One of the hardest things for my client’s to understand is that the SSA disability process works in a hypothetical world, not reality. Social Security doesn’t ask if an employer would actually hire you, if any employers are hiring for jobs you might be able to do, or even if there are any of those employers located where you live. Everything is hypothetical. For some claims, SSA never even asks those hypothetical questions. This is due to the steps that SSA must take in deciding a claim.
Social Security has a 5 step sequential framework. Meaning, you must either be denied or approved at each step. If you cannot be denied or approved at that step, you are then passed to the next step in the process.
STEP 1: SSA looks at is whether you are working and making substantial gainful activity (SGA) currently $1010.00 per month. If you are making more than SGA, you are denied and your claim goes no further. If your making less than SGA, your claim moves to step 2.
STEP 2: At this step, SSA determines if your condition is severe enough to limit your ability to work and whether it is likely to last at least 12 months or end in your death. If your condition is found to be severe and likely to last 12 months, you are passed on to step 3. If not, you will get a denial letter from SSA stating that your condition is not severe and or not likely to last at least 12 months or end in your death. This is a common denial, especially in some kinds of cancer or if you have had surgery on your knees, back, shoulders.
STEP 3: At Step 3, SSA tries to decide whether your condition meets or equals one of its listings, resulting in an automatic finding of disabled. SSA listings require very specific information to be present in your medical records. If SSA finds that your case does not meet or equal a listing, you are automatically passed to step 4.
STEP 4: At this step, SSA looks at your Past Relevant Work over the last 15 years to decide if your Residual Functional Capacity (RFC), the types of work conditions SSA believes you can after taking into account any restrictions from ALL of your conditions, allows you to still perform any of this work. If SSA finds you can still do some past work, they will deny your claim saying you can return to earlier employment. It is important to note, that SSA does not look at how much you would make at this previous employment compared to what you made at your last job. They simply look to see if they think you could do the work. If SSA finds you cannot do your past relevant work, they pass you on to step 5.
STEP 5: In Step 5, SSA considers whether there is other work in the National Economy that you could do, given your RFC, and in what numbers those jobs appear in your area (usually your state, not your city or commute area). That is then compared to the grid rules. These rules use your age, education, and previous work to determine whether you should be found disabled or not disabled. By rule of thumb to be found disabled, a person under 50 must be unable to perform a full range of sedentary work, 50-55 should be limited to sedentary work or less, 55 and older, light work or less. There are some exceptions to these guidelines that your attorney will be able to decide if you qualify for them. If your RFC is found to be above what is allowed for your age and education, you are found not-disabled based on the ability to do other work. Again, this could be a job that no one is hiring for, that there are none available in your area, and pays minimum wage.
These steps remain the same regardless if your claim is at the initial, reconsideration level, or in hearing in front of an ALJ. Thus, you have multiple chances to prove you meet or equal a listing, or that you cannot perform your past relevant work. Your attorney understands this process and will help you address each step in your case to increase the likelihood of success.