Skip to main content

UNDERSTANDING THE 5-STEP SOCIAL SECURITY DISABILITY PROCESS

Receiving Social Security disability payments depend on one thing:  Proving that you are not able to work.

The one and only thing that SSDI pays for is the physical and/or mental inability to work for a period of at least 12 months. 

Who decides if you are able to work?  The Social Security Administration (SSA) will decide.--according to their own strict rules and regulations.

In reaching that important decision, are you disabled or not, Social Security must use a 5-step examination process.  It's important to understand these 5 sequential steps.

STEP 1:  The work Test.  Is the claimant now engaged in Substantial Gainful Activity (SGA)?  If yes, the claim is denied at Step 1.  They look no further.  You cannot be eligible for SSDI benefits if you are working at SGA, regardles of your medical condition.  (In 2026 you are working at SGA if you earn at least $1,690 per month from work or self-employment).

STEP 2.  The Medical Requirement: Does the claimant have at least one severe medically determinable condition the the ability to work for a continual period of at least 12 months OR will end in death (a terminal illness)?  If no, the claim is denied at Step 2.

STEP 3. The Listings Test.  Does the claimant meet or equal one of Social Security's published criteria (Listing) that makes a finding of disability automatic?  Most claimants will not meet this test but can still be approved.  If a Listing is not met, the following determination must be made at Step 3:

  • What is the claimant's Residual Functional Capacity (RFC) now?  In short, is this claimant now able to perform even Sedentary or Light exertion work?  The RFC is largely determined by the objective medical evidence that has been submitted to the SSA.

STEP 4:  The Past Relevant Work Test.  Is the claimant now able to perform any of his/her past relevant work (PRW)?  They look at all your full-time jobs during the past 5 years.

  • If Social Security finds that you are able to perform any one of your past relevant jobs (full time), then you are denied at Step 4.
  • If they find you cannot perform any past relevant work, you move to Step 5.
  • STEP 5.  The Other Work Test.  The final step must answer this question:  Is there any other work in the national economy that you would be able to perform--considering your age, education and residual functional capacity?  If not, the claim will be approved at Step 5.  If the claimant is found able to perform other work which exists in "significant numbers" in the national economy, the claim is denied.  Note:  In a hearing, this Step 5 decision is determined by two factors:
  • First, the hypothetical questions that the Administrative Law Judge (ALJ) asks the Vocational Expert (VE).  The judge formulates the hypothetical questions from the medical record and from the claimant's testimony during the hearing.
  • Second, it depends on the answers given by the Vocational Expert.

Step 5 is technical, complicated and something only a seasoned lawyer or advocate can be expected to handle effectively.  Let me give you an example of a Hypothetical Question from the judge:

Mr. Vocational Expert, let's assume that an individual of the same age, and same education as the claimant can perform work at the Light Exertion Level. He can stand 6 hours during an 8-hour day and sit for 8 hours during an 8-hour day.  He can frequently lift and carry 10 pounds and can occasionally life and carry 20 pounds.  He can frequently reach, stoop, kneel and crouch--but can never crawl.  He can occasionally use ramps and stairs but not ladders, ropes or scaffolds. He should have no concentrated exposure to to unprotected heights or dangerous moving machinery.  

  1. Could such a person perform ANY of his past relevant work

VE Answer:  Yes, Your Honor, he could perform the work of "Marketing Manager," DOT Code 163-167i-018, which is listed in the DOT as Light with an SVP of 3, Semi-skilled. It was reportedly performed at Light exertion level, as well.

 Under this scenario, and if the judge halts the hearing at this point, the claimant will likely be denied at Step 4:  The claimant can perform Past Relevant Work.

However, let's assume that the Vocational Expert answers the judge's hypothetical question with a "No. He could not perform any past relevant work."  So, the claimant has passed Step 4, no past work available.

Now, the hearing moves to Step 5.

The judge asks the vocational exert:  So, with no past relevant work available, is there ANY OTHER WORK that exists in significant numbers in the national economy that the claimant could work, given his age, education and residual functional capacity that I have just staged?

If the vocational expert answers, "No, there are no other jobs available," the claim will be approved at Step 5.

