The 5 Step Sequential Evaluation Process

     As you may have heard or read in the news lately, getting Social Security Disability benefits can be a long and arduous process – and the burden of proof is on the applicant. To evaluate and make a determination of disability, the Social Security Administration uses a "5 Step Sequential Evaluation Process". Although the 5 step process may look simple at first glance, there can be enormous complexity at each step of the evaluation.

Step 1: Is the Claimant engaged in "Substantial Gainful Activity"?

     I always tell clients, "It doesn't matter what physical or mental condition[s] you have. If you are making money at a certain level per month [Substantial Gainful Activity], you are not disabled by Social Security standards."

     Currently, employee earnings over $1,040 per month are considered Substantial Gainful Activity and, if made on a consistent basis, will lead to an automatic determination that you are not disabled.  Keep in mind that under Social Security regulations your condition must have lasted, or be likely to last, for more than one year. This means that you cannot have consistent earnings above the level of Substantial Gainful Activity for a least one year to initially be considered for disability benefits.[1]

Step 2:  Does the Claimant have a “severe, medically determinable impairment"?

     Having a severe, medically determinable impairment means having more than just a series of complaints.  Saying, "I have back pain", "I don't feel good", "I'm depressed", or "I'm tired all the time" are complaints – not conditions established by a treating physician.

     "Medically determinable" means that your condition has been recognized and diagnosed by a doctor. 

     "Severe" means that your condition results in some form of functional limitations, either from a physical or psychological perspective (or combination of both), which would affect your ability to work. The degree and severity of your functional limitations are most relevant at Steps 3, 4, and 5.

Step 3:  Is the Claimant’s impairment so severe that it “meets or equals a Listing”?

     The Social Security Administration has put together a series of medical "Listings" which are used to determine whether your condition is so severe that you are automatically disabled.  The Listings have some flexibility so that even if you don't meet the Listing exactly, you may be found to equal it, resulting in a finding of disability.  Listings can be very detailed and always require strong, "objective medical evidence"[2] in order to be satisfied.

     Overall, the number of individuals found disabled because they meet or equal a Listing is very small. Hence, most individuals fall into what is called a “Step 4 and Step 5” analysis. Of all the steps involved in the process of proving one's claim for disability, numbers 4 and 5 can be the most complicated.

Step 4:  Is the Claimant capable of performing his/her "Past Relevant Work"?

     "Past Relevant Work" consists of any work you have performed in the past 15 years at the level of "Substantial Gainful Activity". Whether you can still perform any of that work may be determined by a Social Security judge or a "vocational expert" – an expert on jobs and how they are performed in the local and national economy.

     By analyzing the requirements of how your past relevant work is generally performed, and taking into consideration any functional limitations resulting from your physical and/or psychological condition, the vocational expert will determine whether you can still perform any of that work.

     If the expert determines that you can perform any of your past work, you will be found not disabled. If the expert determines that you cannot perform any of your past work, we move Step 5.

Step 5:  Is the Claimant capable of performing “any other jobs”?

     A determination of whether you can perform "any other jobs" means looking at other available jobs in the local and national economy, no matter how unskilled, menial, or uninteresting. "Available" for purposes of this step does not mean that an employer is hiring; it means that any given occupation is still being performed in significant numbers in the United States nationally, regionally, and locally.

     Using a similar analysis of how other jobs are performed, combined with any functional limitations resulting from your physical and/or psychological condition, the vocational expert will once again render an opinion if there are a significant number of jobs that you can perform.

     To be successful in your claim for disability, you must generally prove that there is no full-time employment that you can still do[3], either because of a physical or mental condition, or a combination of both.

Eric J. Patrick, Esq.

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[1] Exceptions to this rule, called Unsuccessful Work Attempts, are narrow and require specific evidence to prove.

[2] "Objective medical evidence" can be radiographic or laboratory test results. Clinical evidence consists of the observations and conclusions of the treating physician. Your personal complaints about physical and/or psychological symptoms and limitations are subjective evidence, and are insufficient to meet or equal a Listing on their own.

[3] Exceptions to this rule based on age, education, and category of past work may begin at age 50.

Mental Impairments and Social Security Disability

A severe mental disorder can affect an individual’s ability to work in many ways.  However, having a definitive diagnosis of a mental disorder is not automatically grounds for receiving Social Security Disability benefits.  As with all claims for disability benefits through the Social Security Administration (SSA), the burden of proving disability is on the applicant, and proof requires strong objective and/or clinical medical evidence.

In assessing one’s ability to work an 8 hour day (40 hour a week) job for individuals with a severe mental disorder, the SSA is interested not only in a diagnosis (e.g. depression, anxiety, bi-polar disorder, or PTSD etc.), but in how the condition affects your ability to function overall.  Some of the areas the SSA considers are how the condition affects (1) your understanding and memory, (2) your ability to sustain concentration, (3) your ability to socially interact with co-workers, supervisors, and the public, and (4) your ability to adapt within the workplace structure.

Most importantly, objective clinical evidence and functional assessments regarding limitations must come from an acceptable treating source, such as a psychiatrist (M.D.) or a psychologist (Ph.D/Psy.D).  They must be consistent beginning with when the individual claims to have become disabled.  Specifically, evidence could consist of assessments, prescription history, neuropsychological, IQ, and personality testing, and/or the treating provider’s notes from therapy sessions.

The SSA will also consider additional evidence regarding functional limitations from a non-physician or non-psychologist (e.g. a social worker or Physician’s Assistant) once it determines an impairment to be “severe”.  Vital evidence may also include third party statements, as well as testimony from the Claimant, and any witnesses at the Claimant’s hearing in front of an Administrative Law Judge (ALJ). 

Eric J. Patrick, Esq.