The five step process to qualify for ssd benefits

May 15, 2024

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Originally Posted On: https://cannondisability.com/blog/the-five-step-process-to-qualify-for-ssd-benefits/

INTRODUCTION TO SSA’S SEQUENTIAL EVALUATION PROCESS

The SSA has a five step review process that they use to see if you qualify for SSDI and SSI benefits. Each step is a question that helps the SSA know what to do with your claim. Depending on the answer to the question, the SSA can eliminate your claim, grant claims, or deny your claim and move to the next step. Every case must go through the five step process. However, before the review process begins you must file an application for SSD benefits.

The first thing you need to know is that steps one and two are qualification steps. For example, step one is: Are you working? Step two is: Do you have a severe medical condition?

Once the SSA determines that you are not working due to a severe medical condition, then they move to the next steps of the review process.

You could be found disabled at step three if your medical condition meets the adult listing of impairments. If you don’t meet a listing, then you can win benefits at either step four or step five. Step four and five look at whether or not you can do your past work or other work in the national economy.

If your case proceeds from step one through step five, then a Social Security judge will decide whether you can perform your past work or do any other work. Obviously, if the judge finds you can work, then you will not win benefits. However, if the judge finds that you cannot perform any work, then you will be paid SSDI and SSI benefits.

FIRST STEP: ARE YOU WORKING?

The first step of the Social Security review process is really very simple. If you are working, then you cannot apply for benefits. The only reason that this step gets complicated is that the SSA has its own definition of work. Work, according to the SSA, is earning over the substantial gainful activity (SGA) level.

In 2023, the SGA amount is $1470 per month, prior to taxes being taken out. In 2024, the SGA amount is $1550. Each year the SGA level goes up according to the cost of living. The SGA amount is higher for those who are blind. For example, SGA for statutorily blind people in 2024 is $2590.

People tend to think that they can work and earn slightly below SGA and still be paid benefits. While technically, this is accurate, it doesn’t play out in reality. No judge wants to award benefits to a person who is earning slightly under the SGA amount. The judge thinks, if you can earn some money, then you can earn more money. The judge is not wrong. Therefore, if you want to win SSD benefits, then you should not be working at all due to your medical condition.

ARE YOU WORKING AT THE LEVEL OF SUBSTANTIAL GAINFUL ACTIVITY?

According to the SSA, if you’re earning more $1470 per month in 2023, then you are engaging in substantial gainful activity. In short, you are “working.”

If you are making enough money to engage in SGA, then the SSA will not let you apply for benefits. Or, they will simply deny your SSD claim. If you are making less money than SGA, you can apply for benefits. But, you should not expect to win benefits. The SSA does not usually grant benefits to people who are working. If you are not working at all due to your medical condition, then you have a better chance of winning benefits.

Also, the SSA requires you to have worked five out of the past 10 years on a regular basis in order to even apply for SSD benefits. If it has been more than five years since you stopped working, then you will not qualify for SSD benefits. Instead, you will have to apply for Supplemental Security Income (SSI) benefits.

WHAT IS THE DIFFERENCE BETWEEN SSDI AND SSI BENEFITS

There are two types of Social Security benefits: Social Security Disability Insurance (SSDI) benefits and Supplemental Security Income (SSI) benefits. You can file an application online at the Social Security’s website for either one or both. Below, you can find an explanation as to each type of benefit you can apply for:

Social Security Disability Insurance (SSDI):

SSDI benefits are for those who can no longer work due to a severe medical condition. The amount of money you will receive from SSDI benefits is based on the taxes you paid during your working years. To qualify for SSDI, you must have earned enough “work credits” to qualify.

A work credit is an amount of taxable income. You can earn up to 4 work credits per year. The amount of work credits you will need depends on how old you are when you apply. If you haven’t earned enough work credits at the time you apply, then you will only be able to file for SSI benefits.

Supplemental Security Income (SSI):

SSI is a needs based benefit. It is for only those people with little to no income, such as children and the elderly. Anyone who makes more than a certain amount of money per month cannot receive SSI benefits. The SSA counts the income of those in your house, not just your income and assets.

