We have handled many Social Security Disability Claims in Washington and Oregon. Because Social Security Disability is a federal benefit program, the rules are the same no mater which state you live in. In this article, we provide a checklist of the five questions Social Security asks to determine whether you meet its definition of a "disability." This checklist is more a process, because it is sequential. That means that you need to get the right answer to some of these questions to move on to the next question.
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 that is considered substantial gainful activity is a little over $1,200.00 per month.
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 rules for those folks were self-employed. This is because a self-employed person may be able show little profit in a business, but still be doing significant work.
Sometimes, a friend or family member is helping you by letting you stay on at work, but allowing you to call in sick frequently or only show up an hour or two a day. This is known as "subsidized" work. If you can show that you are only doing 10% of the actual job, then Social Security may consider 90% of your earnings as a "subsidy." This may bring you in below the SGA limits.
However, 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." Social Security will refer to this as a "medically determinable impairment," or "MDI." This means that there is some medical evidence of a problem that has at least some impact on your ability to do work activity.
In our experience, this element of the claim is not a very high hurdle, and if a Judge at a Social Security hearing 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?
We call this the "no-brainer" rule. If you meet a "listing," Social Security is saying that just by looking at your medical records, your condition is so severe that there is no way you could work on a sustained basis. So, what is an impairment listing?
The impairment listings are an appendix to the federal rules that describe how you prove your disability claim. These listings have also been referred to as the "blue book." 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 (1.00), and another chapter that addresses mental impairments (12.00).
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 to be determined disabled. If you "meet a listing," then your condition is so severe that Social Security is decided you are obviously disabled. The process stops here if you meet a listing. Social Security will approve your claim.
The listings are a screening tool for Social Security the quickly approve the obvious cases. If you do not meet a listing, and most of our clients do not, you still have a chance to prove you are disabled by establishing a specific description of your work limitations, also referred to as your "residual functional capacity," also known as your "RFC."
What is Your "Residual Functional Capacity?"
Your Residual Functional Capacity is a description of what you can still do 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 so, then you are probably not disabled because there are less demanding jobs that exist in the national economy that you can perform. More on that below.
Your residual functional capacity is usually the most important issue in the case, because it will determine whether you are disabled. Even so, Social Security does not dig very deep to determine your residual functional capacity. At the initial application phase, the agency that decides your claim will have medical experts (medical doctors or psychologists) review your records to determine your residual functional capacity. These doctors do not examine you, nor do they ask you about your symptoms. We wonder if they read your questionnaires. From a review of medical records, these expert determine your physical and mental work ability. We often argue there is a lot of guesswork involved. Often, it just looks like Social Security is "reaching" when it makes these decisions.
Once Social Security determines your residual functional capacity, it decides whether you can go back to your past work, or perform other work that exists in the national economy.
Past Work and Work Existing Within The National Economy
This is the last part of the five step sequential process, but it is a two part question.
First, Social Security compares your residual functional capacity to your "past relevant work" to see if you can perform any of your prior work within your limitations. The "past relevant work" refers to all of your jobs worked within fifteen years before the date you claim your disability began. If Social Security determines that you are able to perform any of your past relevant work, your claim is denied. If not, it's up to Social Security to determine if there are other jobs that exist in the national economy that you can perform within your residual functional capacity.
This is the second part of this two part question. Social Security will determine if there are jobs in the national economy that exist in significant numbers that you can perform within your functional limits. If Social Security finds jobs that exist within your limits, you are found not disabled, and the claim is denied. This is where most claims are won or lost, and this is why the residual functional capacity determination is so important.
Here are some hard facts on the issue of jobs that exist in significant numbers issue:
The jobs need only exist in significant numbers NATIONALLY. So, you may live on the Oregon Coast, or Southwest Washington, which have different labor markets than Seattle or Portland. However, because this is a federal program, Social Security looks at national numbers.
The jobs only need to exist in significant numbers, which is different than the jobs being available, and Social Security is under no obligation to find the jobs for you.
It does not matter if the existing jobs pay far less than what you were earning before you became disabled.
This is why the residual functional capacity issue is so important. If Social Security agrees that your condition keeps you from showing up at work regularly, then you will not be able to perform any job, no matter how physically or mentally easy. If you would be off task during work more than what employers will tolerate, it won't matter how easy (physically or mentally) the job is, you will not be able to hold the job. In either case, you will be found disabled.
If You Are Over 50 Years Old, The Rules Are Different
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 kind of work, but depending upon your past skills and physical work requirements, you may still be found disabled.
There is a lot to consider when seeking Social Security Disability, and proving "disability" can get involved. If you have questions about a recently denied claim, contact us. We have decades of experience helping people facing the same issues.