The Five-Step Sequential Evaluation Process
When applying for disability benefits, claimants must apply to one of two of the Social Security Administration’s programs: Social Security disability or Social Security insurance (SSI). The Administration must adhere to a five-step process to determine if a claimant is disabled for purposes of disability or insurance as provided by the Administration. The Administration follows each step until it concludes that the applicant is either definitively disabled or does not meet the Administration’s threshold disability requirements, at which point the evaluation concludes.
The five steps used by the Administration to determine disability are:
Step One: The applicant is not engaging in a Substantial Gainful Activity (SGA); and
Step Two: The applicant has a severe medically determinable impairment; and
Step Three: The applicant’s particular impairment meets, or is equal to, one of the impairments listed in the Administration’s regulatory materials known as the “Listing of Impairments;” and
Step Four: The applicant is not able to perform his or her Past Relevant Work (PRW) based on the applicant’s Residual Functioning Capacity (RFC); and
Step Five: The applicant cannot resort to a different line of readily available work considering his or her RFC, age, education and work experience.
As any Los Angeles Social Security Disability Attorney can attest, claimants should not assume the meanings or definitions of any words or abbreviations in the five steps as all are grounded in finite legal language.
In addition to the above five-step process, the claimant must meet a durational requirement which dictates that the disability must be apparent and last for 12 full months. Failing to meet the durational requirement or any one of the above five steps will automatically result in a denial of benefits.
Exceptions to the all-or-nothing approach include the following three “special profiles:”
Profile #1: Claimant is disabled who meets the following criteria:
- Has a severe medically determinable impairment;
- Is age 55 or older;
- Has an 11th-grade education or less; and
- Has no past relevant work experience.
Profile #2: Claimant is disabled who meets the following criteria:
- Has no higher education beyond the 6th grade;
- Has worked 35 years or greater at arduous, unskilled labor; and
- Is unable to do the arduous unskilled labor performed in the past.
Profile #3: Claimant is disabled who meets the following criteria:
- Is not working to pursue a Substantial Gainful Activity (SGA);
- Has committed 30 or more years to an unskilled or semi-skilled non-transferrable profession;
- Can no longer perform his past work due to severe impairment;
- Is closely approaching retirement (age 60 or over); and
- Holds a limited education (likely no formal training beyond high school).
In addition, a claimant who does meet the five-step criteria outlined above may still be found “disabled but not eligible” if his disability is aggravated by an inexplicable refusal to adhere to a prescribed course of medical treatment or is brought upon by chronic alcohol or drug abuse.
If you have further questions about the disability process and would like to speak with an experienced and qualified Los Angeles Social Security Disability Attorney, be sure to contact the offices of Lowenstein Disability Lawyers today.