The Disability Process Maddox and Laffoon

The Disability Process

How SSA Defines Disability

There are three basic elements to SSA’s definition of “disability.”

Unable to engage in Substantial Gainful Activity (SGA)
- SGA is a dollar amount that increases every year
- In 2024 SGA is $1,550 gross income per month
  - But If you are blind, SGA is $2,590 gross income per month

For 12 months or more
- This can be prospective, you do not have to wait out the 12 months to see if you are feeling better and can return to work

As a result of a “medically determinable” mental or physical impairment
- Basically this is a diagnosis from someone qualified to make one
- There are hundreds of MDIs

SSA applies a 5-step process to apply this definition of Disability Process

Disability Process: Step 1 – is the individual working at SGA levels?

IF YES, no benefits unless the work is:

Sheltered (such as through DVR), or
Subsidized (your employer pays you more than your work is worth for personal reasons), or
Doable only because of IRWEs – i.e. you spend a large amount of money out of pocket on Impairment-Related Work Expenses.

IF NO – or if the work is sheltered, subsidized or due to IRWEs – move on to Step 2

Disability Process: Step 2 – is there a medically determinable impairment(s)?

A de minimis test is applied, but usually, there has to be something diagnosed.

IF NO, your claim will be denied. Do be aware, however, that If you apply for disability benefits, SSA will likely send you to one of their contracted doctors solely to assess whether there is an MDI, and if so, what limitations it causes.

IF YES, move on to Step 3

Disability Process: Step 3 – Is a Listing met or equaled?

Listings are regulatory descriptions of medical impairments
There are hundreds of listed impairments organized into 14 groups:
- 1.00 Musculoskeletal Disorders
- 2.00 Special Senses and Speech
- 3.00 Respiratory Disorders
- 4.00 Cardiovascular System
- 5.00 Digestive System
- 6.00 Genitourinary Disorders
- 7.00 Hematological Disorders
- 8.00 Skin Disorders
- 9.00 Endocrine Disorders
- 10.00 Congenital Disorders that affect Multiple Body Systems
- 11.00 Neurological Disorders
- 12.00 Mental Disorders
- 13.00 Cancer (Malignant Neoplastic Diseases)
- 14.00 Immune System Disroders
Simply having a listed impairment does not automatically mean that you are disabled, however, as your particular case must meet the severity criteria described in the regulation.

IF YES, disability will be granted.

IF NO, SSA will make an assessment of what you can still do, despite limitations from your MDI – a Residual Functional Capacity Assessment (RFC). Usually these RFCs are based on medical evidence and address limitations in the ability to sit, stand, walk, lift/carry items, reach, handle, and interact with other people. Some get a little more granular. For example, this is an actual RFC from a real case (I kid you not!):

After careful consideration of the record, I find that the claimant has the residual functional capacity to perform a full range of work at all exertional levels, but does have some non-exertional limitations. The claimant cannot drive, operate heavy machinery such as chainsaws or forklifts, climb ladders, work at heights, swim, or work near hazards such as open flames or scalding water. He cannot work in places where he could drown or in places where he would be required to work in the dark, or be exposed to paring or butcher knives, ropes or children.

Disability Process: Step 4 – can the individual with this RFC perform past relevant work?

PRW is defined as work your have actually performed in the past 5 years and done long enough to learn it
at a disability hearing, this question is usually answered by the SSA’s vocational witness, based on the Dictionary of Occupational Titles and the VW’s own expertise and experience

IF YES – you can perform PRW, either as you did it or as it is generally performed in the national economy – you are not disabled.

IF NO – you cannot perform PRW – move on to Step 5

Step 5 – can the individual with this RFC perform ANY job that exists in “significant numbers” in the national or regional economies?

This is where the rubber meets the road, and where most Social Security Disability cases are decided
at a disability hearing, this question is usually answered by the SSA’s vocational witness

For more on the Disability Process, please contact us at any time. We are your Disability Attorneys for Washington State.

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