Some basic legal concepts in Social Security Disability Insurance claims

While the law and procedure are complex in an SSDI claim, claimants can feel more confident understanding the basic concepts at work.

While it is well known that it can take time and effort to get your application for Social Security Disability Insurance, or SSDI, approved, it helps to understand some of the basic provisions of law that impact the Social Security Administration's analysis of each claim. Of course, an experienced attorney can provide meaningful and impactful representation at the application stage as well as on review or appeal and can answer questions about the process and applicable laws.

What is disability?

The SSA uses a unique definition of "disability" as compared with other benefit types like workers' compensation or private disability insurance:

A claimant must have a severe medically-determinable physical or mental impairment, or combination of impairments expected to last at least one year or result in death that prevent them from engaging in substantial gainful activity or SGA.

Basically, SGA refers to the ability to earn meaningful wages. SGA is work activity (including part time) for pay or profit that involves "significant physical or mental activities," according to the SSA, and that does not bring in average earnings over $1,220 per month (in 2019). Amounts are different for blind claimants.

In other words, you may be able to work a little bit despite your long-term medical problems, but it does not reach the level of substantial work or substantial earnings, so it does not prevent SSDI eligibility.

The five-step sequential evaluation process

For many years, the SSA has used a five-step evaluation process to assess whether a claimant is eligible for SSDI:

  1. Is the claimant engaging in SGA through their work activity? If yes, not disabled. If no, continue.
  2. Does the claimant have a severe medical impairment that would interfere with work activities and is fatal or expected to last at least a year? If no, not disabled. If yes, continue.
  3. Does the claimant's medical physical or mental impairment or combination of impairments meet or equal a listed impairment? If yes, disabled. If no, continue.
  4. Can the claimant return to any of their past relevant work, or PRW? If yes, not disabled. If no, continue.
  5. Considering the claimant's residual functional capacity, or RFC, age, education and transferrable skills can they adjust to and perform work available in significant numbers in the national economy? If yes, not disabled. If no, disabled.

At the third step, a listed impairment is one included on a list of medical conditions that SSA recognizes as so serious that if a claimant's diagnosis matches a listing or equals it in severity, the claimant is automatically found disabled. At step five, the RFC is an assessment of what work skills and abilities for full-time work does the claimant still have after determining the limitations and restrictions caused by their impairments. Both a physical RFC and a mental RFC are assessed.

To help with the assessment at step five, the SSA first looks at whether the claimant meets any of three worker profiles in the Special Medical-Vocational Guidelines. If so, the claimant is disabled. IF not, the SSA looks at the "Grids" or Medical-Vocational Guidelines that are detailed charts based on exertional limitations and different combinations of the factors listed in number five above. The Grids indicate whether certain combinations result in disability or not.

If no guideline applies to a claimant's combination of vocational factors, the Grids are only a guideline to the final decision.

This article only introduces complicated concepts and procedures. A lawyer can answer questions and provide advocacy.

The lawyers at Midwest Disability, P.A., in Coon Rapids, Minnesota, represent SSDI and SSI claimants at all stages of application and appeal in the region and throughout the nation.