If you have a spouse who earns more than $4000 a month, then that income will prevent you from getting SSI benefits. The same rule applies if you are living with a boyfriend and he is paying your bills. Also, the same rule applies if you are living with your mother and she is paying your bills. You cannot get SSI benefits, no matter how severe your medical condition, if you do not meet the income and asset rules for SSI.

STEP TWO: DO YOU HAVE A SEVERE MEDICAL CONDITION?

When medical evidence establishes only a slight medical issue (like a broken arm) or a combination of slight problems which have no more than a minimal effect on your ability to work, then your medical condition is “not severe.” If the SSA finds your condition is not severe, then they will find you are not disabled.

Therefore, to proceed through the SSA review process, you must show the SSA you have a severe physical or mental condition. Additionally, multiple minor conditions can also qualify for benefits if, when combined, they limit the work you could do. The SSA’s decision is based on medical opinions and exams from your doctor and the SSA’s doctors. Learn more about the SSA doctor exam.

Some people have severe medical conditions but are still able to perform activities of daily living and work, because their condition is controlled by treatment. For example, if you have severe diabetes type 2, but it is controlled by insulin, then your illness would not be severe. Millions of people have diabetes and they still are able to work. It is when their symptoms no longer respond to treatment, that they stop being able to work.

THE DURATION TEST AT STEP TWO

Your case will be denied if your medical condition fails the duration test. That is, if your medical condition (1) is not expected to result in death, and (2) has neither lasted 12 months nor is expected to last for a continuous period of 12 months, then you fail the duration test. The duration test is usually invoked by the SSA at step 2, but it may also be invoked at step 3, 4, or 5.

STEP THREE: DOES YOUR MEDICAL CONDITION MEET OR EQUAL AN SSA LISTING?

At step three, the SSA will ask if your medical condition meets or equals a listing from the listing of impairments? The SSA has a list of medical conditions that qualify you for benefits. There are over a hundred specific medical conditions that qualify for SSDI and SSI benefits. Most of them are on our website. Learn more about physical conditions that qualify for SSD benefits. Also, you can learn more about mental conditions that qualify for SSD benefits.

To be awarded benefits by the SSA, you must meet every element of the listing. This is hard to do. However, the main evidence you need to prove you meet a listing is medical evidence. If you do not meet a listing, then you can equal a listing. Think of it as having two medical conditions that, when combined, are as severe as meeting the listing.

In order to meet or equal a listing, you must prove your medical condition with objective testing and medical records. The SSA will look for consistent, ongoing medical treatment. They will also look to see what your treating doctor has to say about your symptoms and how they impact your ability to work. You cannot go to the doctor one or two times and expect to win benefits. You must build a medical records over time by going to the doctor.

TO PROVE YOU MEET AN SSA LISTING YOU NEED MEDICAL EVIDENCE

Once again, you cannot win benefits without medical records. Therefore, if you do not have health insurance, then you need to apply for Medicaid benefits. However, if you cannot get Medicaid benefits or you cannot afford medical care, then we have a list of free and low cost health clinics for you. Choose your state and call the free clinic to get medical care:

When you file for SSD benefits, the SSA will ask your doctor to submit your medical records. As long as your doctor supports your application for SSD benefits, you should be able to prove to the SSA that you deserve benefits. Medical records are the key to winning SSDI and SSI benefits.

STEP FOUR: CAN YOU PERFORM YOUR PAST WORK?

Step four has two parts. The first thing the SSA asks is what is your residual functional capacity (RFC). Social Security will look at the jobs you’ve done over the last 15 years and make a determination, based on your RFC, as to whether or not you can do your past work.

If the SSA decides you can still do your past work as you actually did it, then they will find that you are not disabled, or
If the SSA decides you can do your past work as it is generally performed in the national economy, then they will find you are not disabled, or
If the SSA decides you are not physically and mentally able to do any of your past relevant work, either as you did it or as it is generally done in the national economy, then the SSA will move to step 5. Step five is the final step of the review process.

