How an ALJ decides a Disability Claim

 Disability Lawyer and ALJ Analysis of your Claim

Every case is different, but the Social Security Administration, as well as a disability lawyer, uses a five step approach in determining whether an individual with a disability is eligible for benefits.  All of the rules that go into deciding each step would most likely fill a small library.

Here’s a simple test when looking for an attorney to represent you. Ask he or she to explain what a listing is and/or what SGA means?  While there is no guarantee if they answer them correctly, that they can handle your claim properly. However; if they can’t, then they probably do not know enough about the social security rules and laws to represent you effectively.

The following is the basic analysis the Social Security Administration uses in evaluating each case:

Step 1: Are you working?

 Are you working or have you worked since your alleged onset date?  If so, you will probably be denied at step one unless it is not considered substantial gainful activity (SGA).  SGA is determined by the type, amount, and earnings of the work you have done since your onset date.  If your work is not considered SGA, the ALJ may more closely scrutinize your testimony in determining credibility. If you are not working or your work is not SGA, the administration goes to step 2.

Step 2: Do you have a severe impairment?

Is your medical condition “severe?” If your condition is considered “severe”, the administration goes to step 3.

Step 3: Do you meet or equal a listing?

Does your medical condition (physical or psychological) meet or equal an official “Listing” as described by SSA?  The simplest explanation of a listing is someone who is completely blind or deaf would meet a listing because those impairments are severe even though there are blind and deaf people who work.  There are listings for numerous conditions that generally only attorneys who routinely represent social security claimants are familiar with and the changes that regularly occur with them.  This list describes certain medical conditions that are considered so severe (terminal cancer, heart transplant, etc.) that they automatically mean that you are disabled as defined by law. It also lists other severe impairments relating to different systems of the body: musculoskeletal, cardiovascular, digestive, endocrine, neurological, and psychiatric. If your condition is not on this list, or the medical equivalent of those on this list, the administration goes to step 4.

Step 4: Are you able to do your past work?

Are you able to do your past work?  Social security considers a specific number of years, looks at how you did the job, and also how it is classified in the Dictionary of Occupational Titles (DOT).  If you can, you will be denied. If you can’t, the Social Security Administration goes to step 5.

Step 5 What is your RFC?

At this step, SSA will consider what you have the ability or inability to do considering your impairments, your age, your education, and your past work experience.  SSA will often attempt to identify jobs that a hypothetical individual (you) can do and if they identify jobs that exist, more than likely there will be some you have never heard of and did not realize that is what that job was called.

While I am biased, consider hiring a disability lawyer when filing an appeal after being denied your Social Security Disability Benefits.  Let the attorney focus on the appeal so you can focus on getting the medical treatment you need. Don’t forget to complete the Disability Lawyer Evaluation or if you haven’t applied for Social Security Disability and need to click HERE.