Do You Qualify Medically for Social Security Disability?

Start here to get an idea of how Social Security determines if you meet the medical qualifications to receive disability benefits.

Whether you apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), the medical evaluation is essentially the same. The SSA follows a five-step process for determining if you are disabled. (The main difference between the two programs is that SSDI is paid for through Social Security taxes paid by workers, employers, and the self-employed, while SSI is paid for through general federal tax revenues. SSI is a needs-based program. For more detail, see Eligibility for SSDI vs. SSI Disability Benefits.)

Are You Working?

First, the SSA will determine if you are working and earning more than a set amount of money ($1,130 for the year 2016). If you are, you will be found to be engaging in "substantial gainful activity" (SGA) and ineligible for benefits.

Assuming that you aren't working, or are working below the SGA limit, the SSA will evaluate your medical evidence. The medical evidence must show that you have a severe physical or mental impairment that has lasted or is expected to last for at least 12 continuous months (or is expected to end in death).

Do You Have a Severe Impairment?

At the second step of the disability evaluation process, the SSA will decide whether you have an impairment that is severe. An impairment is severe if it significantly limits your physical or mental ability to work. On the other hand, an impairment is considered non-severe if it is a slight abnormality (or combination of slight abnormalities) that has no more than a minimal effect on your ability to do basic work activities.

Examples of basic work activities include seeing, hearing and speaking; sitting, walking, standing, lifting, carrying, pushing, pulling, reaching, and handling; understanding, carrying out, and remembering instructions; responding appropriately to supervision and co-workers; dealing with changes in a routine work setting; and using judgment in making decisions.

If your impairment is considered non-severe, the SSA will find that you are not disabled based on the medical evidence alone. In other words, the SSA will find you not disabled without considering your age, education, or work experience. If the SSA determines that your impairment is severe, the disability evaluation will continue to the next step.

Does Your Impairment Meet or Equal a Listed Impairment?

The SSA will next consider whether the medical evidence shows that your impairment is as severe as one of the impairments found in their official Listing of Impairments (also known as the Blue Book). The Blue Book lists the most common medical conditions that are severe enough to prevent a person from working. To meet an SSA official listing, the medical evidence must show that your impairment matches each and every requirement of a listed impairment.

Even if you do not meet a listing exactly, you may still be found disabled if the medical evidence shows that your impairment is equal in severity to a listing. You may also equal a listing if you have a combination of impairments that together are severe enough to equal a listing (even if the impairments alone would not meet a listing).

If you are found to meet (or equal) a listing, the SSA will conclude that you are disabled based solely on the medical facts. If you do not meet or equal a listing, you may still be found disabled by showing that you don't have enough remaining function to your past job or by receiving a medical-vocational allowance. The SSA will assess your residual functional capacity (RFC) for performing basic work activities and will consider how other vocational factors, such as your age, education, and work experience affect your ability to work.

(For more on this step, see "Meeting" vs. "Equaling" a Social Security Disability Listing.)

Can You Do Your Past Work?

At the fourth step of the evaluation, the SSA will use your "residual functional capacity" (your RFC, or ability to perform basic work activities despite the effects of your impairment) to determine whether or not you can return to any of your past work. If you are capable of doing your past jobs, you will be found not disabled. If you cannot do past work, the evaluation continues to the next step.

Can You Do Other Work in the National Economy?

At this step, the SSA will consider your RFC, age, education, and work experience to decide if there are other jobs in the national economy that you can be expected to learn and do. If you are capable of doing other jobs, you will be found not disabled. If you are not able to do other jobs, perhaps because you cannot transfer your job skills or learn new ones, you will be found disabled and granted disability benefits via a "medical-vocational allowance."

What Medical Evidence Do You Need?

You are responsible for providing medical evidence to prove that you have a disabling impairment. However, the SSA is required to make every reasonable effort to help you obtain medical reports from acceptable medical sources.

Acceptable medical sources means licensed physicians, licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language pathologists. In addition, the SSA may consider evidence from other medical sources such as therapists, nurse-practitioners, chiropractors, physicians' assistants, naturopaths, and audiologists. The types of medical reports submitted should include your medical history, diagnoses, clinical findings, laboratory findings, prescribed treatment and response, prognosis, and an opinion from your treating doctor describing your ability to perform basic work activities.

In some situations, the SSA will purchase a consultative examination if, for example, you did not submit enough evidence or there are conflicts in the medical evidence. The regulations state that your treating doctor should be the preferred source to provide the consultative examination; however, the SSA may and often does use another medical source if needed.

Since medical evidence is so important in the disability evaluation, be sure to see your doctor regularly and to mention all of your symptoms and any side effects resulting from medications that you take. The SSA's regulations require the SSA to give particular emphasis on medical evidence from your treating doctor because your doctor is in a better position to provide a comprehensive description of your impairment from a long-term perspective. The more medical evidence you can provide, the less likely it is that your disability determination will be based on a consultative examination performed by a doctor who has only seen you once.

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