Eligibility for Disability Benefits Through a Medical-Vocational Allowance

When you apply for disability benefits with the Social Security Administration (SSA)—whether that's Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), or both—the definition of disability is the same. If you can meet the requirements of one of the conditions listed in Social Security's blue book, the SSA will consider you disabled.

But what if you don't meet a listing and you still can't work because of your condition? You might qualify for what's known as a medical-vocational allowance. Here's how it works.

How Social Security Evaluates Disabilities

When deciding if you're disabled, Social Security follows a 5-step sequential evaluation process.

First, Social Security will look at your current earnings to determine if you're engaged in "substantial gainful activity" (SGA). In other words, are you working and earning above the SGA limit? (For 2023, that's $1,470 per month.)

Second, Social Security will evaluate your impairment to determine if it's severe.

Third, Social Security will determine whether your impairment meets or equals the criteria of one of the listed impairments. If your medical condition does meet (or equal in severity) a listed impairment, Social Security will find you disabled, the determination process ends, and you should be granted benefits.

But if Social Security determines that your impairment doesn't meet or equal the requirements of a specific listing, the disability evaluation doesn't end. Instead, it moves on to the fourth and fifth steps: Social Security will assess your remaining functional capacity for work—considering your age, education, and work experience.

If Social Security finds that you can't work in any type of job, you'll qualify for disability benefits based on a "medical-vocational allowance." In fact, this is how most people win disability benefits.

Your Residual Functional Capacity and Why It Matters

Before moving on to the next steps, Social Security will assess what's known as your "residual functional capacity" (RFC). Your RFC represents the most that you can do in terms of work-related activities despite the limitations or restrictions of your impairment (based on all the medical and other relevant evidence in your case record).

An assessment of your RFC will include an evaluation of your ability to perform physical functions such as:

• sitting
• standing
• walking
• lifting
• carrying
• pushing, and
• pulling.

These seven strength demands are referred to as your "exertional" capacity. In general, your RFC will be stated in terms of the exertional categories of sedentary work, light work, medium work, or heavy work.

The assessment will also include an evaluation of your "non-exertional" capacity:

• your ability to perform other physical functions, such as:
  
  • stooping
  • bending
  • seeing
  • speaking, and
• any mental limitations, such as your ability to follow directions and interact socially.

Step Four: Can You Do Past Work With Your RFC?

Once your RFC has been determined, Social Security will evaluate whether you can perform any of your past jobs. Social Security will compare your RFC with the physical and mental demands of your past relevant work. If the SSA finds that you don't have the RFC to perform your past job, the disability evaluation will continue to step five to see if you can perform any other jobs.

Step Five: Can You Do Other Work With Your RFC?

At the final step of the disability evaluation process, Social Security will determine if you have the ability to "adjust" to other work. To make this determination, Social Security will consider your RFC along with "vocational" factors, such as:

• your age
• your education, and
• job skills you've gained through work experience.

If Social Security finds that you have the capability to do any other job that exists in the United States (whether or not there are open positions), your disability claim will be denied. But if Social Security finds that your RFC and vocational factors prevent you from learning or adjusting to other work, you'll be found disabled and awarded disability benefits.

How Vocational Factors Affect Your Disability Evaluation

The vocational factors Social Security considers are:

• age
• education, and
• job history.

Each has an impact on your ability to get a medical-vocational allowance.

Age: The Older You Are, the Easier It Is to Win Disability Benefits

Your age is a big factor in determining whether Social Security believes your RFC allows you to do "other work." In general, the older you are, the more likely Social Security will consider your age a negative vocational factor, and it's less likely you'll be expected to learn or adjust to a new job.

Social Security breaks it down this way:

• Between the ages of 18 and 49, you're considered a "younger individual."
• Between 50 and 54, you're "closely approaching advanced age."
• At age 55 and over, you're considered a person of "advanced age," and you're much less likely to be able to adjust to other work.

Education: Limited Education Limits Your Ability to Find Work

Education refers to what level of school you completed. Your education level is classified into the following groups:

• illiterate or unable to communicate in English
• marginal (less than 7th grade)
• limited (less than 12th grade), or
• high school or more.

The higher your education level is, the more potential jobs there are that you could do. Whereas there are fewer jobs available for someone with little to no education.

Work Experience: The More Skills You Have, the Harder It Is to Be Found Disabled

Social Security will categorize your work experience based on the job skills you would have needed to learn to do your past work. Your work experience will be rated as one of the following:

• none
• unskilled
• semi-skilled, or
• skilled.

The Medical-Vocational Grid

Social Security has developed specific rules in a series of tables known as the Medical-Vocational Guidelines (also called the "med-voc guidelines," or "the grid"). Each rule sets forth specific combinations of the relevant factors that determine whether Social Security will expect you to do other work, including your:

• RFC, and
• vocational factors:
  
  • age
  • education, and
  • work experience.

Where your RFC and vocational factors match the criteria set forth in a specific rule, Social Security must apply the rule. And the applicable rule will say whether or not you're disabled.

The medical-vocational guidelines are a way for Social Security to make sure that disability rules are applied consistently. The disability reviewer just needs to find your specific vocational profile in the grid to determine whether you qualify for disability benefits.

The grid is only helpful to your claim if you're age 50 or older. If you're younger than 50, Social Security will just compare your RFC with the requirements of many types of jobs to see what kind of work you can still do.

The Grid Focuses on Exertional Capacity

The medical-vocational guidelines are designed to evaluate your physical capacity to work given the limitations of your impairment(s). The grid is made up of tables based on each physical RFC level:

• sedentary work
• light work
• medium work, and
• heavy work.

For example, if your RFC is for sedentary work and you're 50 years old or older, you didn't graduate from high school, and you've only worked in unskilled jobs, Social Security will consider you disabled and grant a medical-vocational allowance. But if you're 45 years old with the same background, you won't be considered disabled.

In general, if you're age 50 or over, you have a better chance of being granted a medical-vocational allowance. Likewise, if you're a younger person, you might have a difficult time getting benefits under a medical-vocational allowance.

What if your factors don't match the exact criteria of a rule (for example, what if you have an RFC for light work, but for less than the full range of light work)? When you don't match the grid, the Social Security claims examiner or administrative law judge will use the medical-vocational guidelines as a frame of reference for deciding whether you're disabled or not.

Non-exertional Capacity and the Med-Voc Guidelines

The medical-vocational guidelines determine whether you're disabled based only on the physical difficulties you have in meeting the exertional or strength demands of a job. Those rules are set.

But if you only have non-exertional limitations (for example, you must use the restroom frequently) or mental limitations (for example, you have a reduced ability to follow directions due to a mental impairment), the rules are less solid. When considering non-exertional limitations, Social Security will use the medical-vocational guidelines only as a frame of reference for determining disability.

Getting Help With Your Disability Claim

It's possible to get Social Security disability benefits even if you don't meet (or equal) a listing. But it's an uphill battle. You'll need to prove that no work exists (anywhere in the United States) that you can do given your limitations.

This can be especially tough if your impairments are largely non-exertional. But you don't have to fight alone. Hiring a disability lawyer can improve your odds of winning your disability claim, especially if you don't fit neatly on the grid.