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Social Security Disability Blog

Gap In Medical Treatment And Effects On Social Security Disability Benefits

Thursday, June 30, 2016

Medical records are the focus of every social security disability case. The Social Security Administration (SSA) will thoroughly comb through your medical records to assess the extent of your treatment in order to determine the severity of your disability.

In many instances in a social security disability case, a claimant will stop treating with a doctor. The reasons for the gap in treatment are important. If the medical records are devoid of the reason that treatment stopped, SSA may assume that the symptoms have improved and that you are no longer disabled. It is imperative that, whatever the reason, you have discussed the reason with your doctor so that it appears in your records.

Maximum Medical Improvement

If you stop treatment because you have exhausted the many different treatments recommended by your treating physician and there is no improvement in your symptoms, it can be argued that you have reached medical maximum improvement and there is nothing else your doctor can do for you. In this instance, SSA will use all of the relevant medical records to access your eligibility for benefits.

Financial Problems

Another reason for ceasing treatment is a claimant may not be able to afford treatment. This is true for many claimants and SSA understands that you are not working and your financial situation may not allow for you to treat. Thus, SSA cannot make a negative inference from your lack of treatment due to inability to access low-cost medical care or not having sufficient health insurance.

Reluctance to Have Surgery

You may have been recommended for surgery by a doctor but you refuse to go through with the surgery. Your refusal to treat in this situation, can be seen as a refusal to comply with medical treatment. However, your medical history and treatment can support your refusal to comply with treatment. For instance, if you have already had 3 surgeries without improvement it may be reasonable to decide not to have a 4th surgery.

Mental Impairments

For individuals with a mental disability it is understood by SSA that there may be periods of failing to seek treatment. This could be a symptom of your mental disability so failing to seek treatment in this scenario would not, in and of itself, be a deciding factor as to your eligibility for benefits.

Any claimant who has a situation where they have or intend to stop treatment must ensure their reasoning is a valid reason for which SSA will accept and not hold against you. After all, your medical records are the source of accessing your credibility, as well as the nature and extent of your disability. Without this information SSA can infer that your symptoms are not severe enough to warrant you seeking medical help, thus it is not severe enough to prevent you from working.

By Patricia Zeleznik

The Importance Of The “Disability Onset Date” In Social Security Disability Decisions

Wednesday, January 09, 2013

The “Disability Onset Date” (DOD) is the date that the Claimant has met the evidentiary requirements to prove “disability” as defined by the Social Security law. This date is extremely important in evaluating disability cases. For instance, if the DOD is after the Claimant has turned 50 years old, the Medical Vocational Guidelines might mandate a finding of disability. (See Age: A Crucial Factor in Your Social Security Disability Case). Conversely, if the DOD is after the “date last insured” then it doesn’t matter how disabled the Claimant is, because the Claimant is not insured, the Claimant is not entitled to Social Security Disability Benefits. (See Have I Worked Long Enough to Qualify for Social Security Disability Benefits?).

How is the Disability Onset Date Established?

In the initial application for disability benefits, the Claimant is asked for the date that they became unable to work. The response to this question will be referred to by SSA as the “alleged” DOD. The SSA will evaluate your case to determine if the Claimant meets the criteria for disability as of the date alleged. When considering how to answer this question, the Claimant should provide the date that their condition prevented them from working, not the date that the disabling condition started or was diagnosed. Thus, the alleged DOD should not be the date the Claimant was diagnosed with multiple sclerosis but the date the condition finally stopped them working.

Amending the Disability Onset Date

The Claimant can always amend their alleged DOD. Often this is done at the request of counsel after reviewing the medical records and discussing the case with the Claimant. Situations in which the Claimant may need to amend the alleged DOD are:

  • the Claimant worked after the alleged DOD,
  • a later onset date after the age of 50 will allow for the application of the Medical Vocational Guidelines (typically making it easier to establish disability), or
  • to conform to subsequent medical conditions which occurred after the alleged DOD (i.e., a new traumatic injury occurred after the original condition which combined with the original condition may make it easier to establish disability).

