For claimants applying for Social Security Benefits, the Administration
has established a Five Step test to determine whether or not they qualify
for benefits. To understand why the SSA makes seemingly bizarre decisions
denying benefits, it is important to understand how it is viewing your
case. So, over the next several posts, I will try to briefly go through
each step of this process.
Before we begin, please note that this is the test that applies to claimants when they are seeking to be found eligible for benefits. Where a claimant has already been found to be disabled and the administration is trying to decide whether this person is still disabled (a Redetermination) there are different tests that apply.
Additionally, though it is necessary to meet the Sequential Evaluation Process in order to be found disabled, it is not enough on its own to qualify. Specifically, this test is needed for a determination that you are “medically eligible” for benefits. However, to actually receive benefits you must also meet “non-medical” requirements. Both disability insurance benefits (SSDI) and supplemental security income (SSI) have their own non-medical requirements. For SSI, these requirements are all related to your level of income and financial resources. For SSDI, your non-medical requirements are based upon whether and when you paid into the Social Security trust fund through FICA taxes. Unfortunately, in representing disability claimants over the years, I have seen many individuals who clearly met medical requirements outlined under the Sequential Evaluation Process, but were nevertheless not eligible for benefits because they failed to meet the SSDI or SSI non-medical requirements.
Here is the SSA’s brief overview of this test:
The law defines disability as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. To meet this definition, you must have a severe impairment(s) that makes you unable to do your past relevant work (see § 404.1560(b)) or any other substantial gainful work that exists in the national economy. If your severe impairment(s) does not meet or medically equal a listing in appendix 1, we will assess your residual functional capacity as provided in §§ 404.1520(e) and 404.1545. (See §§ 404.1520(g)(2) and 404.1562 for an exception to this rule.) We will use this residual functional capacity assessment to determine if you can do your past relevant work. If we find that you cannot do your past relevant work, we will use the same residual functional capacity assessment and your vocational factors of age, education, and work experience to determine if you can do other work.
For more information, visit: (http://www.ssa.gov/OP_Home/cfr20/404/404-1505.htm)