The 5 Step Disability Evaluation Under Social Security

By / October 24, 2016 / Social Security Disability Claims Process / 17 Comments

Learn here about the five-step qualification process the SSA will use for your disability evaluation for Social Security benefits and you’re closer to approval.

The Social Security Administration uses a basic 5-step process to determine eligibility for disability benefits:

Step 1: Are you working?
If your disability allows you to work, and you’re able to earn more than a certain amount per month then (usually) the SSA does not consider you to be disabled. The earnings limit in 2017 for non-blind persons is $1,170/month; for the blind, $1,950.  This amount is adjusted each year.

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Step 2: Is your disability severe?
If your average earned income per month does not exceed the limit, then the SSA passes your application along to the Disability Determination Services (DDS) office in your state. For the DDS medical examiners to determine that, indeed, you are disabled; your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting, and remembering—for at least one year. If your disability is not that severe, they will decide that you are not eligible for SSD benefits. But if it is that severe, the DDS goes on to…

Step 3: Is your medical condition on the List of Impairments (LOI)?
The DDS refers to the LOI to see if your condition is listed. If it is, then it automatically means that you are disabled as defined by law. If it isn’t, then the DDS looks to see if your condition is as severe as a condition that is on the list. If it is, then they will consider you to be disabled. If it isn’t, they go on to…

Step 4: Can you do the work you did before?
The DDS decides if your medical condition prevents you from being able to do the work you did before. (Or something similar.) If you can still do it, they will decide that you are not disabled. But if your disability does prevent you from doing that kind of work, the DDS goes on to…

Step 5: Can you do any other type of work?
The DDS looks to see if you could do some other type of work, despite your disability. It evaluates your age, education, medical condition (physical or mental), work experience, and any skills you may have that could be used to do some other work. If you cannot, they will determine that you are disabled. But if you can do other work (even if you don’t care to), then you are deemed not disabled and, therefore, ineligible for SSD benefits.

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The 5 Step Disability Evaluation Under Social Security
5 (100%) 1 vote

  • Dear Frenchie,

    I read your corrective post indicating you have been getting state disability insurance. I suggest that you apply for both Social Security retirement and Social Security Disability (SSDI). You may or may not qualify temporarily for Supplemental Security Income (SSI) while your retirement claim is pending. It will depend on the amount and kind of family income and assets you have.

    The retirement claim will be processed fairly quickly and will get some money coming in. The benefit will be reduced somewhat for taking retirement before your full retirement age, which is age sixty-six. However, if your SSDI claim is approved, which is fairly likely given your limited eyesight, your singular work history, and your age, the benefit will be increased to the higher disability level, which will continue into retirement years.

    Sincerely,
    Kay

  • Dear Rasaen,

    It is possible that you could qualify for disability benefits. Whether or not you are eligible depends on how severely your conditions affect your ability to work and how well documented your illnesses and limitations are. To determine whether you are eligible, you will need to file a claim.

    Sincerely,
    Kay

  • Dear Terry,

    It is unlikely that your attorney would suggest you were going to be approved if she did not really think so. If follow-up questions to the vocational expert resulted in him saying that you could not do the photo technician job with the limitations you have, that would be a positive point.

    Sincerely,
    Kay

  • Dear Sarah,

    The questions that you were asked are related to a claim for Supplemental Security Income (SSI) disability, eligibility for which includes having income and assets below a certain limit. Part of the income review is going over living arrangements and who is paying for your shelter and food costs. If you received these questions quite a while after filing the claim (several weeks or month) you likely have been medically approved for SSI benefits and work is being done in the local office to calculate and pay your SSI claim. If you also applied for Social Security Disability (SSD aka SSDI), it is likely you have been medically approved for SSD as well. SSD will be paid by a central payment center after the SSI claim processing has been completed. On the other hand, if you just filed your SSD claim, the questions are just to screen you for possible SSI eligiblity if your are later medically approved.

    Sincerely,
    Kay

  • Please see my reply to your first post. The representative who is handling your claim has the most current and accurate information, so I would depend on it rather that the information from the call center, which is likely not as current.

    Sincerely,
    Kay

  • Dear GylFokx2go,

    Apparently, the local office got started on updating your financial information quite quickly and within the time frame that the claim could be randomly chosen for a quality assurance (QA) review. I believe she is saying to wait till the QA review is completed–she’ll have to wait, too,and not do any more work on your claim–because if QA approves the processing and the decision, nothing needs to be done. If QA sends the claim back to the decision maker for additional investigation or documentation, you will be contacted if you need to supply anything else.

