After you submit your initial application for disability benefits, Social Security will begin a five-step sequential evaluation process to determine in you qualify for benefits.  If it is determined that a person is disabled at a particular step, claims representatives will move on to the next step.  If a person is determined to not be disabled at that step, then Social Security will not go to the next step. 

The five steps stem from the definition of disability that is found in the Social Security Act.  The Social Security Act is one of three cornerstones used to set policy for the agency.  The other two are The Code of Federal Regulations and Social Security Rulings. 

Per the Social Security Act, the definition of a disability is “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 is expected to last for a continuous period of not less than 12 months.”  This is a strict definition of disability for the purposes of collecting benefits.  No SSDI or SSI benefits are paid for partial disability or any disability lasting less than 12 months unless it results in the death of a person.  SSDI and SSI benefits are for long-term disability only.  Social Security makes the assumption that families will have access to other financial resources to provide short-term support, such as insurance, savings, investments and workers’ compensation, among others.

After you submit an initial application, it may take some time for Social Security to work through the five steps of the application process.  During this time, especially if you are in dire need of benefits, the process will appear to go slow, and you will feel like you are doing nothing but waiting.  While some of that is true, Social Security has strict rules and steps they must follow, and depending on the nature of an application, it can take considerable resources and time to meet that mission. 

Here are the five steps that Social Security follows for processing a disability application:

  • Is the applicant working above the Substantial Gainful Activity level?  This means that if a person is making more than is allowable by Social Security, their application could be denied before any medical issues are even considered.  It means that a person is earning enough so that they are not disabled under the rules that Social Security imposes.  The amount changes each year.  In 2018, that amount was $1,180 per month.  If a person’s income falls below that amount, or they are not working at all, then an adjudicator will move on to the second step.  Otherwise, a person will be denied for what is known as a technical reason.
  • Is the applicant’s condition considered severe enough?  A person must have either a physical or mental condition, or a combination of conditions that are severe and meet the duration requirement of 12 months or more, or ending in death.  To be considered severe, an impairment must interfere with a person’s ability to basic work activities such as lifting, standing, driving, walking, pushing, pulling, making simple work-related judgments, responding to supervision and co-workers, or similar activities.  If the impairments meet the tests for severity and duration, then the adjudicator will move on to the third step. To determine this, an adjudicator will review your medical records and will probably ask a medical examiner to also look at them as well.  So filing complete and thorough medical records is essential if you hope to be approved.
  • Does the impairment or condition meet the severity to be considered one of the listings in Social Security’s Blue Book of Impairments?  Social Security maintains a list of medical conditions that are considered so severe that they automatically pass the test for being considered a disability.  These conditions are listed in the Blue Book of Impairments and include things such as many cancers, muscular conditions, mental disorders, cardiovascular conditions and many others.  The book is divided by major categories of impairments and is also broken down by Adult listings and Children’s listings. Adjudicators who determine that a person’s disability is listed in the Blue Book will approve a person’s application in most cases at this point, assuming all other parts of the application are complete and in order.  If a person’s condition is not listed, they can still be approved for benefits, but they will need to go through additional steps and documentation to be considered for approval.
  • Can the person still perform any of his or her relevant past work?  Social Security will take a look at an applicant’s age, past work history, and other related elements to determine if a person can still perform sustained work-related physical and mental abilities on a regular and continuing basis for 40 hours a week, despite any limitations or restrictions that their current impairments might place on them.  A Residual Functional Capacity (RFC) evaluation will be performed to see if an applicant can handle the physical rigors of work.  A Mental RFC may also be performed to see if a person can meet the mental rigors of a work environment as well.  If a person passes these tests, then they will found to be not disabled, and their application for benefits will be denied.
  • Can the person adjust to doing other similar kinds of work?  Social Security will take all factors into consideration including results of the RFC, age, work experience and so forth to determine if a person can make an adjustment and perform other kinds of work.  If Social Security determines this to be the case, then a person will be considered not disabled and their application will be denied.

Once Social Security has gone through some or all of these steps, you will be mailed a letter either letting you know you were approved for benefits, or that you were denied.  If you are denied, your letter will outline what steps you can take to appeal the decision.