The Social Security Administration has a strict definition of disability that relies on what they call the “5 Step Sequential Evaluation.” This definition is used for both SSDI and SSI cases. The legal definition is:
“the inability to engage in any substantial gainful activity by reason 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 not less than 12 months. . . an individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy.” (42 U.S. Code § 423 (d)(1)(A) and (d)(2)(A)).
To win a disability case you have to show you meet every part of the 5 Step Sequential Evaluation. The 5 Step Sequential Evaluation is a 5 step test used to determine whether or not an individual’s situation complies with the legal definition of disability. The test looks at your life from a medical and vocational stand point and asks:
- Are you able to engage in substantially gainful activity?
- Do you have a severe impairment?
- Do you meet a medical listing?
- Can you go back to the lightest job you’ve held in the last 15 years?
- Is there another job in the national economy you are capable of performing?
Step #1 – Are you unable to engage in substantially gainful activity?
Under the first step, substantially gainful activity is defined for 2014 as earning less than $1,070 a month. The Social Security Administration does not require that you survive on nothing, but they do require that you survive on very little to qualify for this benefit. If you make even a dollar more than this quantity of money, you will not qualify.
Step #2 – Do you have a severe impairment?
Under the second step, the Social Security Administration wants to see that your disability is going to keep you out of work for at least 12 months and that your disability is demonstrated by medically objective tests. What’s a medically objective test? Medically objective tests are tests like X-rays, blood tests, CT scans, nerve conduction studies, etc. Although your doctor’s opinion is extremely valuable in determining whether you have a severe impairment, the Social Security Administration wants to see unbiased evidence that is not influenced by opinion.
Step #3 – Do you meet a medical listing?
The Medical Listing of Impairments is a book used by the Social Security Administration to determine whether your disability automatically complies with the legal definition of disability. The book is divided into body systems like the digestive system and nervous system.
If you had Huntington’s disease, the Social Security Administration would open up to chapter 11.00, Neurological Disorders, and look for section 11.17 which deals with degenerative diseases. That section contains a list of specific criteria that must be present in your medical records to qualify as legally disabled. Most people don’t meet a medical listing, not because they don’t have a real disability, rather because physicians did not go to medical school to learn how to write a report specifically for the Social Security Administration.
Not meeting a medical listing does not mean that you will not be awarded disability benefits, it just means that you go on to steps 4 and 5.
Step #4 – Can you go back to the lightest job you’ve held in the last 15 years?
At step 4 the Social Security Administration reviews your job history, and your testimony about your past work and compares it against your current level of physical and mental functionality. They categorize your work using another book called the Dictionary of Occupational Titles. This book contains a description of every job that exists in the United States. It defines how long it takes to learn, the required skill level, and which of the four physical exertion categories is required to do the job: Heavy, Medium, Light or Sedentary.
If any of your past work is considered light or sedentary, and your medical records indicate that you could do a sedentary job or greater, you will be deemed capable of returning to that job and be denied benefits. A winning case is one that has functional limitations of less than sedentary. If you are deemed incapable of going back to any of your past work, you go on to step 5.
Step #5 – Is there a job in the national economy you are capable of performing.
The test at step 5 simply asks if there is a job somewhere in the country in significant numbers that you are capable of performing based on your age, education, and transferable skills. It is not a real world test. They are not asking whether there is a job in your area, in the State of Utah, or that someone would actually hire you to do. The only question is whether a job exists.
After the judge decides what your physical exertion category you fall into, a Vocational Evaluator will review your medical file and your work history and determine what jobs exist that could accommodate your physical and mental limitations.
If you can prove that your physical and mental limitations are significant enough that you can’t do any of the jobs suggested by the Vocational Evaluator, then you will be awarded benefits. Otherwise, you will be denied benefits.
Successfully proving every point of the 5 Step Sequential Evaluation can be complicated and confusing. If you’re interested in pursuing a Social Security Disability claim now, call the Utah attorneys at the Summit Disability Law Group. We will walk you through the whole process in a free consultation so that you understand how a claim works and how to avoid the major problems that keep people from getting the benefits they deserve. Call us at today to set up your FREE consultation.
Image courtesy of United States Government