Frequently, the issue of amending the DOD is raised by the Administrative Law Judge (ALJ) at the hearing. The ALJ may have reviewed the evidence and may believe that a different (usually later) DOD may allow for a favorable decision in the case. Choosing to amend the DOD, especially at the hearing, needs to be considered carefully. On the positive side, if the ALJ has raised the issue, it most likely means that the ALJ believes that the Claimant will have met the evidentiary requirements to prove disability as of that date. Thus, amending the DOD to this new date may result in a favorable decision.

However, changing the DOD may result in a decrease in benefits. First, there may be a loss of past due benefits. For example, if the original DOD was 1/1/2010 and the Claimant amend to 1/1/2011, the Claimant may have lost out on 12 months of past due benefits. (See How do I Calculate My Past Due Benefits for Social Security Disability?). Second, by changing the DOD the Claimant may delay Medicare eligibility. Medicare benefits begin 24 months after the Claimant is first entitled to monthly disability benefits. Using the original DOD in the previous example, 1/1/2010, monthly benefits would begin in June 2010 because of the 5 month waiting period. This means that the Claimant would be entitled to Medicare in June of 2012 because of the 24 month waiting period for Medicare benefits. But if the Claimant amended the DOD to 1/1/2011, the Claimant would have to wait until June 2013 for Medicare eligibility.

Partially Favorable Decisions

The SSA sometimes unilaterally amends the DOD through a “partially favorable decision.” In these cases, the Claimant receives a partially favorable decision indicating that the SSA has decided that the Claimant is disabled but that the disability is not established until a later date — not the alleged DOD from the initial application. Typically this occurs for one of two reasons. First, the new date reflects an actual change in the Claimant’s condition as reflected in the medical records. This could be the date of a new injury, the date of a surgery, or simply a date in the medical records when the doctors indicate a definite worsening of condition. Second, the SSA may have amended the DOD to take advantage of the Medical Vocational Guidelines which make it easier to establish disability after the age of 50. In these circumstances the new DOD may just be the Claimant’s 50th birthday.

A partially favorable decision can be appealed. However, upon appeal the SSA will re-examine the entire case and consider all the issues again. The next decision could actually take away the benefits the Claimant was just awarded in the partially favorable decision. Any decision to appeal a partially favorable determination should be handled with extreme caution. The risk of losing a guaranteed source of monthly income and medical insurance benefits may outweigh the chance for some additional money in past due benefits.

By David Galinis

How To Find Out Your Monthly Social Security Disability Benefit Amount

Friday, June 22, 2012

Each year the Social Security Administration (SSA) used to send out statements to each taxpayer. These statements would indicate what earnings had been reported to the SSA, whether the taxpayer had contributed enough to qualify for benefits, and what the monthly benefit would be for both disability and retirement benefits. As a cost saving measure in March 2011, SSA stopped sending out those statements to anyone under the age of 60. This was frustrating for younger individuals who were deciding whether to apply for Social Security Disability as they had no idea what their monthly disability benefit would be.The good news is that as of May 2012, the statements are once again available – but now in an online version. Visit the “my statement” page on the Social Security website, create a user ID, and you will know precisely the amount of your monthly disability benefits if you are found to be disabled.

By David Galinis

Navigating Through The Social Security Disability Claims Process

Tuesday, January 31, 2012

A claim for Social Security Disability benefits could take anywhere from 6 months to 6 years! During that time, the claimant will have to complete an application, and possibly navigate his or her way through 3 levels of appeals at the Social Security Administration (SSA) and another 3 levels in Federal Court. What follows is an explanation of the major steps along this arduous path.

Application for Disability Benefits

Three forms are required to be completed to start the claims process for Social Security Disability Benefits: a Disability Benefit Application, Adult Disability Report, and a medical release form. These forms can be obtained at your local SSA office. However, SSA would much rather you apply online. While you can use an attorney to assist you at this stage of your claim, one is not required. In my experience, most individuals apply for benefits without an attorney and seek representation if their claim is denied.

The information requested in these forms falls into four basic categories:

  • work history
  • educational background
  • medical conditions, and
  • medical providers’ names and address.

With this information, SSA will open an official claim and begin the process of evaluating disability.

