THE DEFINITION OF DISABILITY

Inability to engage in 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.

DISABILITY UNDER SOCIAL SECURITY IS BASED ON THE INABILITY TO WORK.

The Social Security Administration (“SSA”) considers an individual “disabled” if, due to an established medical condition, he or she: – meets or equals one of our medical Listings (criteria that are presumed to preclude work for most people); – cannot perform any of his/her work that was done before; or – cannot make an adjustment to other work.

THE FIVE-STEP SEQUENTIAL EVALUATION

Under the authority of the Social Security Act, the Social Security Administration has established a five-step sequential evaluation process for determining whether an individual is disabled (20 CFR 404.1520(a)). The steps are followed in order. If it is determined that the claimant is or is not disabled at a step of the evaluation process, the evaluation will not go on to the next step.

STEP 1

IS THE INDIVIDUAL WORKING ABOVE SGA LEVEL?

At the first step, we consider an individual’s work activity, if any. SGA stands for Substantial Gainful Activity and the amount changes each year. For 2020, it is $1,260 for the non-blind and $2,110 for the blind. If an individual is working and his or her earnings average more than the SGA limit a month, then he or she is found not disabled. If an individual is not working or his or her earnings are less than SGA, the adjudicator goes to step two.

STEP 2

IS THE INDIVIDUAL’S PHYSICAL AND/OR MENTAL CONDITION SEVERE?

At the second step, we consider the medical severity of an individual’s impairment(s). An individual must have a medically determinable physical or mental impairment (or a combination of impairments) that is severe and meets the duration requirement. To be severe an impairment or impairments must interfere with basic work-related activities. To meet the duration requirement the impairment(s) must be expected to last twelve months or to result in death. If the impairment(s) are not severe or do not meet the duration requirement, the individual is found not disabled. If the impairment(s) are severe and meet the duration requirement, the adjudicator goes to question three.

STEP 3

DOES THE INDIVIDUAL’S MEDICAL CONDITION MEET OR EQUAL THE SEVERITY OF A LISTING? SEE LISTINGS HERE.

At the third step, we also consider the medical severity of an individual’s impairment(s). SSA maintains a listing of medical criteria that are considered to be so severe that an individual is found to be disabled if his or her medically determinable physical or mental impairment(s) matches them. An individual’s impairment(s) can be found to meet the listed criteria exactly or to be of equal severity.

If an individual has an impairment that meets or equals one of the listings and meets the duration requirement, he or she is found to be disabled. If an individual does not have an impairment that meets or equals one of the listings or the duration requirement is not met, the adjudicator goes to Step 4.
However, before going from step three to step four, the individual’s residual functional capacity (RFC) is assessed. This RFC assessment is then used at both step four and step five.

WHAT IS RESIDUAL FUNCTIONAL CAPACITY OR RFC?

Ordinarily, RFC is a function-by-function assessment of an individual’s maximum ability to do sustained work-related physical and mental activities on a regular and continuing basis (8 hours a day, for 5 days a week) despite the limitations and restrictions resulting from his or her medically determinable impairments. In short, it is an accounting of an individual’s capacity for full-time work.

RESIDUAL FUNCTIONAL CAPACITY (RFC)

For the physical RFC (PRFC) an individual’s medical condition is evaluated in terms of the physical demands of work used in the Dictionary of Occupational Titles (DOT) and the Selected Characteristic of Occupations (SCO). Mental RFC (MRFC) is evaluated in terms of the mental demands of work set out in the Code of Federal Regulations (CFR). The sole purpose of assessing RFC is to determine an individual’s ability to work at steps 4 and 5.

THE BASIS FOR STEPS 4 AND 5 FROM THE SOCIAL SECURITY ACT

An individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work. For purposes of the preceding sentence (with respect to any individual), “work which exists in the national economy” means work which exists in significant numbers either in the region where such individual lives or in several regions of the country.

STEP 4

CAN THE INDIVIDUAL DO ANY OF HIS/HER PAST RELEVANT WORK?

At step 4, a function-by-function comparison of the individual’s RFC and past relevant work (PRW) is completed. If an individual retains the physical and mental capacity to perform any PRW, he/she is found not disabled. If no PRW can be done, or the individual has no relevant work, the adjudicator goes to step five.

At this step SSA does not consider a claimant’s: – Age; – Education; – Body Habitus; – Employability; or – Whether PRW exists in significant numbers in the national economy.

STEP 4 HAS TWO PARTS

Does the individual retain the capacity to perform PRW as he or she actually performed it?

