When someone applies for Social Security Disability or SSI, the Social Security Administration follows a five-step sequential evaluation for determining eligibility. This process is followed regardless of the level of decision (application, reconsideration, or a hearing). This is the process used for adult claims. For information on the process for childhood SSI click here.
The five steps are as follows:
1. Whether the claimant is engaging substantial gainful activity?
The general rule is that a claimant cannot engage in full-time employment and be approved for SSD or SSI. Substantial gainful activity (SGA) is work that is both substantial and gainful. Each year the SSA determines a level of earnings considered SGA. A claimant should not automatically assume that if she is working and earning below SGA, that she will be safe in terms of the disability application. The decisionmaker could still decide later that the work is evidence of ability to perform certain categories of work and thus find that the claimant is not disabled further down the sequential process.
2. Whether the claimant has a medically determinable impairment that is "severe" or a combination of impairments that is "severe"?
An impairment or combination of impairments is severe if it limits an individual's ability to perform basic work activities. Case law has generally required only minimal limitations of work activity in order for an impairment or combination thereof to be considered severe. Very few claims are denied at this step of the sequential process.
3. Whether the claimant's impairment or combination of impairments meet or medically equals the criteria of an listed impairment?
If a claimant's impairment(s) meets or equals a listed impairment in Appendix I, then the Social Security Administration will find that person disabled without considering age, education, and work experience. Most claimants do not meet Step 3 of the process and are evaluated at the "Vocational Steps" described below.
4. Whether the claimant has the residual functional capacity to perform the requirements of his or her past relevant work?
At this point in the process, the SSA must determine the claimant's residual functional capacity (RFC). A claimant's RFC is her ability to do physical and mental work actiivites on a sustained basis despite limitations from her impairments. The decision maker must consider all of the claimant's impairments, including those that are not severe.
Again, the burden of proof is on the claimant to show he or she cannot perform his or her past relevant work. The reason must be due to exertional and/or nonexertional restrictions and limitations relating to the medically determinable impairments and not from being fired or inability to be hired.
If the claimant can perform his or her past relevant work, then the inquiry stops and non-disability is determined. If the claimant cannot perform his or her past relevant work, then usually the claim moves on to Step 5.
5. Whether the claimant is able to do any other work considering her residual functional capacity, age, education, and work experience?
If the claimant is able to do other work, she is not disabled. If the claimant is not able to do other work and meets the duration requirement (has lasted or expected to last at least one year), she is disabled. Although the claimant generally continues to have the burden of proving disability, a limited burden of going forward with the evidence shifts to the Social Security Administration. In order to support a finding that a claimant is not disabled at this step, the SSA has to provide evidence that demonstrates other work exists in significant numbers in the national economy that the claimant can do, given the residual functional capacity, age, education, and work experience of the claimant.