The Social Security Administration (SSA) uses a 5-step sequential evaluation process to determine whether an applicant qualifies for Social Security Disability Insurance (SSDI). Understanding this process is crucial, especially if you’re navigating a claim or appealing a denial. At Melanson Law Group, we help clients in Massachusetts, Connecticut, and Maine understand these steps and build strong cases to secure the benefits they deserve.
Step 1: Are You Engaged in Substantial Gainful Activity (SGA)?
The SSA first determines if you’re working and earning above the SGA limit (as of 2024, $1,470 per month for non-blind individuals). If you’re earning more than the limit, you are generally not considered disabled.
Step 2: Do You Have a Severe Impairment?
To qualify for SSDI, you must have a medically determinable physical or mental impairment that significantly limits your ability to perform basic work activities. The impairment must last—or be expected to last—at least 12 months or result in death.
Examples of Severe Impairments:
- Musculoskeletal conditions, such as arthritis or degenerative disc disease
- Chronic illnesses like heart disease or diabetes
- Neurological conditions, including Parkinson’s Disease and neuropathy
Key Tip: Comprehensive medical evidence, including doctor’s reports, imaging studies, and treatment records, is essential to proving the severity of your condition.
Step 3: Does Your Condition Meet or Equal a Listing?
The SSA maintains a list of impairments, known as the Blue Book, that automatically qualify as disabling if you meet specific criteria. These conditions range from cardiovascular and respiratory disorders to mental health issues and neurological conditions.
- If your impairment matches a listing, you may be approved at this step.
- If not, you proceed to Step 4.
Key Tip: Even if your condition doesn’t meet a listing exactly, the SSA can find you disabled if your condition is “medically equivalent” to a listing. A skilled disability lawyer can help argue this point.
Step 4: Can You Perform Your Past Relevant Work?
The SSA examines whether you can return to jobs you’ve held in the past 5 years. This is based on your residual functional capacity (RFC), which measures your ability to perform physical and mental tasks. (note, the SSA recently began considering work from 5 years back, instead of 15 years. This is a favorable development for claimants.)
- If you can still perform your past work, your claim will be denied.
- If not, you move to Step 5.
Key Tip: Applicants over the age of 50 may benefit from special rules, as the SSA is less likely to expect them to adapt to new types of work. This can be particularly advantageous for manual laborers or those with limited education.
Step 5: Can You Perform Other Work?
If you cannot return to your past work, the SSA considers whether you can adjust to other types of jobs in the national economy based on your RFC, age, education, and work experience.
- For individuals 50 and older, the grid rules often make it easier to demonstrate that retraining or adapting to new work is unrealistic.
- For younger applicants, proving disability at this stage requires demonstrating very limited RFC and lack of transferable skills.
Key Tip: Vocational expert testimony often plays a crucial role at this stage. Preparing to challenge the expert’s conclusions can make or break your appeal.
Why Understanding the 5-Step Process Matters
The SSA’s sequential evaluation process is designed to be comprehensive but can feel overwhelming. Missing details at any step or failing to provide adequate medical or vocational evidence can lead to a denial.
At Melanson Law Group, we work closely with clients to ensure their cases align with the SSA’s criteria at every stage. Whether you’re filing your initial claim or appealing a denial, our legal expertise and personalized approach can make all the difference.
Take Action Today
If you are appealing an SSDI denial in Massachusetts, Connecticut, or Maine, contact us today for a free consultation. Let us help you secure the benefits you deserve and navigate the SSDI appeal process with confidence.