How Social Security Defines Disability
Copyright © 2015 AARP
You’re supposed to either be incapable of working for at least a year or have a condition that will end in death to qualify for Social Security disability benefits. This status can be hard to prove, and experts may not even agree.
The SSA weighs many factors, including an applicant’s work experience, skills, education, and age, in addition to his or her health condition.
As the process unfolds, the SSA wants to answer five important questions. The answers to these questions determine how it rules on your claim.
Are you working for money?
The SSA describes this level of work and earnings as substantial gainful activity. The SSA may deduct special expenses you need to work, such as a wheelchair or taxi.
In measuring gainful activity, the SSA has special rules for two categories of workers:
People who are blind: The SSA defines blindness as vision that can’t be corrected beyond 20/200 in your better eye or a visual field limited to 20 or fewer degrees in your better eye.
The self‐employed: If you work for yourself, the SSA has a few ways of looking at whether your work activity should disqualify you for disability benefits. It wants to know the following:
Do you perform “significant services” for the business, and is your average monthly income above the gainful‐activity limit?
Do you perform work tasks similar to healthy, self‐employed individuals who work in the same kind of business in your community?
Is the work you provide worth the gainful‐employment pay level? How much would you have to pay someone else to do it?
Do you have a severe medical problem?
The SSA defines disability as being unable to do substantial and gainful work for at least a year or until your death. The disability must be serious and debilitating — the SSA doesn’t provide partial benefits for limited health problems.
The fact that an individual may be diagnosed with a potentially grave illness, such as cancer, doesn’t automatically mean that a claim is approved. The SSA uses the idea of “severe condition” to make sure that an applicant has a problem that is more than meaningless and to screen out those whose problems are minor.
Disability evaluators want evidence that a person isn’t capable of working. The SSA may arrange a consultative medical exam if it believes further information is needed about your condition.
Is your disability on “the list”?
The SSA maintains a long and highly detailed list of severe impairments that it considers to be disabling.
The list for adults includes 14 broad categories of disorders and specific, disabling conditions within those categories.
Check here for the SSA’s list of adult impairments, as well as find links to extremely detailed explanations.
The SSA has developed a sub‐list of more than 200 conditions considered so severe that they allow for fast‐track approval of disability claims. This effort is called the Compassionate Allowance Initiative.
Children can’t qualify for SSDI on their own, but they may be eligible for payments if they’re the financial dependents of a breadwinner who has earned Social Security benefits.
An impairment doesn’t need to be on the list to qualify as a disability. If your condition is listed, however, that goes a long way toward getting a claim approved.
Can you perform the tasks required by your former job or a similar job?
Your age becomes extremely important at this stage of the process. The SSA asks you for a detailed description of the tasks you used to perform. It won’t rely on your description alone, but it may call on vocational experts to comment on what’s expected in the workplace. It also may consult a vast online compilation of job descriptions, known as the Dictionary of Occupational Titles.
The SSA divides most occupations into four main categories of exertion, based on their physical demands. The main categories of exertion are as follows:
Sedentary: This is the label for jobs, including many office jobs, that mostly require sitting and no heavy lifting. Sedentary workers may have to carry files or tools, but they don’t have to lift objects heavier than 10 pounds.
Light: This sort of work may include various sorts of light labor, such as lifting up to 20 pounds, lots of walking and standing (up to six hours), or even sitting while doing tasks that require the use of arms or legs.
Medium: This work is more physical, requiring some lifting of up to 50 pounds and frequent lifting of up to 25 pounds. In addition, medium work may require other physical demands, such as bending, stooping, kneeling, squatting, or climbing.
Heavy: This work involves lifting up to 100 pounds and frequently up to 50 pounds.
The SSA also has a category for “very heavy” labor, for those jobs that require lifting of more than 100 pounds.
Exertion categories may be irrelevant if the problem is mental.
Can you do any other available work in the economy?
If you’re younger than 50, the SSA is more likely to conclude that you can adapt to work you’ve never done before. By contrast, a disability applicant 50 or over, who is in similar physical shape, may get a more favorable decision, and an applicant 55 or over has an even greater chance.
The SSA has put together lengthy tables (technically called medical–vocational guidelines, but often referred to as “the grid”) that seek to boil down these considerations, based on broad categories of age, skill level, education, and work experience.
Providing the SSA with the fullest possible record from a qualified doctor who knows you, who clearly and specifically states your limitations, and who has phrased them in a way that fits with SSA guidelines can make all the difference in your claim.