Does the individual retain the capacity to perform PRW as generally performed in the national economy?

WHAT IS PAST RELEVANT WORK?

Three-part test.
The work must have been: (1) Substantial Gainful Activity (SGA); (2) Performed in the fifteen year relevant period; and (3) Performed long enough to learn it (reach average performance).

THE BURDEN OF PROOF IS AN INDIVIDUAL’S THROUGH STEP 4

An individual is responsible for submitting evidence showing that he or she has an impairment which prevents the performance of past relevant work. If this is shown at step 4, the adjudicator goes to step 5.

At step 5 the “burden of proof” shifts to SSA to show that work, other than what the individual performed in the past, exists in significant numbers in the national economy that he or she can make an adjustment to, considering the limiting effects of the individual’s impairment, age, education, and work experience.

STEP 5
CAN THE INDIVIDUAL MAKE AN ADJUSTMENT TO ANY OTHER WORK?

At the fifth and last step, an individual’s RFC and age, education, and work experience are considered to see if he/she can make an adjustment to other work. If an individual can make an adjustment to other work, he or she is found to be not disabled. If an individual cannot make an adjustment to other work, he or she is found to be disabled.

THE SPECIAL MEDICAL-VOCATIONAL PROFILES

At step 5, the adjudicator first considers the Special Medical Vocational Profiles.

These Profiles are specific combinations of severity and the vocational factors of age, education and work experience. In essence, the Special Medical-Vocational Profiles are exceptions to the Medical-Vocational Guidelines. If the criteria of a profile is met, an individual is found to be disabled without any further evaluation. If no profile is met, then the adjudicator goes on to consider the Medical-Vocational Guidelines (“The Grids”).

THE MEDICAL-VOCATIONAL GUIDELINES (OR TABLES, GRIDS, OR RULES)

Are based only on exertional limitations or restrictions.

Cross reference a claimant’s RFC exertional level with his/her age, education, and work experience and provide an outcome backed by a significant number of occupations.

RFC EXERTIONAL LEVELS IN THE RULES

• Sedentary– lifting/carrying less than 10 lbs occasionally, a negligible amount frequently; standing/walking at least 2 hours – 201.00
• Light– lifting/carrying up to 20 lbs occasionally, 10 lbs frequently; standing/walking 6 hours – 202.00
• Medium– lifting/carrying up to 50 lbs occasionally, 25 lbs frequently; standing/walking 6 hours – 203.00
• Heavy– lifting/carrying up 100 lbs occasionally, 50 lbs frequently; standing/walking 6 hours – 204.00
• Very Heavy– lifting/carrying over 100 lbs frequently; standing/walking 6 hours – 204.00

Age Categories

• Younger Individual, 18 – 49
• Closely Approaching Advanced Age, 50 – 54
• Advanced Age, 55 and Older
• Closely Approaching Retirement Age, 60 or Older (Table 3).

Education Categories

• Illiteracy in English or Inability to communicate in English or Both(All three possibilities are treated the same.)
• Marginal Education(6th grade or less)
• Limited Education(7th – 11th grade)
• High School Education and Above(including GED high school equivalent diplomas)

MEETING A RULE

These rules are designed to evaluate every case in a uniform manner.

In order for a rule to be met, all of the findings of fact must coincide with the rule’s specific criteria. An individual must: – be able to perform substantially all of the strength demands defining the level of exertion, and – meet the education criteria, and – meet the age criteria, and – meet the work experience criteria.

If a rule is met, it directs the finding of disabled or not disabled and must be cited in the determination or decision.

If the rule directs a finding of disabled, no occupations are cited – the rule provides administrative notice of the existence of sufficient numbers of occupations.

TRANSFERABILITY OF SKILLS

Transferable skills can only be derived from past relevant work.

The past relevant work must be semi-skilled or skilled.

Skills are never transferable to unskilled work.

A transferability of skills analysis (TSA) is only done when it makes a difference in the determination or decision.

TRANSFERRING SKILLS

An individual has transferable skills when the skilled or semi-skilled job functions performed in past work can be used to meet the requirements of other work within an individual’s RFC. Transferable skills should be a vocational advantage that outweighs RFC, age and education when competing in the labor market. As age increases, the likelihood of successfully adjusting to other work decreases.

SUMMARY OF ALLOWANCE AND DENIAL

At step 1, a claim can be denied but not allowed.

At step 2, a claim can be denied but not allowed.

At step 3, a claim can be allowed but not denied.

At step 4, a claim can be denied but not allowed.

At step 5, a claim can be allowed or denied.