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Monday, December 19, 2011

5 STEP SEQUENTIAL EVALUATION

The Social Security Administration has developed a five (5) step sequential process to determine if a claimant is eligible to receive disability benefits. This test is only for adults as children have a different test to determine eligibility.
Step 1: Substantial Gainful Activity
Is the claimant working? If so, how much? There is a presumption that certain amounts of income constitute substantial gainful activity (SGA). In 2011 the limit is $1000.00 per month. (Blind claimants have a higher limit). This amount changes almost yearly. Of course a person can still be found to be performing SGA even if the monthly income is less than $1000.  So if you are working at a substantial gainful level your disability process ends here. You do not continue to the other steps.
Step 2: Severe impairment
The claimant must have a severe impairment or a combination of impairments which significantly limit his physical or mental ability to do basic work activities without regard to age, work history, or education.  The level of proof at this level is considerably low and the majority of claimants proceed on past this level. 
Step 3: Listing of Impairments
SSA has established a list of impairments that qualify for disability benefits. At this stage a claimant must show that he meets or equals at least one of the listed impairments. This determination is made without regard to a persons age, education, or work history. Most claimants do not meet or equal a listing level impairment. The Social Security definitions and requirements contained in the listings are designed for the most severe cases. Even if a claimant does meet or equal a listed impairment the claimant must also meet the durational requirements that the impairment is expected to last 12 months or longer or end in death.  If a claimant equals or meets a listed impairment and meets the durational requirement benefits are awarded at this step. If the claimant does not meet or equal the listings then the case will proceed on to the fourth step.
Step 4: Past Relevant Work
If a claimant has a severe impairment (step 2) but does not meet or equal a listed impairment (step 3) then SSA will look at past relevant work. Past relevant work is work performed 15 years prior to the onset of disability. Given a residual function capacity does the claimant have the ability to return to their past relevant work? A residual function capacity is basically a determination of what a person can do despite their impairment. For example a person with COPD may no longer be able to lift 50lbs but can still lift 10lbs on a sustained basis. The constraints of the residual function capacity will determine if the claimant can perform their past relevant work. For example, if your past relevant work required you to lift 50lbs and walk 8 hours a day and your residual function capacity due to a back injury limited you to only lifting 25lbs and walking 4 hours a day then you would be found unable to return to your past relevant work. If you are determined that you can return to your past relevant work you will be denied disability at this step.
Step 5: Ability to perform other work
So SSA says that you cant go back to your past relevant work but now asks are there other jobs you can go do. The determination at this step factors in your residual function capacity, age, education, and prior work. The majority of SSA disability claims are decided at step 5. If it is determined that you cannot perform other work the a claim for benefits would be awarded. If you are over 50 don’t be alarmed by the requirements under step 5. SSA has a table called “GRIDS” that factor in age. If you are 55 and your past relevant work is Heavy concrete layer then SSA will require you to go be retrained to perform sedentary jobs.

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