Disability Determination Services

Once a claim is initiated, SSA transfers your case to a state agency which gathers the evidence and makes the initial determinations as to disability. In Maryland, this state agency is known as Disability Determination Services (DDS) and is located in Timonium. A primary function of DDS is to request your medical records from the medical providers you identified in your initial application for benefits. If DDS finds that the medical records are lacking in some respect, they may scheduled an appointment with a doctor selected and paid for by DDS. This is called a “consultive examination.” This doctor will not provide treatment to you and will typically not provide any information to you. DDS will evaluate the medical evidence received from your medical providers along with any consultive examinations to make their determination. This process from completing the application for benefits to the initial determination usually takes between 3 to 6 months.

Despite what many believe, about 40% of the initial applications are approved at the DDS level. Why are the other 60% rejected? Please refer to my first post 3 Reasons Your Claim Was Denied.

Reconsideration

If your initial claim is denied, you have 60 days to file an appeal, a Request for Reconsideration. This is the juncture at which most people seem to hire an attorney. Two forms need to be filed to perfect the appeal: a Request for Reconsideration and an Adult Disability Report – Appeal. In the Request for Reconsideration form you indicate that you want an appeal and a brief reason. I say “brief” because the form itself only allows for a couple sentences. In the second form you note any changes in medical conditions or providers since the initial application.

Upon receipt of the 2 forms, your case is again transferred back to DDS. If additional medical treatment or providers were listed on the disability report, DDS will request those additional medical records. DDS may again schedule a consultive examination. A different person (or people) will evaluate your case. The decision usually takes another 3 to 6 months from the filing of the Request for Reconsideration. In the overwhelming majority of cases, the reconsideration is usually denied, usually for the same reasons.

Hearing

As with the last appeal, the Request for Hearing must be filed within 60 days from when the reconsideration was denied. Along with the request, another Disability Report must be completed with new conditions, treatment, and/or medical providers. Upon receipt of the required forms, your case is transferred to your local Office of Disability Adjudication and Review (ODAR). Once at ODAR, the case is assigned to a federal administrative law judge. That judge’s assistant requests the additional medical records necessary to bring the evidence up to date. Many times an “Attorney Advisor” will review the file to determine whether a hearing before a Judge is needed. In some cases the Attorney Advisor will issue a favorable decision without the need for a hearing.

If your case goes to a hearing, that hearing usually takes place within 9 to 12 months from when the Request for Hearing was filed. The hearing will be conducted by a federal administrative law judge. This hearing is your first (and potentially last) opportunity to actually testify. All the prior decisions were made solely on the basis of a document review. As you can imagine, the hearing level is very important as it is your opportunity to speak to and argue your case to the person making the decision.

Sometimes the judge will issue a decision from the bench. More often, though, the Judge’s decision comes in writing within 30 days. If you were adding up the time it takes at each of the stages, you will see that if the case goes to a hearing, a decision in your case could easily take 2 years from the initial application.

Post Hearing Appeals

And still there are more levels of appeals. The judge’s decision can be appealed to the SSA Appeals Council within 60 days. The Appeals Council will review the evidence (including a transcript of the hearing) and decide whether an error of law was committed. It can take a very long time, some times as long as 2 years, to get a response from the Appeals Council. If the Appeals Council does not reverse the judge (or remand it for another hearing), the case can then be appealed to United States District Court, then to Circuit Court, and potentially even to the United States Supreme Court.

On a final note, it is very important to be aware that all of these appeals are on the record. This means that even though your case may take 6 years with 3 SSA appeals and 3 federal court appeals, your hearing in front of the administrative law judge was your one and only opportunity to speak to the person making the decision and explain the nature of your disability.

By David Galinis

Eliminate The Early Retirement Penalty With Social Security Disability Benefits

Wednesday, October 12, 2011

While it’s possible as early as age 62, choosing to receive Social Security retirement benefits before your normal retirement age is penalized. The “early retirement penalty” can amount to a 30 percent reduction in your monthly benefit. And what’s worse is that the penalty is permanent. Thus, although your monthly benefit will change with cost of living adjustments, the initial reduction as a result of the penalty will continue even past normal retirement age. As a general rule, you should wait until your normal retirement age (66 or 67) or, even better, get an increased monthly benefit by delaying your retirement until age 70.

But what if you simply cannot work until your normal retirement age? If you are under 62, it is probably time to apply for social security disability benefits. These benefits are calculated using your normal retirement age. Thus there is no early retirement penalty.

