Your application for Social Security disability could be approved at the first level, or it might have to go through several levels before it is ultimately approved. At each level, the adjudicator will use the same criteria to determine if the applicant is eligible for benefits.
Do You Qualify for Social Security?
There will be a different person making a decision about your SSDI application at each stage of the process. At the initial application and reconsideration stages, a Disability Determination Service (DDS) Examiner will evaluate your claim. At the hearing stage, an Administrative Law Judge will make the decision. Regardless of who is looking at your claim, they will evaluate your claim based on the following requirements.
1. Is Your Disability Preventing You From Working?
The first thing a Social Security agent or Administrative Judge will look at is whether or not you are working. If you are able to work and earn more than the current allowed Substantial Gainful Activity (SGA) level ($1,260 per month in 2020), then you will not be considered disabled, and therefore will not be eligible for disability benefits. After all, disability benefits exist for those who aren't able to work due to their conditions.
Suppose the work you do currently does not count as "substantial gainful activity". In that case, the Social Security Administration will still look at the type of work you perform, and how much of it you do when determining whether your disability qualifies for benefits.
While there's no standard set of hours worked that can still qualify, it can be useful to think about what the work you do says about your condition. As an example, it may be harder to prove that someone who is working full-time is disabled, compared to someone whose condition prevents them from working full-time or at all.
2. Do You Have a "Severe Impairment?"
To determine if you meet the SSA's definition of a "severe impairment", the adjudicator will examine medical evidence to decide if your symptoms are severe. To be considered severe, your symptoms must limit your ability to perform basic work functions. These functions include physical functions such as standing, walking, sitting, and lifting, but it also includes mental functions like remembering details, carrying out simple instructions, and responding to typical workplace scenarios.
Additionally, your impairment must have interrupted your ability to do these work functions for at least 12 months in order to count as a severe impairment. There are many situations that could leave you unable to do your job functions for a short amount of time, but if the impairment has not lasted at least 12 months, it will not qualify as "severe" for the purposes of your disability application. In these types of situations, it may be beneficial to explore short-term or long-term disability insurance, rather than Social Security.
3. Is Your Condition in the SSA's "Blue Book"?
Once the examiner has confirmed that your disability is both preventing you from working and also qualifies as "severe", they will next determine if your medical condition meets or is “medically equal” to one of the conditions found in the Social Security Administration’s Listing of Impairments. Known as the "Blue Book", this list includes the medical impairments/disabilities that can qualify for SSA benefits and details the conditions your specific impairment must meet. There are currently 14 major categories of disabilities in the SSA's Blue Book, and each category can contain dozens of specific conditions.
It's important to realize that just because you have a disability that's listed in the Blue Book does not mean that you're automatically eligible for benefits. In addition to needing to meet the other requirements, your particular disability must meet the SSA's standards for severity, duration, and debilitating effects in order to qualify. For example, Psoriasis is a condition listed in the Blue Book, but not all Psoriasis diagnoses will get benefits. Your Psoriasis must negatively affect your ability to perform your basic work duties (as well as meet other specific criteria).
If you do not meet the qualifications for a listing, or if your disability is not listed in the Blue Book, you may still be able to qualify for Social Security benefits. In this case, the examiner must determine whether your condition is as severe as a comparable condition that is listed in the Blue Book. In this situation more than others, it's vital to have an experienced disability attorney who can gather the proper evidence to submit on your behalf.
4. Are You Capable of Returning to Your Past Work?
The objective here is to determine if you have the ability to perform work you have performed previously. To make this decision, the adjudicator will evaluate your Residual Functional Capacity (RFC). Your RFC identifies what you are capable of given your medical condition. In order to do so, the SSA will evaluate your work history to determine two key things:
- Whether your condition prevents you from returning to your previous role in the same capacity, and
- Whether you have actually paid into the Social Security system through payroll taxes.
If you have not paid into the Social Security system in the past (perhaps because your disability has prevented you from ever maintaining gainful employment), there are still options. Supplemental Security Income (SSI) is a separate program available to those individuals who do not have an extensive work history and therefore may not qualify for the more typical Social Security Disability Insurance (SSDI).
If it is determined that you can perform the work you performed previously, your claim will be denied. If you cannot do the work, the examiner will move to the final determining factor.
5. Is It Possible for You to Do Other Work?
At this stage, the adjudicator will determine if you are able to do some other kind of work and whether it is reasonable to expect you to find employment considering your abilities, age, education, and work experience. If there is no work you can do given your disability, you will be approved for your benefits (including back pay). If the examiner believes there is work you can do, you will be denied.
This stage can be tricky because you and your social security disability attorney must prove to the SSA that not only are you not capable of doing your old job but that you're also not capable of performing other jobs. For instance, if you've been a retail worker your entire life, you must also prove that your disability is preventing you from becoming an office admin assistant, a delivery driver, etc.
