How Does Social Security Decide if My Health Problems Qualify for Disability Benefits

Under federal law, Social Security evaluates whether or not you have a health condition that qualifies for disability benefits by applying a FIVE-PART TEST.

Aside from Step 3, you must pass each test to win benefits, which provide monthly income and Medicare or Medicaid health coverage when you can’t work.

If you miss one of the required steps, Social Security will say you don’t have a type of disability that makes working impossible, and deny your benefits.

For most people applying for Social Security Disability in the Fox Valley and Northeast Wisconsin, your case will likely be determined at either Step 4 or Step 5 of the five-part test.

Winning benefits can be a great help financially and in your personal sense of stability.

The 5 Steps in Qualifying for Social Security Disability Benefits

1. Are you currently working?

Social Security has its own definition for work. Under their definition of work, they look at whether you’re engaging in what they call “substantial, gainful” work activity.

In 2021, this means having a monthly gross income of $1,310 for any disability applicants other than those with blindness.

In addition to the earnings requirement, the work you engage in must last for a sufficient period of time.

For example, if a Social Security claimant attempts to return to work while applying for disability and can only work three months before having to stop, Social Security will likely call that an unsuccessful work attempt.

You could still get Social Security Disability benefits after a short attempt at work like that.

2. Did you stop working because of a severe physical or mental impairment?

This is perhaps the simplest of the five steps.

For most people, it’s easy to establish that you stopped working as a result of a severe physical or mental impairment.

You’ll need medical evidence to confirm your impairment.

3. Do you meet a Social Security Disability medical listing?

People with certain health conditions automatically qualify for disability benefits under Social Security Disability rules.

For example, a person who has one grand mal seizure per month while taking epilepsy medication will be determined to have a qualifying disability.

This is the only part of the five-part test where if you don’t qualify, you don’t automatically lose your claim.

If you can’t get automatic qualification under Step 3, you simply go to Step 4 of the analysis.

For most Social Security Disability claimants, your case will likely be determined at either Step 4 or Step 5 of the five-part test.

4. Are you capable of performing your past relevant work?

Past relevant work is work that you did within the past 15 years, and it lasted long enough for you to learn it and perform at a substantial gainful activity level.

With one very limited exception, the Social Security Administration will look at the period 15 years back from the date they make their decision on awarding your benefits. So if you filed a claim in January 2021 and Social Security made a decision in July 2021, they considered your work record back to July 2006.

Social Security has a system for coding all the jobs in the national economy. These coded jobs all have predetermined periods that it takes for you to learn the job. That’s what decides if you were in the job long enough to learn it—and for the job to be considered relevant to what you could do today.

When Social Security determines whether or not you can still perform your past relevant work, they will look at the following:

 

  • How you performed your past relevant work
  • How the job is generally performed in the national economy

 

5. What is your “residual functional capacity?”

After Social Security determines that you cannot perform your past relevant work, they will apply your “residual functional capacity” to determine whether or not you have a disability.

Residual functional capacity is the maximum amount of activity you can handle despite the limitations of your medical conditions. It includes factors like how long you can stand or walk, or how much you can lift.

Social Security will next use what it calls “medical vocational guidelines” to compare the activity level you’re able to perform with your age, education and work history.

If the medical-vocational guidelines don’t result in a finding of disability, Social Security will likely call a vocational witness to determine whether or not a person with your residual functional capacity can work.

You Can Get Help When You’re Applying for Social Security Disability

It starts as a simple idea: You qualify for Social Security Disability benefits and can get a financial break when your health problems leave you unable to work.

But it quickly gets more complicated when you have to show how your particular health problems prevent you from doing the types of work available to you.

If you wonder whether you have a case for disability benefits, you can get a disability lawyer to look at your situation and provide a FREE CONSULTATION.

Disability attorney Tim Geary has helped thousands of people for over 20 years. Talk to him to get started on the next chapter in your life.

Disclaimer: Blog entries are not intended to be a substitute for actual legal advice. It is important for a representative to understand the specific facts and circumstances of your case before they can provide you actual legal advice. If you have questions about your Social Security Disability, please contact a qualified representative to discuss your case.

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