If you are 62 or older you have a few more issues to consider because you can apply for both disability benefits and early retirement benefits. Applying for both programs has its advantages. First, you receive early retirement benefits each month while your social security disability claim meanders through the disability evaluation process. This process can sometimes take two years. Second, if you are found disabled and entitled to disability benefits before your early retirement benefits began, the early retirement penalty disappears. Not only will your monthly benefits be increased but you will receive money for the preceding months in which you were received less than your full disability benefit amount.

Unfortunately, there are disadvantages to applying for both programs. First, you could lose your claim for disability benefits. If so, you would be stuck with the early retirement penalty for life. Second, you could win your disability claim but the SSA could find you entitled to disability benefits after you began receiving your early retirement benefits. In this scenario there would be a reduced permanent benefit – although not as severe as the early retirement penalty.

One final item of good news is that if you are in your 60’s its going to be easier to prove disability. Remember that for those under age 50 the standard for disability is an inability to do any kind of work – not just the kind of work you have done in the past. (See Age: A Crucial Factor in your Social Security Disability Case). While the rules do relax at age 50, they relax even further at age 55. And at age 60, the battle is mostly won if we can prove an inability to do your prior work.

By David Galinis

Age: A Crucial Factor In Your Social Security Disability Case

Friday, July 01, 2011

While the severity of the impairment is the most significant factor in Social Security Disability cases, age follows right on its heels as the second most important factor. The reason is simple – the law is different for people of different ages. The younger a person is, the more difficult it is to prove an inability to work. Conversely, every year older will make the case for disability a little bit easier.

 

The basic idea is that as we get older, the real opportunity to change careers diminishes. As an example, consider a 55-year-old construction worker who has only worked in construction his entire life. Let’s further assume he has an impairment that prevents him from working construction but would permit him to work in an office, a sit down job with very little lifting. The problem is that at 55 he probably will not be able to make the transition to working in an office. It’s too late in his working career to learn a completely new set of skills. Recognizing this fact, the Social Security Administration’s (SSA) rules separate the world into three different age groups and treats each differently.

Younger Persons

I have some good news for all you 49ers out there, the SSA considers anyone under the age of 50, to be a “younger person.” The bad news is that as a “younger person,” the SSA has determined that you are still able to learn how to do a completely new job. In considering our construction worker, let’s say he is 45 when he becomes unable to work in construction. SSA would deny his claim for disability because as a “younger person” he does have the ability to learn how to do a desk job.

Closely Approaching Advanced Age

Claimants between the ages of 50-54 are considered to be “closely approaching advanced age.” According to SSA rules, these individuals will have some difficulty transitioning to new types of employment but this difficulty will only partially limit their ability to transition. For the construction worker who now is limited to sedentary work (no lifting over 10 pounds), the SSA will find that he cannot make the adjustment to that type of work and consider him disabled. However if that same construction worker can do light work (no lifting over 20 pounds), SSA will find that he can make the transition to light work and will deny benefits.

Advanced Age

The good news for you unfortunate souls 55 and over is that if you cannot perform your prior work, you are probably entitled to benefits. This is an oversimplification but it is not far from the truth. In the construction worker example, even though he may still be able to do light work (lifting up to 20 pounds), at age 55 SSA will find him disabled. Any claimant who is over 55 years old and cannot perform the work they have performed for the past 15 years has a very good claim for benefits.

Sometimes 49 Equals 50

Regardless of vanity, I may argue to the SSA that you should be considered to be 50, even though you are only 49. There is a rarely used portion of the Social Security regulations that provides that age categories should not be applied “mechanically.” 20 CFR § 404.1563(b). Thus if the law would grant you disability benefits at age 50 but you are only 49 and 6 months, SSA may “deem” you to be 50 and grant the benefits. Don’t worry – your “deemed” age is a part of attorney client privilege. What happens at the hearing, stays at the hearing!

By David Galinis

Back Problems: The Most Common Source Of Disability Claims

Tuesday, February 22, 2011

If your back has ever “went out,” you understand just how devastating back problems can be. In my practice, impairments involving the spine are the single most common disabling condition. What follows below is my legal (as opposed to medical) understanding of back problems and my strategies to obtain disability benefits as a result of them.

