How Social Security Determines a Disability Claim

Topics on This Page

• Applying While Working
• Substantial Gainful Activities
• Severity of Injury
• List of Impairments
• Ability to Work

Disability Guide Topics

• Social Security Disability Guide
• Filing for Disability: Requirements
• Filing for SSDI: Medical Records
• Collecting Disability Payments
• Why a Disability Claim Gets Denied
• Other Benefits and Disability for Children
• When to Talk to a Lawyer

If you completed your application over the phone or online, Social Security may contact you for further information.  They also contact you to verify information.  Social Security may also send you documents to sign such as medical releases.

You will also get a copy of the information you filed online or over the phone to review it for changes or accuracy.  Once the application and disability report is complete, the information is sent to Disability Determination Services.

The Disability Determination Service

Determinations of disability for Social Security are made by Disability Determination Services (DDS) Office in your state.  This agency is funded and administered by Social Security Administration.  Decisions made by DDS are subject to appeal.

Disability Claims Examiners

Disability claims are reviewed by an evaluation team.  This team consists of a medical or psychological consultant and a lay disability evaluation specialist is responsible for making the disability determination.

How Do Examiners Evaluate Your Claim?

DDS uses a five step process set out the in the federal rules and regulations to evaluate your claim.  The steps in the process are as follows:

1. Are you Working?

If you are working and your earnings average more than a certain amount each month, you will generally not be considered disabled.  This amount changes every year.  If you are not working or your income does not meet the level of substantial gainful employment you progress to the next step.

Is your Medical Condition “severe”?

Your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting, and remembering—for at least one year.  Social Security will request information from your doctor to determine this.  If you do not have a doctor, they will send you to a doctor to get this information.  If it is determined that your condition is severe you go to step three.

Is your Medical Condition on the List of Impairments

Conditions on this list are considered so severe that they automatically mean that you are disabled as defined by law.  If the severity of your medical condition or combination of conditions meets or equals that of a listed impairment, the state agency will decide that you are disabled.  If it does not, the state agency goes on to step four. 

Can You do the Work you Did Before?

At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before.  If yes, you qualify, if not you go to the last step.

Can you do Any Other Type of Work?

The agency evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work.  If you cannot do other work, the state agency will decide that you are disabled.

2. Are you in Substantial Gainful Activity?

What is “substantial gainful activity?  -- The term "substantial gainful activity" describes a level of work activity and earnings.  Work is "substantial" if it involves doing significant physical or mental activities, or a combination of both.

"Gainful" work activity is either of the following:  work performed for pay or profit; Work of a nature generally performed for pay or profit; or  work intended for profit, whether or not a profit is realized.

3. What is the severity of your impairment?

How the SSA evaluates your symptoms (both physical and mental) -- Your impairment(s) is not severe if it does not significantly limit your physical or mental ability to do basic work activities, such as: sitting, standing, walking, lifting, carrying, handling, reaching, pushing, pulling, climbing, stooping, crouching, seeing, hearing, speaking; understanding, carrying out, and remembering simple instructions; using judgment; responding appropriately to supervision, co-workers, and usual work situations; and dealing with changes in a routine work setting.

How much does pain affect your everyday life?  Evaluating pain is one of the more difficult aspects of proving a disability claim because pain is subjective.  Social Security will consider the claimants reports of pain, but also looks for medical conditions that would account for the source of pain.  They will also look for evaluations from treating physicians and testimony of relatives, friends, or co-workers for testimony about how pain may limit the claimant’s ability to function in a work setting.

4. Is Your Injury in the Listing of Impairments? Are They Equivalent?

If DDS determines that your symptoms match or are equivalent to the severity of any of the conditions in the Listing of Impairments, then you will be found to be disabled by law.   The evaluation of your claim would stop at this point and you would begin receiving benefits.  If you condition does not meet the listing of impairments then Social Security will look to other factors to determine disability.

5. Can you Perform your Prior Job?  Or Any Job?

If you are not engaged in substantial gainful employment, your condition is severe, but you do not meet or equal any of the categories in the listing of impairments, Social Security looks to see if you can perform your prior job or any job.