If you are wondering, “When is a person considered disabled by the SSA?” or “How does Social Security determine if I am disabled?” then you have come to the right place. This page explains how Social Security determines if you are disabled for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
What Is The Definition of Disability Used By The SSA?
“Disability” under Social Security is based on your inability to work due to an impairment, either physical or mental (psychological or psychiatric) in nature. For all individuals applying for disability benefits under Title II (SSDI) and for adults applying under Title XVI (SSI), the definition of disability is the same.
The law defines disability as the “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.”
See, 42 U.S.C. § 423(d) and § 1382c(a)(3).
These statutes further state:
“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.”
See, 42 U.S.C. § 423(d)(2)(a) and § 1382c(a)(3)(b).
In simpler terms, Social Security considers you disabled if:
- You cannot do work that you did before;
- Social Security decides that you cannot adjust to other work because of your medical condition(s), and
- Your disability has lasted or is expected to last for at least one year or to result in death.
This year-long requirement means that short-term conditions that last less than one year do not qualify as disabling conditions, no matter how severe. That excludes a lot of claims.
Social Security follows a five-step sequential evaluation process in reviewing disability claims. Click the link in the previous sentence for more details about the 5 step process.
Substantial Gainful Activity
Generally, SGA is defined as earning more than a set monthly amount, currently $1,550 per month for non-blind individuals (in 2024). However, this set dollar amount does not apply to all situations. For example, where someone is self-employed and may not have much in earnings after expenses, there are other tests Social Security applies to determine if someone is doing SGA.
Applicants cannot work and earn above the SGA amounts and win benefits. We understand that some applicants continue to work after applying for benefits and plan to quit if approved. However, the claim will always be denied and never approved if the claimant continues to earn wages above the SGA level.
Anyone earning more than the SGA amount who applies for Social Security disability insurance or SSI benefits will be denied immediately without having their impairments or medical records evaluated. This is what we call a “technical denial.”
Disabled individuals may work part-time when they apply for Social Security Disability as long as they do not earn more than the SGA amount (as long as this doesn’t make Social Security think they could work full-time).
The Listing of Impairments
The “Listing of Impairments” (often called the “Blue Book”) is a catalog of medical conditions that can be so severe that they automatically mean that you are disabled as defined by SSA rules. However, meeting a listing is just one way to be found disabled by the SSA. Even if a person’s condition does not precisely meet the criteria outlined in the Listing of Impairments, they may still be found disabled after considering other factors such as age, education, work experience, and functional limitations.
Medical Evidence Needed to Qualify For Social Security Disability
Social Security requires sufficient medical information from you to help determine the existence, severity, and duration of your impairment(s). As stated above, a disabling condition is a medically determinable physical or mental impairment that results in marked and severe functional limitations.
The medical condition(s) must be shown to exist by means of medically acceptable clinical and laboratory findings. Under the law, symptoms alone cannot be the basis for a finding of disability. However, the effects of symptoms may be a factor in Social Security’s decision whether a person is disabled. If the medical evidence alone shows that a person is disabled or not disabled, Social Security decides the case based on that information. Otherwise, Social Security considers other factors, such as your functional capacity in light of your impairment(s), age, education, and work background.
Records from your medical providers should include a thorough medical history and all pertinent clinical and laboratory findings (both positive and negative). Longitudinal clinical records and detailed historical notes discussing the course of your disorders, including treatment and response, are very useful for Social Security since it is interested in the impact of the illness over an extended period. In mental health cases, your providers should produce the results of any mental status examination, including any psychometric testing.
I always stress to my clients that their medical records are key to the success of their claims. I recommend seeing a doctor every three months or so. This is crucial because infrequent visits might suggest that the conditions aren’t as serious as claimed. In past denials, Administrative Law Judges have often doubted the credibility of claimants who describe intense pain but don’t seek regular medical care or go to the emergency room.
Residual Functional Capacity Assessments
You should also submit a statement of your doctor’s opinion about what work-related activities you can still do despite your impairment. This is referred to as your residual functional capacity (RFC). Such an assessment should tell Social Security your doctor’s opinions about physical and mental functions and, to the extent possible, the reasons to support the opinions, such as your clinical findings and observations.
These opinions should reflect your abilities to perform work-related activities on a sustained basis, i.e., eight hours/day and five days/week. Examples of work-related functions include:
- Physical Work-Related Functions: Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, and handling.
- Mental Work-Related Functions: The ability to understand, remember, and carry out simple instructions, the ability to use appropriate judgment, and the ability to respond appropriately to supervision, co-workers, and usual work situations, including changes in a routine work setting.
Your doctor’s descriptions of any functional limitations noted throughout the time the doctor treated you are critical.
Medical-Vocational Rules
Social Security will use the above-referenced RFC assessment to decide whether a disability applicant can work doing their past job (full-time). If it decides the claimant cannot perform their past work, Social Security is required to use a set of rules called the medical-vocational grid to determine if there are other jobs in the national and regional economy that the applicant can still do given their impairments (or be expected to learn to do).
For example, a nurse who is limited in standing and walking might be expected to switch to doing data entry in a medical facility, given their knowledge of medical terminology, if the other work is more tolerable physically. If an applicant is older (starting at age 50), has a limited education (less than high school), and does not have transferable job skills, the medical-vocational grid framework may not expect the person to learn a new job and will consider the person disabled.
For additional information on what medical conditions are considered disabilities, please see our page on disabling medical conditions and impairments.
