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Applying for the First Time

Need to File Appeal for Denied Claim

Inquiring if You are Eligible

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Have you worked 5 out of the last 10 years?

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Who's Eligible?

To qualify for Social Security Disability Insurance you must have worked and paid into the program through FICA payroll taxes for for five out of the last 10 years. You must have been determined disabled before reaching the full retirement age of 65-67. In determining who is eligible for Social Security Disability benefits, the Social Security Administration uses a process called sequential evaluation to determine who receives benefits.

The five-step sequential evaluation asks:

1. Are you working?
2. Is your condition "severe"?
3. Is your condition found in the list of disabling conditions?
4. Can you do the work you did previously?
5. Can you do any other type of work?

At step 1, if you are currently working, Social Security looks at your income; and if you are making over $830 a month in 2005, your claim is denied. If you are not working, or you are not earning over this amount, your claim goes to the next step.

At step 2, your disability caseworker checks to see if you have a “severe” impairment, which is a medical condition that has more than a mild affect on your ability to work. If you don’t have a “severe” impairment, your claim is denied. If you do have a “severe” impairment, your claim goes to the next step.

At step 3, your disability caseworker checks to see if your medical condition is found in Social Security’s “Listing of Impairments.” This is a list of mental and physical conditions with certain medical findings considered bad enough to prevent a person from doing any significant work activity. This means that if your condition matches, or closely matches, the description of a listed condition, you will be found medically disabled. If it doesn’t, your claim goes to the next step.

Adult Listings

By step 4, a medical doctor and/or a mental doctor who works in the Disability Office will most likely have reviewed your case. Since, by this step, it has been decided that your condition does not meet or equal a listing, this doctor must provide a set of limitations caused by your current medical condition. After reviewing your medical records, this doctor describes your current limitations on a “Physical Residual Functional Capacity Assessment” (RFC) form for physical conditions. There is also a form for mental conditions, which is not discussed in this article.

Physical Residual Functional Capacity Assessment

The residual function form describes functional limitations in terms of sitting, standing, walking, lifting, carrying, bending, crouching, crawling, kneeling, climbing, feeling, handling, fingering, reaching, seeing, communicating, and environmental restrictions. It tells your disability caseworker the most work activity you can do on a sustained basis in an 8-hour work day. Your disability caseworker compares the functional limitations described in this form to the description of physical and/or mental abilities required for jobs you did in the past fifteen years to see if you can still do these jobs. If you can still do them despite your current limitations, your claim is denied and you are returned to past work. If you can’t do these past jobs because of your current limitations, your claim goes to the next step.

At step 5, your disability caseworker looks at your current limitations (RFC), your age, education, and any skills you may have learned during your last fifteen years of employment. All of this information is combined under Social Security’s rules to decide if you can do any other type of work.

This might sound confusing, but remember that Social Security’s definition of disability says you must be unable to perform past work and any other work. Just because you can’t do your past work does not mean you can’t do other work. You might have done some past jobs where you learned skills that can be transferred, or used in other jobs. If so, your disability caseworker may decide that you can use these transferable skills to do less strenuous types of work than you have done in the past.

If your disability claim makes it to step 5, you can see why it is so important to complete all forms correctly, including the “Work History Report” form, as it should tell your disability caseworker exactly how you performed past work, including any skills you may or may not have learned.

Social Security feels that someone who has a higher education and is less than fifty years old has a greater ability to learn to do a new job than someone who is over fifty years old and has a limited education.

Based on all of these issues, if it is found that you can’t do your past work and can’t do any other work, your claim is allowed at step 5. If you are found disabled at step 5, your file is returned to your local Social Security office, and you are sent a letter telling you about your benefits. If you are found “not disabled,” Social Security will send a letter telling you why your claim was denied.

Free Legal Consultation

Contact Mark & Associates P.C. today for a free, no obligation Social Security Disability claim evaluation. You can complete the evaluation form on the left side of this page or call 1-866-662-9594.