THE DECISION MAKING PROCESS USED BY SSA TO EVALUATE CLAIMS

The Social Security Administration uses a step by step process called the “Sequential Evaluation Process” to evaluate claims.  If you satisfy one step, you go on to the next and so on.  If you meet the listing step, however, you win without any further evaluation.  If you cannot meet a listing, you can still win by other avenues.  But, if you lose at any other step, you lose your claim.

STEP 1: Are you working?

If you have earnings in a specified amount per month, you generally cannot be considered disabled.  The monthly SGA amount for statutorily blind individuals differs from others who are not blind.  SGA for the blind does not apply to Supplemental Security Income (SSI) benefits, while SGA for the non-blind disabled applies to Social Security and SSI benefits.  This first step is usually not an issue at a disability hearing since most people have stopped working before applying for benefits.

Visit the Social Security Administration website to see a list of SGA amounts and years:  https://www.ssa.gov/oact/cola/sga.html

Step 2: Is your condition severe?

Your impairments must interfere with basic work-related activities for your condition to be severe. If not, you lose. If yes, you go on to the next step. Many applications are denied on this basis. The evaluator will often say that you have problems and may not be able to perform your past work but that your condition is not severe enough to prevent you from performing other available work.

When you get to a hearing in front of an Administrative Law Judge, severity is rarely an issue since most conditions are deemed severe in light of Federal Cases construing the term “Severe” very liberally. The main issue at the hearing usually involves step number 5 below.

Step 3: Is your condition found in the list of disabling impairments?

The Social Security Administration maintains a list of impairments for each of the major body systems. Each listing has several elements and if you meet each required element, your condition will be presumed to be so severe that SSA will determine that you cannot work.  Thus, if you meet all of the terms of a listing, you win. If not, you go on to the next step.

Meeting a listing is very difficult and most people will not meet a listing.  However, some people will actually meet a listing but the medical records may not prove all elements of the listing.  In such cases, you can often meet the listing by having your doctor perform the proper tests to fill in the gaps and prove you meet a listing.  Some people will come close to meeting one or more listings.  A Claimant can still win at this step if the Claimant has an impairment or combination of impairments that meets or medically equals a listing.  Therefore, even if you don’t meet the literal terms of a listing, it is helpful to show why you come close to meeting all the listings resembling your conditions.  Further, even if you don’t meet a listing but you come close, Judges are often swayed by this when deciding the following steps.

Many doctors feel you are disabled but are unaware of the standards you need to satisfy to prove disability.  An effective method of proving you meet a listing is simply by making a copy of the listing or listings that apply to your case.  Take the listing or listings to your doctor.  Your doctor will be able to tell you whether you meet a listing and, if so, your doctor can write a brief letter in that regard with references to relevant test results.

You can view various listings HERE.

Step 4: Can you perform your past relevant work that you performed in the last 15 years?

If you can perform any jobs that you performed within the past 15 years, you will lose at this step.  If you cannot perform any of those jobs, you go on to the next step.

Step 5: Can you do any other type of work?

Once your case gets to a hearing, this is usually the most critical step.  This is typically what the big fight is over.  Many people think that if they cannot perform their last job, they are disabled. Such is not the case under Social Security rules.  If you cannot perform work that you performed within the past 15 years, the process will simply continue on to this step.  At this final step, Social Security will look at your age, education, experience, training, and your limitations and decide whether there are any other jobs that you can perform.  If there are other jobs that you can perform and they exist in significant numbers, then you will lose.  If there are no jobs that you can perform or if jobs you can perform do not exist in significant numbers, then you should win.

At the hearing, the Judge will typically pose several hypothetical questions to a Vocational Expert hired by Social Security.  A Vocational Expert is an expert on jobs and they are supposed to be well versed in the types of jobs that exist and what abilities are required to perform those jobs.  In response to at least one of the hypothetical questions, the Vocational Expert will usually testify that there are several jobs that you can perform. If the Judge accepts that testimony, you will lose.  This is why it is so important not only to have an Attorney with you at the hearing, but to have an Attorney with years of formal and on the job training in the art of cross-examination and trial techniques taught in law schools.

When preparing your claim, you should think of the easiest jobs imaginable and ask yourself whether you would be able to perform that job and if not, why not.  This is a good question that you should think about and discuss at length with your attorney as soon as you can in the process, several times during the process, and even before you submit your application if possible.  Be able to explain in detail why, in light of your condition and limitations, you cannot perform that job.  It is a good exercise that helps you understand the process and prepares you well for your hearing.

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