But assume the VE had answered the Step 5 question differently?  Suppose the VE had responded,

"Yes, Your Honor.  I will give you 3 other jobs available.

1.  Food and Beverage Order Clerk, DOT number 209-567-014. Light exertion level, SVP 3, Unskilled.  There are approximately 137,450 jobs in the national economy.  (A basis for denial).

2.  Hand Packager, DOT number 920.587-018.  Light exertion, SVP 2, Unskilled.  There are 209,000 jobs in the national economy.....and

3.  Marker (Retail Trade), DOT number 209-587-034.  Light, SVP 2, Unskilled.  There are 19,755 jobs in the national economy.

The Vocational Expert has just given the judge potential grounds for a Step 5 denial.  The VE has told the judge that there are  OTHER jobs that the claimant can perform.  Therefore, he is not disabled.  IF the hearing ends here, a denial will be issued.

 But here is where a good lawyer is worth his/her weight in gold.

A lawyer will NOT let the hearing end here!

A claimant's lawyer will question the vocational expert and his testimony.  A good lawyer will get the expert to admit, under oath, that either those jobs cannot be proven to exist--or that the claimant, in fact, is not able to perform any of them.  

Thus, the hearing ends--not with certain denial--but with a better chance for approval.

This is something the claimant cannot do for himself.  Most claimants lack the knowledge, training or skill to effectively cross examine a vocational expert.  Most claimant will let the hearing end with the VE's negative testimony, sealing his fate and dooming his claim.  

 

 



    Comments

    Post a Comment

    Popular posts from this blog

    MOST IMPORTANT FACTORS IN A SOCIAL SECURITY DISABILITY CASE

    What are the top 3 most important factors in a Social Security disability case? 1.  Medical Evidence. 2.  Medical Evidence 3.  Medical Evidence 4-10     Medical Evidence Federal regulations set the eligibility requirements for Social Security disability (SSDI) benefits.  A claimant must meet these strict legal requirements More than anything else, the claimant's medical evidence will determine the outcome of the claim or appeal.  Without strong objective medical evidence Social Security cannot legally pay you a benefit. Objective Medical Evidence means the result of medical examinations, laboratory tests or imaging studies (X-rays, PT scans, MRI or CT scans). This type of evidence can only be obtained by going to your doctor. There's an old adage that says truthfully:  "The path to Social Security disability benefits runs straight through your doctor's office."  Being approved for an SSDI benefit requires objective medical proof. ...
    Post a Comment
    Read more

    IS IT HARD TO GET SOCIAL SECURITY DISABILITY IN TENNESSEE?

      How hard is it to get Social Security disability (SSDI) in Tennessee? It can be very difficult.  In the beginning stages of the process, it seems like the agency is out to deny as many claims as possible.  Later--in the appeals process--it takes more technical and legal skill to move through the labyrinth of obstacles. What's the usual reason for an SSDI denial? If you look at all the denial letters, the most comm on reason given is:  You are not disabled according to our rules. The 2 main explanation for finding claimants not disabled are: 1.  You are able to perform some of your past relevant work. 2.  You can't perform any of your past work but you are able to do other work. Those are the two "catch all" reasons Social Security gives for nearly all of their denials.  Both of these reasons fall into the category of a medical denial .  The claimant's condition is not deemed severe enough to prevent all work. There are other reasons for d...
    Post a Comment
    Read more

    WHY SOCIAL SECURITY DISABILITY IS SO HARD TO GET

    You might think that you can fill out a few forms and Social Security will find you to be disabled and start your check.  After all, you've paid into Social Security through the FICA payroll deduction for years.  You feel that the benefits are "yours."  However, the Social Security Administration does not think that way. Instead of "common sense," they use the  20 Code of Federal Regulations . They make it far more complicated, time consuming and just plain difficult. That's why it's not uncommon for a disability claim to take 12 to 24 months or longer to be decided.  Why is SSDI so difficult? 1.  SSDI is very specific and covers a very limited group of claimants. The terms for receiving disability are very narrow and must be proven down to the letter.  This requires complete and thorough medical evidence from your doctors, counselors, hospitals or other providers. 2.  Just the forms are a nightmare.       There are over 450 qu...
    Post a Comment
    Read more