Proving the Social Security Disability Claim

We handle Social Security disability claims for Oregonians and Washingtonians. The rules apply equally, because Social Security is a federally administered program. This article gives a general description of the sequential evaluation process for the Social Security Disability claim. My goal is to describe this process in plain English.

There are five questions that the Social Security Administration will resolve to determine whether a person is disabled. These questions are asked in a certain order, and are sequential. This simply means that you must meet the requirement of the first question in order to get to the second question.  However, there is a "second chance" if you do not meet an "impairment listing."

Are You Performing Significant Gainful Activity?

"Significant Gainful Activity" means working regularly and making money. If you are working, you are not disabled. Social Security will look at the amount you are earning in a month to determine whether that constitutes significant and gainful activity. At the time of this article, the monthly amount of income considered for substantial gainful activity is slightly above the thousand dollars month. In other words, if you are earning less than $1090.00 month, then you are not generally performing substantial gainful activity. 

Please note that the monthly amount of earnings that is considered "significant gainful activity" changes year to year, depending upon the cost of living. You can check with the Social Security Administration website to find out how much monthly income is considered significant gainful activity.

There are a lot of exceptions to this rule. There are also a different set of rules for those folks were self-employed. This is because a self-employed person may be able to keep books and a way that shows little or no profit or income, but at the cost of a lot at work.

If Social Security finds that you are engaged in substantial gainful work activity, also referred to as SGA, then your claim will be denied.

Is Your Condition Severe?

Establishing a "severe" condition sounds a lot more difficult than you may think. If you have an objectively verifiable medical condition that causes more than a minimal interference with the ability to perform work activity, then the chances are that you have established your condition has "severe."

In our experience, this element of the claim is not a very high hurdle, and if a Judge finds that a Claimant does not have a severe medical condition, there is a good chance this finding will be reversed.

Do You Meet an Impairment Listing?

First, we need to describe what is meant by "impairment listing."

There is an appendix to the rules that describe how and what you need to prove on your disability claim. I describe this appendix as a catalog of disabilities. There are twelve chapters, and each chapter addresses certain categories of medical problems. For example, there is a chapter that addresses orthopedic issues, and another chapter that addresses mental impairments.

Within each chapter, there are listings. A listing will describe certain medical findings with a specific condition that has to exist in your medical records in order for you to be determined disabled. If you "meet a listing," then your condition is so severe, that Social Security is decided you are obviously disabled. If this is the case, you have proven your case, and you do not need to resolve any further questions.

I often refer to this as the "no-brainer" question. Somebody who meets a listing is obviously disabled, and so this part of the process is used more as a screening tool to pick out the obvious cases.

However, if you do not meet an impairment listing, it simply means that your case is not a "no-brainer" in the eyes of Social Security. You still have a second chance of proving disability.

What is Your "Residual Functional Capacity"?

We need to define "residual functional capacity." We also refer to this as RFC. This simply means what you are still able to do on a sustained and regular basis at work. You may have suffered an injury, and are no longer to perform "heavy" work, which has its own definition. However, there may be lighter work that you can perform within your limitations.  If this is the case, then you are not disabled because you can work some kind of job within your limitations.

Social Security will look at all of your claims file materials to determine your residual functional capacity. They will determine how long you can sit, stand, walk, lift, carry, squat, kneel, and bend, along with many other work functions. If somebody is alleging a mental impairment prevents them from working, Social Security will look at things like the ability to work with others, concentrate, remember, and adapt to normal changes in the work routine. In our experience, medical opinions play a large role in establishing a residual functional capacity finding. However, it sometimes looks like Social Security is "reaching" when it makes these decisions.

Your residual functional capacity is key to establishing whether not you are disabled under this system.

Can You Still Perform Work Existing Within The National Economy?

Simply stated, the issue is whether there is any kind of work you can still perform within the physical and/or mental limits established in the residual functional capacity finding. This question is answered using different rules, depending upon your age at the date you claim your disability began.

Social Security generally asks two questions. The first is whether not you can perform any of your "past relevant work." Your "past relevant work" is the work that you have performed within 15 years prior to the date you claim your disability began. If Social Security finds that you are able to do any of your past relevant work, then you will be found not disabled.

However, if Social Security finds that you are no longer able to do any of your past relevant work, then the final question is whether or not there any other jobs that exist in the national economy you can still perform. If the Social Security Administration finds that there are jobs that exist in the national economy that you can still perform, you are not disabled. These jobs must exist in significant numbers.

A lot of clients who consult with us think that proving disability simply means proving the inability to perform past work activity. However, depending upon your age, if there is any job that exists, even if it's a minimum wage, entry level position, and you are physically and mentally able to perform that job, then you are not disabled.

Another common misunderstanding is that these jobs need only exist in significant numbers in the "national economy." The job market on the Oregon Coast may be much different than Seattle, Portland, or Salem, but that is not relevant. The jobs need only exist, and on the national level.

If you are over the age of 50, the rules change.  Generally, the rules do not require older workers to make the same adjustments to new work as somebody who is considered a "younger individual." The requirements for adjusting to other work are further relaxed at age 55, and then again at age 60. You may technically be able to perform some work, but depending upon your skills, and the exertional level of past work, he still may be found disabled.

If you have a Social Security Disability claim pending, and you have questions, call us at 503-325-8600. Our answers are based on our twenty years of experience handling these cases.