How Social Security determines whether you are disabled seems like a mystery. Just what does Social Security do with all of the information they collect? What questions do they ask to determine if you qualify?
Each time Social Security makes a determination on your case, the agency goes through a “five-step sequential evaluation process.” In essence, Social Security asks a series of five questions. The answers to those questions determines whether or not you are considered disabled under Social Security's disability standard. This article explains those five steps.
The first question Social Security asks is whether you are working. In general, if you are working a substantial amount, that is, earning more than $1,040 gross income per month, Social Security will deny your application for benefits. If you are not working, or you are working but earning less than $1,040 per month (what Social Security calls substantial gainful activity), the evaluation proceeds to Step 2.
A “severe” condition is one that interferes with basic work-related activities such as standing, walking, seeing, hearing, understanding, and carrying out instructions. If you have more than one condition, Social Security must consider whether the combination of impairments is severe. If your condition is not severe, Social Security will deny your case. If your condition is severe, the evaluation proceeds to Step 3.
Social Security maintains a list of conditions that are so severe that they are automatically considered disabling. If your condition is on this list and is severe enough to meet the criteria set out by Social Security in the listing, you will be found disabled. If your condition is not including on the list, you may still be disabled under Step 3 if your condition is "equal in severity" to a listed condition. Please note that a physician must document how you meet the listing criteria or that your condition is of equal severity to a listing in order for you to be approved at this step. If your condition does not meet or equal a listing, Social Security proceeds to Step 4.
At Step 4, Social Security considers what you remain able to do, taking into account the limitations imposed by your conditions. This is called your “Residual Functional Capacity,” or RFC. The agency compares your RFC to the demands of any work you performed within the past 15 years. If you are able to perform any of this work, Social Security will determine you are not disabled. If you are not able to perform your past work, the agency proceeds to Step 5.
At this step, Social Security considers your age, education, and past work experience to determine whether you can adjust to different work. If your RFC shows that are not able to perform other work, or if you fall under a medical-vocational rule that says you can't "adjust" to other work because of your advanced age or lack of education, Social Security will find you disabled and approve your case. If Social Security determine that you are able to adjust and perform other work, you won't be considered disabled.
The above is meant as a general guide to the five-step sequential evaluation process. There are many complexities and details that go along with making the determination at each step. Learn more in our section on medical eligibility for Social Security disability. Also, an experienced Social Security attorney will be able to address how each step of the process applies in your specific case and at which step you might be denied.