Social Security Disability Insurance and Supplemental Security Income Determination

Once it has been determined that you meet the “earnings requirement” for purposes of receiving SSDI benefits and/or that you meet the “income and resources requirement” for purposes of receiving SSI benefits, Social Security must determine whether you are “disabled” as it defines that term.  In order to accomplish this, your claim is sent to a State agency called Disability Determination Services, which is responsible for gathering medical records, obtaining additional information from you, and sometimes scheduling appointments for you to be examined by physicians or a psychologist of its choice.  This portion of the process is the same for both SSDI and SSI claims.  According to Social Security, disability is defined as “the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months” (20 CFR 404.1505).  What this means is that, because of the limitations your medical conditions cause, you must be unable to work on a regular and continuing basis in the kinds of jobs you have performed in the 15 years before your disability began, and that, based on your age, education, prior work experience and limitations, you could not perform any other work day-in-and-day-out. 

The first question is whether you are working and/or whether you worked during the first 12 months after your disability began.  If you did work or are working when you apply, your gross earnings must be under a certain monetary limit called substantial gainful activity, which, in 2013, was $1,010.00 per month.  If you have worked at substantial gainful activity levels in the first 12 months after your disability began, you cannot be found to be disabled until after that level of earnings has stopped.

Secondly, it must be determined that you have at least one “medically determinable impairment”, which means that you have to have at least one condition that has been diagnosed by a medical or osteopathic doctor or a licensed or certified psychologist.  (There are a few limited circumstances in which other health care providers can provide acceptable diagnoses.)  This medically determinable impairment must have more than a minimal effect on your ability to do basic physical and/or mental demands of a job.  Next, it must be determined whether the impairment you have is of such severity and specificity that you could be found to be disabled without even considering whether you could work in jobs similar to those you performed in the past or even in other jobs. At this third step of the process, Social Security compares your condition to the Listings of Impairments, which are found in Social Security’s regulations.  These Listings are divided into a number of areas such as musculoskeletal system, respiratory system, cardiovascular, system, neurological system, and mental disorder, to name some.  If your condition meets the requirements of a specific Listing, Social Security should find you to be disabled. 

If your condition does not meet a Listing, the physical and/or mental limitations you have as a result of your conditions must be determined.  This is called your “residual functional capacity” (RFC) and is the most, not the least, you could be expected to do day-in-and-day-out (8 hours a day, 5 days a week).  It includes such things as how long you could sit at one time and throughout the day, how much standing and walking you could do at one time and throughout the day, and how much you could lift and carry including how frequently you could do this.  It also includes the limitations you might have in reaching, bending, kneeling, seeing, hearing, getting along with others, following directions, staying on task, concentrating, and working at a reasonable pace.  While the limitations your doctors provide may be used in arriving at an RFC, the limitations that Disability Determination Services formulates may differ from the restrictions your doctors have given you.

Once the RFC has been formulated, a determination is made as to whether you would be able to perform the kinds of work you did in the 15 years before your disability began.  If you would not be able to perform work similar to the work you previously performed, it must be determined whether any jobs exist within your limitations, given your age, your education, and your prior work experience.

In determining whether a child is disabled for purposes of receipt of SSI, a different set of criteria are used.  Children must also have a medically determinable impairment, but the process thereafter is much more centered on functional abilities as compared to children without impairments.  More information on such applications can be found on Social Security’s website.

Information provided by Ruth K. Irvin, Attorney