The Social Security Administration (SSA) will use the following mandatory 5 steps (in strict order) to determine if you qualify for an SSDI benefit.
1. Are you now working at substantial gainful activity (SGA)? In 2018, if you have employment income of at least $1,180 per month, you cannot be paid an SSDI benefit. The case dies at Step 1 and can go no further, no matter how sick you are. Social Security is not for persons who are working.
2. Do you have a severe medically determinable impairment, documented by medical records, that could reasonably produce symptoms severe enough to prevent working? Has this impairment lasted, or is it expected to last for at least 12 consecutive months--or to end in death? If not, the case stops here. (Social Security has no short-term benefit for impairments lasting less than 12 months)*.
3. Do you meet one of Social Security's published Listings? These listings are for individuals who have multiple severe symptoms which are obviously disabling. Most claimants will not meet a listing, but may go on to be approved at steps 4 or 5. Also, while at step 3, the decision maker must determine what the claimant's 'residual functional capacity' is. In other words, what is the most the claimant is able to do in terms of work-like activity, in spite of the impairment?
4. Are you able to perform any one of your 'past relevant" jobs? A past relevant job is any job you performed during the past 15-year period and performed it at SGA levels. If you are found able to perform any one of your past relevant jobs, you are not disabled and will not be paid a benefit. If you cannot perform any past job and are age 50 or over, you may be approved here. Or, you may go on to the final step before a decision is made.
5. If you cannot perform any of your past relevant work--and especially if you are under age 50--the final question becomes: Are there ANY jobs (of any type) in the national economy that you could perform, given your age, education, residual functional capacity and past relevant work history? If Social Security can identify at least one job that exists in significant numbers in the US economy that you could perform, a denial will generally ensue.
The final step includes the ability to perform even sedentary, unskilled work. If you are found able to perform work that is typically "sit down" work and that requires very little training or education, you will be denied at the final step. I see claimants denied because SSA finds that they can do the work of inspector, assembler, laundry folder or ticket taker.
So, you see, there is a very strict method to all of this. The judge knows exactly where he or she is going with questions during the hearing. It isn't a matter of just convincing the judge that you don't feel like working. It's a matter of convincing the judge that you meet all 5 of the specific rules to get a benefit. And let me say, frankly, the odds are usually stacked against you.
Behind these 5 steps, there are thousands of rules, regulations, definitions and requirements. The claimant who doesn't know the rules has little or no chance of meeting them. So take someone to the hearing with you who knows the rules and how to use them. "Yes, it's that important."
*Note: You do not have to wait 12 months to file a claim. It's just that your medical impairment must be expected to last for at least 12 months. In other words, no short-term impairments will qualify.
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