What Is the Five-Step Process for Evaluating Disability Claims?

 Posted on February 26,2021 in Social Security disability

If you have suffered an injury, an illness, or another physical or mental condition that has caused you to be unable to work, you may rely on public benefits to meet your needs. Social Security disability benefits, which may include Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), can provide much-needed income that will allow you to cover your daily living expenses. However, your application for these types of benefits may be denied. If you appeal this decision, your case will be reviewed by an Administrative Law Judge (ALJ), who will follow a five-step “sequential evaluation” process to determine whether you are disabled and whether you should receive benefits.

Understanding the Five-Step Sequential Evaluation Process

To be considered disabled, a person must have been unable to participate in substantial gainful activity (SGA) for at least 12 months, or the condition that prevents them from engaging in SGA must be expected to last at least 12 months or result in death. When evaluating a claim, an ALJ will look at the five following factors, in order:

1. Is the person currently working above SGA level? If you are currently working and earning an income that is at least the amount that the Social Security Administration considers to be substantial gainful activity, you will not be considered to be disabled. In 2022, the SGA level is a gross income of $1,350 per month, or $2,260 for those who are blind.
2. Is the person’s physical and/or mental condition severe? The ALJ may review medical records and the testimony of medical experts to determine whether your physical or mental disabilities would interfere with basic work-related activities. A physical condition is considered severe if it prohibits you from performing activities such as sitting, standing, walking, lifting, and carrying, while a mental condition is considered severe if it affects your ability to understand and carry out instructions, make work-related decisions, or respond appropriately to coworkers, supervisors, or customers.
3. Does the person’s condition meet or equal a condition on the Listing of Impairments? The Social Security Administration uses a listing of different conditions that are severe enough to make a person disabled without considering factors such as your education and work experience. If your condition is included in this listing or is equivalent to a condition on the list, you will be considered disabled. However, if your condition is not on the listing, the following two steps will be used to evaluate whether your condition has made you disabled.
4. Can the person perform any Past Relevant Work? The ALJ will look at your residual functional capacity (RFC) to determine whether you are capable of performing work on a full-time basis and whether you are subject to any limitations or restrictions. Your RFC will be compared with the substantial gainful activity you have done in the past. If you no longer have the capacity to perform past relevant work, you will be considered disabled.
5. Can the person perform other types of work? In the final step, the ALJ will consider your RFC along with your age, work experience, and education to determine whether you can adjust to other types of jobs. The ALJ will usually hear testimony from a vocational expert to determine whether there are jobs available in the national economy where you would be able to work within your limitations and restrictions. You will only be considered disabled if you would be unable to adjust to other types of work.

For steps one through four, you will be required to provide evidence that you are disabled. For step five, the Social Security Administration will have the burden of proof to show that positions exist where you should be able to participate in substantial gainful activity.

Contact Our Milwaukee County Social Security Disability Claim Lawyer

Whether you are applying for Social Security disability benefits or need to appeal the denial of your application, Attorney Jonathan Pearson can provide the legal help you need. He will help you meet all requirements to show that you are disabled, ensuring that you can receive the benefits you deserve. Contact our Milwaukee Social Security disability attorney today at 414-240-4801 to set up a free consultation.

Sources:

https://www.ssa.gov/oidap/Documents/Social%20Security%20Administration.%20%20SSAs%20Sequential%20Evaluation.pdf

https://www.ssa.gov/OP_Home/cfr20/404/404-1520.htm

https://www.ssa.gov/oact/cola/sga.html