Criteria Used to Determine Eligibility for Social Security Disability

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.

Basic Criteria Used to Determine Eligibility for Disability Benefits

Social Security Disability Criteria ListThere 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 criteria, in this order:

  1. Substantial Gainful Activity. The first thing an agent will look at is whether 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. If you are not engaged in SGA, the examiner will move to the next criterion.
  2. Severe impairment. To determine if you meet this criterion, the adjudicator will examine medical evidence to decide if your symptoms are severe. To be considered severe, the symptoms must limit your ability to perform basic work functions. If your condition is determined to be severe, the examiner will move to the next test.
  3. Medical listings. Next, the examiner will 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. If you meet a medical listing, you will be approved. If you do not meet a listing, the examiner will move on to the next criterion.
  4. 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. 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 factor.
  5. Other work. At this stage, the adjudicator will determine if you are able to do some other kind of work and if 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. If the examiner believes there is work you can do, you will be denied.

At each of these steps, an adjudicator has some degree of discretion. If you are denied at the initial application stage, it is possible that the adjudicator at the reconsideration stage will have a different opinion on the criteria. You will also have the opportunity to present more evidence at the reconsideration stage.

An Indiana Disability Attorney Can Help

If your initial claim is denied, your best bet is to talk to a Social Security disability attorney to help you strengthen your claim for the next stage of consideration. The disability attorneys at Keller & Keller are here to review your application and help you present a stronger case the next time around. Call our Indianapolis office to find out if we can help you.


James R. Keller
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