Two Paths to an Award of Disability Benefits – Part 1

Are you considering applying for Social Security disability benefits or awaiting a decision on your application? If so, you may be wondering how the Social Security Administration (SSA) will determine whether you qualify. What factors weigh into this decision? The answer is the same in every case: The SSA uses a 5-step sequential analysis to evaluate a claim for disability benefits. The decision-maker will ask:

1. Is the claimant working?
2. Does the claimant have a severe physical/mental impairment?
3. Does the claimant’s impairment “meet or equal” a condition found in the SSA Listing of Impairments?
4. Can the claimant do work he or she has done in the past?
5. Can the claimant do any other work?

This analysis provides two alternative paths to an award of benefits:

Path #1: Through Your Medical Findings

• To obtain disability benefits based on your medical findings alone, all of the following must be true:
• You are not engaged in “substantial gainful activity.” This means you are not working or, if you are working, you are earning less than a minimal amount set by Social Security.
• You have a severe physical or mental impairment that has been diagnosed by a medical professional and documented with medical tests.
• Your impairment has lasted or is expected to last for at least 12 continuous months or end in death.
• Your medical records show that your impairment meets or is the medical equivalent of an impairment described in the Social Security Listing of Impairments.

OR

Path #2: Through Functional Limitations on Your Ability to Work

To obtain disability benefits based on your limited ability to function in a work setting, all of the following must be true:

• You are not engaged in “substantial gainful activity.”
• You have a severe physical or mental impairment that has been diagnosed by a medical professional and documented with medical tests.
• Your impairment has lasted or is expected to last for at least 12 continuous months or end in death.
• You are unable to do your past relevant work (i.e., the easiest job you have had in the past 15 years).
• Considering your functional limitations, age, education, and work experience, there is no other work you can do that exists in the national economy in significant numbers.

No doubt about it: This analysis is complicated. To help you make sense of it, we’ve created a diagram that shows how these two paths intersect and diverge. You can download it here. We also will provide more information about both of these paths in our next couple of emails. In the meantime, if you have any questions about how the SSA will analyze your claim for benefits, please call us. We would be happy to sit down with you to discuss your case.