You may be asking yourself, “Am I disabled?” Or, “How does Social Security determine if you are disabled?”
This page will provide you with some information to learn about how Social Security determines if you are disabled for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
Social Security’s definition of disability in SSDI or SSI is the same. It is the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) 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.
Social Security Follows a Five (5) Step Sequential Evaluation Process in reviewing disability claims. Click the link in the previous sentence for more details about the 5 step process.
What Factors Does the Social Security Administration Consider to Determine Whether I am Disabled and Eligible to Get Disability?
In evaluating whether to approve a Social Security Disability Benefit claim, the Social Security Administration is required to consider your age, education level, work experience over the past 15 years, and the specific disabling conditions you are suffering from.
In short, each claim is individually evaluated and no two claims are alike. An experienced attorney can and should explain to you what will be required to win your individual case given your age, education, prior work experience, and disabilities. In cases I handle, I will sit down with you and explain how each of these factors affects your unique case. I will go over all of your physical and mental conditions and resulting limitations with you. I will then explain how all of these vocational (or job) factors combine to determine your disability outcome.
When Is a Person Considered Disabled For Social Security Disability?
“Disability” under Social Security is based on your inability to work due to an impairment, either physical or mental (psychological or psychiatric) in nature. Social Security considers you disabled under its rules for SSDI and SSI 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.
Using Social Security’s language, you must be being unable to do substantial gainful activity (SGA for short, further discussed below). In addition, your impairment must have prevented you from doing SGA for at least 12 months, or will be expected to prevent you from doing SGA for at least 12 months. (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.)
Substantial Gainful Activity
To qualify as a disabled person under Social Security’s rules, a disability claimant must be unable to perform “substantial gainful activity” or SGA. Generally, SGA is defined as earning more than a set amount per month, currently $1,040 per month (in 2013). 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 be working and earning above the SGA amounts when they apply for benefits and win benefits. We understand that some applicants continue to work after applying for benefits, and plan to quit if they are approved for benefits. However, the claim will always be denied and never approved if the claimant continues to earn wages above the SGA level. In fact, anyone earning more than the SGA amount who applies for Social Security disability insurance or SSI benefits will be denied immediately, without even having their impairments or medical records evaluated. This is what we call a “technical denial.”
Disabled individuals may be working 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 lead Social Security to think you could work a full-time job).
Medical Evidence That Qualifies You for Disability
As stated above, a disabling condition is a medically determinable physical or mental impairment that results in marked and severe functional limitations. Social Security requires sufficient medical information from you that will help it determine the existence, severity, and duration of your impairment(s). 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, although the effects of symptoms may be an important factor in Social Security’s decision whether a person is disabled. If the medical evidence alone shows that a person is clearly disabled or not disabled, Social Security decide the case on that information. Otherwise, Social Security go on to consider other factors, such as 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 a period of time. In mental health cases, your providers should produce the results of any mental status examination, including any psychometric testing.
Residual Functional Capacity Assessment
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” or RFC. Such an assessment should tell Social Security your doctor’s opinions about both physical and mental functions and, to the extent possible, the reasons to support the opinions, such as the clinical findings and/or observations of you. These opinions should reflect your abilities to perform work-related activities on a sustained basis, i.e., 8 hours/day and 5 days/week. Your doctor’s descriptions of any functional limitations noted throughout the time the doctor treated you are very important.
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.
Medical-Vocational Rules
Social Security will uses 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 his or her 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 his or her 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 his or her knowledge of medical terminology, if the other work is more tolerable physically. If an applicant is older (starting at age 50) and 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 visit our section on disabling medical conditions and impairments.
Should I Apply for Social Security Disability Benefits?
Why should you apply for Social Security Disability Insurance (often called SSD or SSDI for short) and/or Supplemental Security Income (SSI) disability benefits from the Social Security Administration (SSA)?
First, if you found disabled then you are entitled to monthly cash benefits. However, in addition to cash benefits, also qualify for medical health insurance benefits. SSI recipients qualify for Medicaid right away, and SSDI recipients qualify for Medicare after two years of receiving benefits.
As for when you should file a disability claim, here are two lists that may help:
Reasons to Apply for Social Security Disability
If all of the following apply to you, you should are eligible for disability benefits and should file an application:
- You have a mental or physical condition that is severe.
- Your disabling medical condition has lasted at least one year, or is expected to last for at least one year or longer.
- Your condition is severe enough that it prevents you from performing full time work, or keeps you from earning more than $1,040 per month (or $1,740 if you’re blind). Social Security considers this the Substantial Gainful Activity (SGA) level.
If you believe your medical condition is severe, will last 12 months or longer, and will prevent you from earning SGA, you should contact your nearest Social Security field office to start a disability claim. Do not hesitate to do this because the application process on a disability claim can be extremely lengthy.
Reasons NOT to Apply for Social Security Disability
You should not apply for disability if any of the following apply to you:
- Your condition is not severe.
- Your condition is expected to be temporary, or last less than one year. An example would be a broken leg that is expected to heal within 12 months.
- You are consistently able to earn over $1,040 per month (even though you think you are eligible for benefits because you cannot work full-time or earn as much as you used to make).
- You have not worked long enough or paid enough Social Security taxes to be eligible for SSDI, and your family income or assets are too high to qualify for SSI.
Work with an Experienced Florida Social Security Disability Lawyer
Every case is unique, so I encourage you to give us a call to discuss your individual case. The Ortiz Law Firm represents Social Security Disability claimants in Northwest Florida and Southwest Alabama. If you’d like to speak to an experienced Social Security Disability attorney contact us at (866) 853-7703 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access Social Security Disability benefits and how to move forward with the process.