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Todd R. Renda, Social Security Disability and SSI Disability Attorney

The Evaluation Process for your Social Security Disability Claim

The Evaluation Process for your Social Security Disability Claim

Social Security uses a 5-Step sequential evaluation process to determine if your SSDI or SSI claim will be approved.

At each phase of a disability claim, there is an adjudicator, or decision-maker. At the Initial Application and Reconsideration phases, the decision-maker is a Disability Determination Service (DDS) Examiner who works in consultation with a DDS Physician. At the Hearing phase, the decision-maker is the Administrative Law Judge who often consults with a Medical Expert (ME). The following evaluation is employed by the adjudicator at each phase.

Step 1: Non-Medical Criteria

First and foremost, you cannot be working above what Social Security calls a Substantial, Gainful Activity (SGA) level. Basically, you cannot be earning more than $1,170 on a gross (pre-tax) monthly basis. The SGA rule is the most important non-medical criteria, but there are other non-medical criteria that must also be satisfied for your claim to progress to a complete medical review. No matter how severe and debilitating your medical conditions may be (even with well supported medical evidence), if you do not meet the non-medical eligibility requirements, your claim will not advance past Step 1 and your claim will be denied.

Step 2: Severe Impairment

The question at Step 2 is whether your impairments are severe. To determine whether your impairments are severe, all medical evidence is assembled. Once all evidence has been assembled, the adjudicator reviews the information and decides whether your symptoms are severe. To be considered severe, the symptoms must limit your ability to perform basic work-like activities. If your symptoms are determined to be severe, your claim progresses to Step 3, otherwise it is denied at Step 2 and you can appeal.

Step 3: Medical Listings

At Step 3, the question is whether your impairment meets or equals a medical “Listing.” Social Security has broken down the human body and mind into 14 different Impairment categories, called the “Listing of Impairments.” If the adjudicator reviews your medical records and determines you meet a medical listing, you are found to be Disabled at Step 3 and you are eligible to receive disability benefits. If, however, you do not meet a medical listing, the claim proceeds to Step 4.

Step 4: Past Work

The objective of Step 4 is to determine whether you can perform work you performed previously. To determine this, the adjudicator determines your Residual Functional Capacity (RFC). Your RFC identifies what your body and mind can still do after considering your medical symptoms. In developing your RFC, the adjudicator will consider all impairments and symptoms, including mental and physical, and including severe and non-severe impairments.

Once the adjudicator has developed your RFC, they will then list your Past Relevant Work (PRW), which is any job you performed during the 15-year period immediately preceding the Alleged Onset Date (AOD) of your disability. In general, if there is a job that you performed within 15 years of your AOD in which you worked close to full-time for a period of at least a few months, that job will likely be considered Past Relevant Work.

After finalizing your list of Past Relevant Work, the adjudicator must now classify it. The type of work you have done in the past will be classified by both exertion level and by skill level. Once all your PRW has been classified, the adjudicator must then determine whether you have the functional ability to perform any of your past work. If the adjudicator determines you can still perform the functions required in your past work, you will be found Not Disabled and denied. You would then be able to file an appeal.

Step 5: Other Work

Step 5 considers whether you can perform any other type of work, even if you have not performed it in the past. The adjudicator utilizes the same Residual Functional Capacity (RFC) developed in Step 4, and considers your Age, Education, and Work Experience.

For more information on the evaluation process, we recommend exploring the Social Security website.

Having an attorney to walk you through each one of these steps of your evaluation makes the process much easier to understand and be prepared for.

Contact Renda Law today to set up your Free Consultation and we will guide you on how to prepare for the evaluation and what you will need to win your case.

Todd Renda