The Social Security Administration uses a five-step sequential evaluation process to decide whether you are disabled. These rules apply to you if you file any of the following applications for Social Security disability benefits: Supplemental Security Income benefits, Social Security Disability Insurance benefits, child’s insurance benefits, and widow’s or widower’s benefits. Social Security will consider all evidence in your case record when it decides whether you are disabled under its rules.
How Social Security Determines Disability
The sequential evaluation process is a series of five “steps” Social Security follows to decide a disability claim. If it can find that you are disabled or not disabled at a step, Social Security decides, and it does not move to the next step. If Social Security cannot find you are disabled (or not disabled) at a step, it moves on to the next step.
Before it goes from Step 3 to Step 4, it will assess your “residual functional capacity.” (See paragraph (d) below.) Social Security uses this residual functional capacity assessment when evaluating your claim at Step 4 and Step 5. These are the five steps Social Security follows:
1. Are you working?
In the first step, Social Security considers your work activity, if any. If you are doing substantial gainful activity (SGA), Social Security will find that you are not disabled.
If you are not working, Social Security goes to Step 2.
2. Is your condition “severe”?
In the second step, Social Security considers the medical severity of your impairment(s). Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, Social Security will find that you are not disabled.
If your condition does interfere with basic work-related activities, Social Security goes on to Step 3.
3. Is your condition found in the listing of impairments?
In the third step, Social Security also considers the medical severity of your impairment(s).
For each of the major body systems, Social Security maintains a list of medical conditions that are so severe they automatically mean that you are disabled. This is known as the Listing of Impairments.
If you have an impairment(s) that meets the requirements of one of its Listings of Impairment and meets the duration requirement, Social Security will find that you are disabled.
If your condition is not on the list, Social Security must decide if it is of equal severity to a medical condition on the list.
Note: Social Security has two initiatives designed to expedite its processing of new disability claims:
- Compassionate Allowances: Certain cases that usually qualify for disability can be allowed after the diagnosis is confirmed. Examples include acute leukemia, Lou Gehrig’s disease (ALS), and pancreatic cancer. The SSA has compiled a list of Compassionate Allowance conditions.
- Quick Disability Determinations: Social Security uses sophisticated computer screening to identify cases with a high probability of being allowed under the Quick Disability Determinations initiative.
If your impairment does not meet or equal a listing, then Social Security goes to Step 4.
4. Can you do the work you did previously?
Suppose your condition is severe but not at the same or equal severity level as a medical condition on the list. In that case, Social Security must determine if it interferes with your ability to do your previous work (your “past relevant work”).
In the fourth step, Social Security assesses your abilities even with your disabling conditions (residual functional capacity) and past relevant work. If you can still do your past relevant work, Social Security will find that you are not disabled.
If you cannot do your past relevant work, Social Security proceeds to Step 5.
5. Can you do any other type of work?
At the fifth and last step, Social Security will decide if you can adjust to other work. It will consider your medical conditions, age, education, past work experience, and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adapt to different work, your claim will be denied.
How Social Security Decides If Your Benefits Continue or End
If you are already receiving Social Security disability benefits, the Social Security Administration will use a different sequential evaluation process to decide whether you continue to be disabled. Social Security explains this process in §404.1594(f)
a. If you are working.
If you are working and your work is substantial and gainful, Social Security will find that you are not disabled regardless of your medical condition or your age, education, and work experience.
b. You must have a severe impairment.
If you do not have any impairment or combination of impairments that significantly limits your physical or mental ability to do basic work activities, Social Security will find that you do not have a severe impairment and are, therefore, not disabled. Social Security will not consider your age, education, and work experience. However, you can have a period of disability for a time in the past even though you do not now have a severe impairment.
c. When your impairment(s) meets or equals a listed impairment in Appendix 1.
If you have an impairment(s) that meets the duration requirement and is listed in Appendix 1 or is equal to a listed impairment(s), Social Security will find you disabled without considering your age, education, and work experience.
d. When your impairment(s) does not meet or equal a listed impairment.
If your impairment(s) does not meet or equal a listed impairment, Social Security will assess your residual functional capacity based on all the relevant medical and other evidence in your case record, as explained in §404.1545. (See paragraph (f)(2) of this post below and §404.1562 for an exception to this rule.)
Social Security uses its residual functional capacity assessment at the fourth step of the sequential evaluation process to determine if you can do your past relevant work (paragraph (e) below) and at the fifth step of the sequential evaluation process (if the evaluation proceeds to this step) to determine if you can adjust to other work (paragraph (f) of this section).
e. Your impairment(s) must prevent you from doing your past relevant work.
If Social Security cannot decide at the first three steps of the sequential evaluation process, Social Security will compare its residual functional capacity assessment, which is made under paragraph (d) of this section, with the physical and mental demands of your past relevant work. (See §404.1560(b).) If you can still do this work, Social Security will find you are not disabled.
f. Your impairment(s) must prevent you from adjusting to other work.
(1) If Social Security finds that you cannot do your past relevant work because you have a severe impairment(s) (or you do not have any past relevant work), Social Security will consider the same residual functional capacity assessment is made under paragraph (d) of this section, together with your vocational factors (your age, education, and work experience) to determine if you can adjust other work. (See §404.1560(c).) If you can adapt to different work, Social Security will find you not disabled. If you cannot, Social Security will find you disabled.
(2) Social Security uses different rules if you meet one of the two special medical-vocational profiles described in §404.1562. If you meet one of those profiles, Social Security will find that you cannot adjust to other work and are disabled.