    Sincerely,
    Kay

  • Dear Gary,

    You can apply for Social Security Disability and/or Retirement benefits at any time. If you apply for both benefits and are approved, any months of reduced retirement (see below) that overlap with months of disability will be changed to the higher disability rate.

    If you apply for retirement now, the retirement benefits will be reduced substantially from the amount you would get if you waited until full retirement age, which for your is age sixty-six, and the reduction is permanent. However, given that you are not working, you would be financially ahead for many years to do so. You can ask a Social Security claims representative to calculate the age at which getting a lower benefit permanently would begin to lose money for you overall. And again, if you are approved for disability, the early retirement would be changed to disability so the big reduction would not apply ongoing.

    Sincerely,
    Kay

  • Dear Breeh,

    The request for a conversation is probably to gather information from you about your condition and how it affects your activities of daily living or to fill in information about your treatment. (Your prior claim file probably will not be accessed or reviewed). The request means that your claim is being actively investigated to gather information for a decision.

    Sincerely,
    Kay

  • Dear Bert,

    You can file a formal dire need request for expedited handling and submit it together with copies of documents that show that you are in danger of foreclosure on your home. Submit it to your local office and request it be forwarded to the Disability Determination Services (DDS). Wait a month from the last call to follow up. In the meantime, if your doctors say you are disabled, try getting a statement from them to give to your home lender together with proof of a pending disability claim to see if they will hold off on foreclosure. If you are foreclosed upon, keep in mind that in most states, you have a period, often six months, during which you can catch up payments and get the house back.

    Sincerely,
    Kay

  • LeeArtress

    Hello Kay,
    I have been diagnosed with peripheral artery disease and originally applied for ssdi in June of 2014 after bypass surgery in my right leg and a forefoot amputation on the right foot. I was denied because I didn’t understand the process and did not follow through correctly. I applied again in march of 2016 and had a physical CE on November 22 in which the doctor told me I met a listing(.45 abi). My question is how soon could I see an approval and will I get back pay retroactive to my original application date? Thanks!

    • Kay Derochie

      Dear Lee,

      You could get a decision in a month or it could take much longer; it depends on how busy your area’s Disability Determination Services is. You will be paid based on the current application; maximum retroactivity before month of application is twelve months.

      Sincerely,
      Kay

      • LeeArtress

        Thank you.

        • Kay Derochie

          You are welcome, Lee.

  • I had a question but can’t find the response HELP

    • Kay Derochie

      Dear Treviszia,

      Responses are not generally posted immediately. Your question was answered a few minutes ago, but you posted it under a different Social Security article so you may continue to have trouble finding it. Here’s what I responded:

      The processing time for new claims runs from two to five months. I suggest that you call the DDS and ask the examiner whether they are waiting for anything from your doctors. If so, you can try to follow up on the needed records or statements. If nothing is needed, politely ask for a realistic estimate for completion of the review. Note that the DDS does not get the claim immediately and three months from when they got it would be after November 11 (not October 31) when allowing at least a week for the DDS to receive the claim. So, you might want to wait to follow up until about November 18.

      Sincerely,
      Kay

  • Dimitra

    Hi , I have been found disabled, my husband gets 850.00 monthly from ssd we are raising our 11 year old Granddaughter we both have a car my granddaughter gets 250.00 monthly from public assistance, would I still be eligible for ssi

    • Kay Derochie

      Dear Dimitra,

      If you are approved for Social Security, your benefit will be based on your earnings record, not on your family income and assets.

      If you were medically approved for Supplemental Security Income (SSI), you will be eligible for SSI if your and your husband’s countable resources including the equity value of the vehicle with the lower equity value are $3,000 or less. Equity value is the retail value reduced by the amount you owe on the vehicle. Your granddaughter’s support and income do not affect (SSI) payment.

      If your resources are below the limit, you and your husband will each receive $135 SSI if he also applies for SSI and you and he are treated as an SSI eligible couple. Couple rate $1,100 – $830 (all but $20 of SSD) = $270 / 2 people = $135. If he does not apply for SSI, your SSI benefit would be about $386. The value in his applying for SSI would be that he could get Medicaid, which would likely pay his Medicare Part B premium for him as well as providing prescription coverage.

      Sincerely,
      Kay

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