THE SSA DOESN’T CONSIDER WHETHER YOU CAN FIND A JOB

Unfortunately, the SSA doesn’t have to consider whether or not you can actually find a job. Instead, all they have to consider is whether you can do the job. If they find that you can perform your past work, then they will not pay you SSD benefits.

Even if you argue that you cannot find a job or that no one will hire you, it doesn’t matter to the five step review process. You will still not win benefits, because they have found you capable of working. Additionally, the SSA does not consider whether a job pays enough money for you to make a living. They also do not consider the following:

whether you would be hired,
whether a job opening exists,
whether you would be required to move,
whether you want to do this work,
whether you still have a certificate or license to do your past work.

STEP FIVE: CAN YOU DO OTHER WORK IN THE NATIONAL ECONOMY?

At step 5, the burden of proof shifts to the SSA to prove that there are “other” jobs (besides your past jobs) that you can perform. In order to make this decision, the SSA will look at a variety of factors. For example, they will look at your age, education, work experience, and your RFC.

These factors determine whether you can work in jobs that are consistent with your RFC. This determination involves the use of a set of tables known as the medical-vocational guidelines. The older you are and the fewer work skills you have, the easier it is to win benefits.

Once you reach the SSA hearing, there will usually be a vocational expert (VE) who will testify about these factors. The VE is an expert witness. The Social Security Judge calls a VE to testify about whether a person like yourself can do certain jobs. Also, the VE testifies about the number of jobs available in the economy. VEs have training in job placement. They also know the numbers and types of jobs that exist in the nation.

The Judge listens to your hearing testimony and reviews the medical records. They will also review opinions from the SSA doctors and your doctor to determine how your medical conditions impact you on the job. Then, the Judge will ask the VE questions about what kinds of jobs you could do. Likewise, your attorney will ask questions. Your attorney can also question the VE’s testimony. If you do not know how to question a VE, then hire a lawyer. Often it is VE testimony that determines whether you win or lose your SSD and SSI benefits.

IS IT WORTH THE ATTORNEY FEE TO HIRE AN SSD LAWYER?

It isn’t easy to win Social Security benefits. Likewise, the five step review process is frustrating for most people. But, having an attorney throughout the review process can make it easier. It is our belief that when you have a law firm with experience handling your Social Security case, then the SSA makes sure they follow their own procedures. Your lawyer can make sure the SSA applies the five step process correctly.

Additionally, when you have an attorney with legal experience, they will have access to Social Security’s decisions. Therefore, they can submit medical evidence that may be missing from your case. Additionally, if you listen to your attorney, she can tell you what medical evidence you need to obtain to win your case.

There is evidence that hiring an attorney with the proper experience raises your chances of winning your SSDI and SSI benefits by 30%. It is also smart to hire an attorney to help you with your hearing. After all, you are the star witness at your hearing. If you hire an attorney with experience, then they can prepare you to testify at your hearing. Learn more about how to prepare for your SSD hearing.

OUR LAW FIRM CAN HELP YOU WIN YOUR SSD BENEFITS

In the past 30 years, we have won millions of dollars in ongoing and past due benefits for our clients. If you want to win SSD benefits, then you need to hire an attorney with the experience to win your case. Also, you need a lawyer to prove to the SSA, through the five step process, that they should pay you SSD benefits. We can do that. Contact us today.

If you want to learn more about our lawyers and staff, then read our About Us page. For instance, Andria Summers is can help you choose the best Medicare Advantage plan. She has also won thousands of SSDI cases. Dianna Cannon has been helping SSD and SSI clients win benefits for more than thirty years. Brett Bunkall also has years of legal experience helping people obtain their SSI and SSD benefits. We are experts. You can trust us to help you win SSD and SSI benefits.

In the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. Also, we help our clients with their Medicare benefits. Our lawyers and staff can help you apply for Social Security benefits using the SSA’s website.

Likewise, there are also many forms you will need to fill out. But, don’t worry. If you have questions about SSA’s forms, then we will answer them. You can also learn more about SSA’s appeal forms. Call us for a free review of your SSD case today. Contact us now for help with your SSDI benefits application. We can help you win Social Security benefits using the five step SSA review process.