Keys to a Favorable Decision

SSA uses a five-step process to decide if you are disabled.

Step 1:  Are you working?

By "working" SSA really seeks to determine if you are engaging in what they consider "substantial gainful activity."   

If you are working and your earnings average more than a certain amount each month (presently $1040/mo), SSA generally will not consider you disabled. The amount changes each year.  If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.
 
Special rules for self-employment are used to consider if work/management contributions are SGA.

Special rules also apply to situations where a person is receiving special accommodations not normally allowed for in the competitive work force.

Step 3:  Is there a listing level condition?

 The state agency has a List of Impairments that describes medical conditions that are considered so severe that this automatically means that you are disabled as defined by law.  If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled.  This, however, requires very exact medical documentation.  

For additional information about "Listing Level Impairments" go to:
www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

If it does not (or your records simply do not show all the evidence required for the listing), the state agency goes on to step four.

Step 2:  Is your condition "severe?

or the state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities—such as standing, walking, lifting, carrying, sitting and remembering. 
 
SSA considers all combined physical and/or mental impairments to determine if a condition is severe.  They rely on objective medical evidence from your medical records to evaluate your condition.  These must be expected to last for at least one year or be expected to lead to death. 

KEY 1:  EXCELLENT MEDICAL RECORDS documenting your conditions and limitations are of utmost importance.  It is vital to identify every treating physician who has relevant medical evidence concerning your condition.  Generally, SSA will request medical evidence 1 year prior to your alleged onset of disability.  If there is key evidence prior to this, we will want to request this also.

Step 4:  Can you do your past work?

At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before.  In considering this, they will first determine your "Residual Functional Capacity" based on a review of your medical records.   If it does not, the state agency will decide that you are not disabled. If it does, the state agency goes on to step five.


KEY 2:   Accurately describing the physical requirements of the work done PRIOR to becoming disabled  is also very important.   This is done during the application process and also on a Work History report.  These  should not be glossed over--we can help with these reports.

Step 5: Can you do any other type of work?

If you cannot do the work you did in the past, the state agency (or Administrative Law Judge, at the hearing level) looks to see if you would be able to do other work. This evaluation considers your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work.  Void of a supportive statement from your treating physician, opinions of state experts are relied upon heavily. 

If you cannot do other work, the state agency will decide that you are disabled. If you can do other work, the state agency will decide that you are not disabled.  (There are a number of other special rules for people who are blind.)    This is largely based on age, education and past work skills.

​KEY 3: If your treating physician is willing to offer an informed opinion regarding you physical and/or mental functional ability, this can be very helpful.  We provide forms for our clients to take to their doctors.

KEY 4:  Different "grid-rules" apply depending upon one's age category. We can explain how this affects your claim.

KEY 5:  Claimant compliance in meeting deadlines and satisfying requests for information, reports,medical releases, consultative exams, etc. is vital.  Having a representative does not eliminate a claimant's responsibility for providing key information in a timely manner...but it does make it more manageable.