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The Five Step Sequential Evaluation Process In Disability Cases

To be found disabled under the Social Security Act, individuals, with exception, must have a medically determinable physical or mental impairment so severe that they are unable to do their previous work, but cannot, considering their age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy. The regulations of the Social Security Act provide a sequential evaluation process for determining disability.

To adjudicate a routine disability case, the SSA follows a set procedure, or sequence of inquiries. At some point in the process, the SSA will consider whether a person’s severe medical impairments meet or equal a Listed impairment.  The Listings of Impairments depict some fairly severe medical conditions. It is not easy to medically meet the criteria, and even harder to medically equal the criteria.  But, if a person “meets or equals”, the case is paid.  If not, then the injury proceeds, and the next step will require that the SSA reaches conclusions as to the applicant’s  residual functional capacity (RFC) .

This was an example of the procedural inquiry at Step 3.   Again, the SSA’a procedural process is really a five-step sequential evaluation process, which analyzes a claimant’s condition to determine if a disability exists under the terms of the Social Security Act.  The analysis goes step by step, and each step involves a question. If the answer to a query enables the SSA to make a finding of disability or no disability, the decision is made and the evaluation comes to an end.  The SSA issues the appropriate decision (subject to appeal).  In other words, a query may or may not yield a determination of disability or no disability, if it does not, the evaluation simply moves on to the next step. Here is a brief description of the five-step sequential evaluation process:

1. Are you working? 
If an applicant is engaged in “substantial gainful activity” then the result will be a determination that the applicant is working.  Case is denied.  Remember, SGA is a concept and legal term of art.  There are ways to demonstrate that in spite of the numbers,you are NOT gainfully employed at an SGA level.

2. Is your medical condition “severe”? 
An applicant’s medical condition must be so bad that it interferes with the ability to conduct basic work related activities.  The severity stage is a step to screen out minor medical problems.   It is not hard to demonstrate a severe medical impairment. Also, “unless your impairment is expected to result in death, it must have lasted or must be expected to last for a continuous period of at least 12 months.”   So you must have a severe medical impairment, and it must last or be expected to last 12 months.   Consider someone who has a need replacement and is able to work again in 6 months.  They lose- they failed to meet the 12 month rule.

3. Does your disability meet a Listing? 
If a condition meets one of  Social Security’s Listings or the condition is of equal severity to one of these listings, the result will be a finding of disability.  This is purely a medical determination.  Sometimes the objective roof is strong that an attorney or Judge can point to medical records that literally track the requirements of the Listings, and the case can be paid.  More often than not, a medical advisor will issue an opinion as to this inquiry.  If you “meet or equal”, you win.

4. Can you do past relevant work? 

Social Security examines the work that an applicant has performed over the past 15 years to determine whether or not he or she can still do this particular work (or type of work). If Social Security makes an affirmative determination in this regard, then it will not find the applicant disabled. However, if Social Security determines that due to physical or mental impairments it is not possible to perform past relevant work, then the query will proceed to the next and final step in determining whether or not a disability exists.  At this stage, the SSA must consider the exertional and non-exertional demands of the past work, and compare those against the claimant’s residual abilities (RFC).

If you an do your past work, you fail to meet your burden of proof and lose.  If you cannot, then the case goes on to Step 5,and the burden of proof is on the SSA at this stage of the game!

5. Can you do any type of work? 

If at step four it is determined that an applicant can no longer do past relevant work, the next query is whether the applicant has the ability to  adjust to another type of job or work. This includes the consideration of age, education, any medical impairments, physical condition, past work experience and any transferable job skills.

If it is determined that an applicant may make an an adjustment to another type of work, the result will be a finding of no disability (you lose). Conversely, at this point, if the query fails to result in a finding that the applicant may make an adjustment to some other job, the result will be a finding of disability. The Social Security Act’s applicable regulations further mandate that if the result is a finding that an applicant is capable of adjusting and doing other work, Social Security is “responsible for providing evidence that demonstrates that other work exists in significant numbers in the national economy.”    Significant numbers is a concept, and just accept that it does not take many jobs to rise to a significant number.  A cautionary tale about what is a significant number can be found in an old Sixth circuit case  of Hall v. Bowen.

One of the best ways to make sure you understand all of the steps and processes associated with applying for social security disability benefits is to retain the services of a qualified Kentucky Social Security Disability attorney. Contact Sullivan Law Office today. We offer free consultations, so you have absolutely nothing to lose! We look forward to hearing from you. Call 888-587-0228 or visit us online.The Five Step Sequential Evaluation Process In Disability Cases

2016-10-28T14:48:06+00:00