Principal Attorney
For the purposes of SSDI claims, the SSA defines a “disability” as a medical condition that prevents a person from engaging in substantial gainful activity for at least 12 months, or that is expected to result in their death. The SSA focuses on work ability when it comes to disability determination, not diagnoses alone. Even applicants with serious conditions will not qualify for benefits if they are still capable of consistent work activity. That narrow definition explains why claims can succeed or fail based on the medical and work-related evidence available.
The SSA’s Five-Step Disability Evaluation Process
The SSA uses a five-step process to determine whether a person meets its definition of disability for SSDI. Each of these steps focuses on a specific aspect of eligibility:
Step 1: Review of Current Work Activity
First, the SSA checks to see whether the person is currently working and earning over the monthly substantial gainful activity (SGA) limit. If their earnings exceed that limit, the SSA denies the claim at this step. Otherwise, the SSA moves on to Step 2.
Step 2: Evaluation of Medical Severity
Next, the SSA reviews the applicant’s medical records to decide whether their condition significantly limits their ability to perform basic work activities. Social Security also considers whether the condition is expected to last at least 12 months or result in death. If the condition meets these standards, the SSA moves on to Step 3.
Step 3: Comparison to Listed Medical Impairments
Next, the SSA compares the condition to the medical listings in its Blue Book. If the medical evidence matches the criteria for a listed condition, the SSA can approve the claim at this step. If the condition does not meet or equal a listing, the SSA moves on to Step 4.
Step 4: Assessment of Past Relevant Work Ability
During Step 4, the SSA evaluates whether the applicant can still perform any job they’ve done in the past. If the SSA decides the person is capable of doing any jobs they’ve held in the past 15 years, it denies the claim. If not, the SSA moves on to the final step of its evaluation process.
Step 5: Determination of Ability to Perform Other Work
Finally, the SSA looks at whether the person could perform any work given their condition, including their disability, age, education, work history, and residual functional capacity. If the SSA finds realistic work options, it will deny the claim. Otherwise, it may approve the claim.
Medical Eligibility Under SSA Rules
Medical eligibility is based on how a person’s condition affects their daily functioning over time. The SSA requires medical evidence from acceptable sources, such as physicians, psychologists, and treatment facilities, to determine medical eligibility. Records must show a medically determinable condition that limits basic work activities and is expected to last at least 12 months or result in death. A diagnosis alone is not enough to qualify for SSDI. Medical records must clearly link the condition to real limitations that affect the claimant’s ability to perform substantial gainful activity on a regular basis.
Residual Functional Capacity
Residual functional capacity (RFC) is the SSA’s term for what a person can still do despite their medical limitations. If a person’s condition meets a listed impairment in the Blue Book, the SSA does not require an RFC assessment. If a condition does not meet a listing, the SSA uses an RFC assessment to decide whether they’re capable of any past work or other available work. The SSA reviews physical, mental, and sensory limits, including standing, walking, lifting, concentrating, and interacting with others, to assess RFC. This assessment shapes the SSA’s final decision in many SSDI claims.
Contact a Florida Disability Attorney Now
If you feel unsure about where you stand under SSA disability rules, the team at Disability Advocates Group can help you make sense of all the details. Contact us today for a free initial consultation to discuss your situation and how we can help you with your claim.