The 5-Step Sequential Evaluation in deciding Social Security Disability Claims
Social Security uses a five-step evaluation process for all adult disability claims to decide if a person is disabled. Here is what SSA says about the five steps:
The five-step sequential evaluation process. The sequential evaluation process is a series of five “steps" that we follow in a set order. If we can find that you are disabled or not disabled at a step, we make our determination or decision and we do not go on to the next step. If we cannot find that you are disabled or not disabled at a step, we go on to the next step. Before we go from step three to step four, we assess your residual functional capacity. (See paragraph (e) of this section.) We use this residual functional capacity assessment at both step four and step five when we evaluate your claim at these steps. These are the five steps we follow:
(i) At the first step, we consider your work activity, if any. If you are doing substantial gainful activity, we will find that you are not disabled.
(ii) At the second step, we consider the medical severity of your impairment(s). If you do not have a severe medically determinable physical or mental impairment that meets the duration requirement in section 404.1509, or a combination of impairments that is severe and meets the duration requirement, we will find that you are not disabled.
(iii) At the third step, we also consider the medical severity of your impairment(s). If you have an impairment(s) that meets or equals one of our listings in appendix 1 of this subpart and meets the duration requirement, we will find that you are disabled.
(iv) At the fourth step, we consider our assessment of your residual functional capacity and your past relevant work. If you can still do your past relevant work, we will find that you are not disabled.
(v) At the fifth and last step, we consider our assessment of your residual functional capacity and your age, education, and work experience to see if you can make an adjustment to other work. If you can make an adjustment to other work, we will find that you are not disabled. If you cannot make an adjustment to other work, we will find that you are disabled.
Step 1: Engaging in a Substantial Gainful Activity (SGA)
Even you have a clearly disabling condition, if you are able to work at a substantial gainful activity level (SGA), you are not disabled. Example, you may be blind, which meets SSA requirements for disability. However, your employer provided you special equipment to do your job and you are in fact working a full time, competitive, job. Under Social Security regulations, you are not considered disabled. Because you are able to work, you do not qualify for Social Security disability benefits.
If you are working full time, but your medical expense, which let you work, are so high that your pre-tax income is still below SGA threshold, then your expenses (called) Impairment Related Work Expenses (IRWEs)) mean your work does not count as SGA.
If you are working at an SGA level, but the work is not competitive: you either got a job through a friend or family member, or a very generous employer, and you not held to the same standards as another worker in the same position. This would also apply if you are being paid a “subsidy" — in other words you are being paid more than the work is actually worth.
Step 2: Severity
For an impairment to be severe, it has to cause more than a minimal effect on your ability to perform daily activities, and meet the duration requirement. For athis discussion, some examples are probably best. If you have high blood pressure that is well controlled with medication, with no symptoms from the blood pressure, that is considered a “not severe" impairment. If your blood pressure starts going out of control, or causing damage to your heart or other organs, then it would become a severe impairment.
A broken leg is a severe impairment, becasue it has more than a minimal impact on activities, but it is probably not "severe" under SSA guidelines becasue it will not meet the duration requirement (see below).
Proving you have a “severe" condition is a pretty easy – it is a very low standard and it is usually fairly easy to show that a condition has more than a minimal effect on daily activities.
The second part of this is more difficult. The condition has to be expected to remain severe for 12 months or longer. A broken leg that heals is 6 months does not qualify. The impairment and effects must be disabling for 12 full consecutive months. Not 51 weeks – 12 full months.
Step 3: Listing Level Impairment
Some medical conditions are so severe that SSA agrees they are disabling no matter what your age, your old job or your education. If you have a condition which is contained in the Social Security Listing of Impairments;AND the medical findings match what is required for your listing, you may be found disabled without Social Security considering the last two steps. This is “meeting a listing." You can also be found disabled at this step if your condition “equals a listing." For most people, having conditions that equal a listing means that you have several conditions which, in combination, are just a severe as a condition that exactly meets a Listing.
Step 4: Ability to Perform Prior Work
If you are able to perform any of the work you have done at in the 15 years before your disability began, Social Security can deny your claim. Past relevant work (PRW) must have been performed at the SGA level (currently about $1000 per month or more) and have lasted for six months or longer, otherwise it is not PRW and cannot ordinarily be used against you at this Step.
Example: If you previously performed very physical work labor, but for 1 year also worked as a construction supervisor, you may be denied based on your ability to still be able to perform the supervisory job. This could be true even if the supervisor job was not your most recent work. It also does not matter if the employer is out of business or if you cannot get hired for that type of work anymore.
Step 5: Ability to Perform Other Work
Even if you are unable to perform any of your past jobs, you can still be denied if there is other work you can still perform which exists in substantial numbers in EITHER you local area OR the national economy.
Decisions based on whether a person can perform other work in the economy is a difficult area of the law. At this step a number of factors are considered – age, education, and work history, along with the limitations on your ability to work (physical and mental). And, the rules change depending on age categories: 18-49, 50-54, 55-60 and over 60.
Ages 18 to 49: the general rule is that you have to prove that there is no work in the national economy that you can still perform on a sustained basis – not even a sedentary (sit-down) job.
Ages 50 to 54: the rules are little easier, but you still have to eliminate most kinds of jobs to win your case. If you can do more than sedentary work, you will have a tough time proving disability.
Ages 55-60: If limited to a sit down job, and none of your past work was sedentary work, you should usually be able to prove you are disabled (depending on the type of work you did and your education).
The rules get even easier once you reach age 60.
This is just a quick review of the five-step sequential evaluation process. There are numerous exceptions to this process, and many special rules that apply. Consider getting an attorney to help you work through this difficult process.