The Complex SSDI Process Can Be Simplified to a 5-Step Process…
1. Are you currently working, engaged in “Substantial Gainful Activity,” and do you have sufficient work credits?
First, Social Security will see if you are working currently. Most work that earns you $1,180 per month (the 2018 SGA limit), is likely “Substantial Gainful Activity” (SGA) according to Social Security. If you are engaging in SGA, you won’t be eligible for SSDI disability benefits even if you are disabled. In order to have SSDI eligibility, you need to have a certain amount of work credits – quarters of a year where you worked, earned, and paid into the Social Security tax system. The rules are complicated, but generally, most people need to have earned at least 20 credits over the past ten years. You can earn four credits per year, one for each quarter of the year (three months). You count backwards from the time you were disabled, to determine if you have sufficient work credits to be eligible for SSDI coverage – the last date of your eligibility is called your “date last insured” (DLI). For people who stopped working long before they became disabled, the DLI is often a subject of dispute in their SSDI claim.
2. Is your disabling condition severe?
DDS will then examine your claim to decide whether or not you have a severe disabling condition. The critical question here is whether your impairment or collection of impairments actually prevent you from working. It’s not sufficient that you have, for example a back injury or issue that can be controlled with medication – that type of impairment is less than severe, and isn’t preventing you from working. However, if you have painful back issue that cannot be corrected and impairs your ability to work – that is a severe condition.
3. Do you meet or equal a “listing”?
Social Security has an official list of impairments, and a detailed list of the requirements to “meet” that listing. The listings are technical and complex, but if you meet the specified symptoms and severity, then you are disabled according to Social Security. The listings contain only the most common and severe impairments. If you don’t technically meet the technical specification of a particular listing, DDS will see if a combination of impairments, or an impairment you have that’s similar is the equivalent of a listing – this is called “equalling a listing”. Most people’s ailments will not fit perfectly into the box of an official listing. So, Social Security will analyze whether you have an impairment that’s the equivalent of one of the listings.
Equalling a listing requires that (a) your impairment or impairments are not listed, but are of the same severity of a listing (b) you have a medical record/data that isn’t exactly the same as required by the listing, but effectively shows the same result, or (c) you have a combination of impairments that is the functional equivalent of one of the specific Social Security listings.
4. Will your Residual Functional Capacity (RFC) allow you to perform your prior job?
If you don’t meet or equal a listing, the DDS medical examiners will analyze if your condition prevents you from doing the work you used to do. If you can still do your prior jobs, then you are not disabled according to Social Security. The analysis associated with your Residual Functional Capacity (RFC) is complex, and will take into consideration what kinds of functions you can still do, your age, your education, your work experience, etc…the medical-vocational analysis is highly technical and complex. If the DDS Social Security office finds you cannot do your prior work, they move to step 5.
5. Can you perform any other work, or any other jobs?
Crucial to note in this step is, it doesn’t matter if there are no particular jobs available in your community, in your geographical location. DDS only looks to whether you can do any other work, even with your limitations, based on your Residual Functional Capacity. It doesn’t matter if that job you may be able to perform is lower paying, doesn’t require much skill, or isn’t available anywhere near you – that’s enough to deny your SSDI Disability claim. The older you get, the easier it is for Social Security to determine you are disabled, because the regulations state that if you are over 50 or over 55 it will be more difficult for you to adjust to other work.
Within each of these steps, there are lots of important details, this is just a brief summary of the complex process.