically and/or mentally able to perform the work if it were available.
The SSA looks to the requirements of “past relevant work” when determining an applicant’s ability to return to that position. For example, did the applicant’s past work require physical exertion, and, if so, how much? In this evaluation, the SSA will look for evidence answering such questions as:
- Did the applicant lift objects?
- How many pounds did they have to lift?
- How often did they have to lift?
- Was the applicant required to stand?
- If so, for how long?
- Was the applicant’s past work at a skilled position?
- If so, what types of skills were needed?
These are just a few of the many questions that may have to be answered regarding an applicant’s past work.
Because this step of an applicant’s eligibility for Disability benefits is extremely complicated and confusing, the assistance of an experienced Social Security Disability attorney can be essential to a successful benefit claim.
Step 5 – Can the applicant do any other work?
Once the Social Security Administration determines that an applicant can no longer perform the activities required for his or her “past relevant work”, the SSA will consider if an applicant can perform any other work. In this determination, the SSA will take into account the applicant’s age, education, past work skills and experience, as well as their medical/mental condition.
Social Security will consider the applicant’s “residual functional capacity” to perform a job with his or her current condition. One’s residual functional capacity is a determination of an applicant’s abilities, limitations and restrictions. Some of the areas assessed include:
- The amount of weight an applicant can carry or lift
- The length of time an applicant can stand and/or sit continuously
- The applicant’s mental limitations with respect to working with other employees or the public
- Environmental restrictions
Age is also a significant factor because the Social Security Administration does recognize that as a person gets older their ability to learn new skills diminishes. Generally, the SSA recognizes that it is much more difficult for a person over the age of fifty to learn new skills and that physical capability also diminishes at this age. What a person can lift or carry at age twenty five may be very different than what they can lift or carry at age fifty five.
In order to deny a claim, the SSA does not have to find a particular position for an applicant with pay equal to an applicant’s past work, of equal skill, or near where an applicant lives. Rather, the SSA simply must determine that there are positions that the applicant could theoretically perform in their present condition. If, after considering all the factors, it is determined that the person does not have enough “transferable skills” to do other work, the applicant will likely be found to be disabled and eligible for Social Security Disability benefits.
Call the Philadelphia Area Social Security Disability Attorneys at Silver & Silver to Help You Navigate the Disability Claim Process
The Philadelphia Social Security Disability attorneys at Silver & Silver guide our clients through the SSA’s Five-Step analysis to help ensure a successful Disability claim. Our attorneys work diligently to gather the necessary evidence so that our clients’ applications for benefits are presented in the most favorable light.
If an appeal to an Administrative Judge becomes necessary, our experienced, skillful litigators are prepared to fight for our clients’ rights in court. We strive to provide superior legal representation so that our clients will be awarded the Disability benefits to which they are entitled.
With offices in Ardmore, Pennsylvania, we are conveniently located to meet with disabled individuals and their families throughout the Philadelphia region including Delaware County, Montgomery County, Bucks County, Chester County and Berks County, as well as the South Jersey communities of Camden County, Burlington County, Gloucester County, Cumberland County, Atlantic County and others. Call us to schedule a free consultation at 610-658-0500 or 1-800-94-SILVER or contact us online and we will be respond to your inquiry within two business days.