How Social Security Reviews Cases: The Five-Step Sequential Process

The Social Security Administration’s definition of disability is, “ the inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of 12 months or longer.”

This is a strict definition of disability.  Social Security provides benefits only for total disability.  You will not receive benefits for partial disability or for any disability lasting less than twelve months, unless it results in or is expected to result in death.

The sequential evaluation process is a series of five “steps” that are followed in a set order to determine whether or not you are disabled.  If you are found disabled at the first step, you can go to the second step.  If you are not disabled at the first step, you cannot go to the next step.  Each step can be expressed in the form of a question asked by the adjudicator about an individual applying for disability.  The five steps flow from the definition of disability found in the Social Security Act.

Step 1:  Are you working above SGA level?

  • At the first step, your work activity is considered.
  • SGA stands for Substantial Gainful Activity and the amount changes each year.  For 2014, SGA is 1,070 per month.
  • If you are working and your earnings average more than the SGA limit a month, then you are found not disabled.
  • If you are not working or your earnings are less than the SGA, the adjudicator goes to Step 2.

Step 2:  Is your physical and/or mental condition severe?

  • At the second step the severity of your impairment (s) is considered.
  • You must have a medically determinable physical or mental impairment or a combination of impairments that are severe and meet the duration requirements.
  • To be severe, your impairments must interfere with basic work-related activities.
  • To meet the duration requirement, your impairment(s) must be expected to last twelve months or longer or result in death.
  • If your impairment(s) are not severe or do not meet the duration requirement, you are found not disabled.
  • If your impairment(s) are severe and meet the duration requirement, the adjudicator goes to Step 3.

Step 3: Does your medical condition meet or equal the severity of the listing?

  • The Social Security Administration maintains a list of medical criteria that are considered to be so severe that you are found to be disabled if your medically determinable physical or mental impairment matches the criteria.
  • Your impairment(s) can be found to meet the listed criteria exactly or to be of equal severity.
  • If your impairment meets or equals the listed criteria exactly, you will be found disabled at this step.
  • If your impairment does not meet or equal the listing or the duration requirement is not met, the adjudicator goes to Step 4.

Step 4:  Can you do any of your past relevant work?

  • If the adjudicator determines your impairment does not meet or equal the listings, he or she will determine what you are able to do physically and mentally. This is called a Residual Functional Capacity.  The sole purpose of the Residual Functional Capacity is to determine your ability to do work at Steps 4 and 5.
  • At Step 4, the adjudicator determines your ability to do past relevant work.  Past relevant work is any work you’ve done in the past 15 years.
  • If your past relevant work can be performed, or you have no past relevant work, the adjudicator goes to Step 5.

Step 5:  Can you make an adjustment to other work?

  • At the fifth and last step, your Residual Functional Capacity and age, education, and work experience are considered to see if you can make an adjustment to other work.
  • If you can make an adjustment to other work, you are found not to be disabled.
  • If you cannot make an adjustment to other work, you are found disabled.

As you can see, determining disability involves a multi-step reasoning process.  Your representative can help explain how the five-step sequential process applies in your Social Security Administration Disability claim.