1. What Types of Back Injuries May Qualify for Benefits

Most significant back problems involve disc injuries. The discs are the cushions between the bones in your back, the vertebra. You can think of them as jelly donuts as they have a jelly-like substance in the middle. They sit in between the vertebra and allow for the range of motion you have in your spine. The most significant disc injury occurs when one of these discs ruptures and the jelly-like substance in the middle is pushed out – just like smashing a jelly donut. When the substance comes out, it can come into contact with the spinal cord causing nerve damage. This is commonly referred to as a herniated disc and can certainly be a source of disability.

Bulging discs, however, are usually not a source of disability. Bulging discs are relatively common findings on an MRI. People with absolutely no back pain can have an MRI with bulging discs. As we all get older we tend to get more bulging as the process of aging compresses the spine. This compression of the discs (jelly donuts) causes them to bulge. Typically a bulging disc (or discs) by itself does not correspond to a disabling impairment.

2. Back Problems as a Listed Impairment

In my previous post, 5 Step Disability Evaluation Process, I described the disability evaluation process. The third step was to determine if the Claimant had a Listed Impairment. If the Claimant has a Listed Impairment, disability is granted without a consideration of whether the Claimant could return to work. A back condition has to be very severe to meet the requirements for a Listed Impairment.

As a threshold matter, there must be some nerve root compromise to qualify for the Listed Impairment for spinal disorders. From a symptom perspective, the pain and other symptoms cannot be localized in the back but need to radiate into the legs (or arms). As discussed above, something (most commonly that jelly-like material) is coming into contact with the spinal cord or nerve roots coming from the spinal cord. This needs to be demonstrated with an objective diagnostic test – like an MRI or EMG.

If that preliminary test has been met, the Claimant can meet the listing one of three ways. First, he or she could show that there is ongoing nerve root compression. This is demonstrated byallthe following:

  • limited range of motion,
  • atrophy (muscle loss),
  • sensory or reflex loss, and,
  • if it’s a low back problem, a positive straight leg raising test (e.g. a test the doctor does by raising the Claimant’s leg while he or she is lying on the examination table).

If the Claimant cannot show ongoing nerve root compression, the Claimant could show spinal arachnoiditis. This is a very rare condition involving inflammation of the membranes that protect the spinal cord. The diagnosis would have to be confirmed through an operative note or pathology results.

Failing nerve root compression and arachnoiditis, the Claimant’s final way to meet the listing is showing lumbar spinal stenosis resulting in pseudoclaudication resulting in an inability to walk effectively. Stenosis is a narrowing of the spinal canal causing a compression of the spinal cord. Pseudoclaudication typically involves severe leg pain with walking or standing. It is often accompanied by numbness and weakness in the legs.

3. What if the Back Condition Is Not Severe Enough to Meet a Listing?

Most Claimants do not meet the technical requirements for the listed impairment. Many have some of the elements, but very few have all the requirements to meet the listing. In those situations, the Claimant must prove that his or her residual abilities would preclude returning to work.

As a direct result of the back impairment, Claimants often have difficulty doing the following types of activities:

  • lifting,
  • prolonged standing,
  • prolonged sitting, and
  • walking.

Back problems indirectly – either because of pain or the effects of pain medication – also can cause difficulties:

  • concentrating,
  • staying on task,
  • being punctual, and
  • missing work due to flare-ups.

For Claimants under age 50, these impairments must not only prevent a return to the Claimant’s past work but also prevent any other type of work. When I ask my clients with back problems why they cannot work, they often indicate to me that they cannot sit or stand for very long. Unfortunately, these restrictions usually are not sufficient to prove disability. SSA has determined that there are jobs that allow for a sit/stand option. In other words, there are jobs that can be performed either sitting or standing. Additionally, SSA has found that these jobs will also allow for the employee to change positions frequently. Thus, the inability to sit or stand for prolonged periods of time rarely is sufficient to prove disability.

The more typical rationale for granting disability for Claimants under the age of 50 is that the effect of his or her pain, pain medications, and frequent flare-ups would so decrease his or her productivity, that the Claimant would be unable to sustain work. The argument is that while at work the Claimant would be unproductive because of pain and/or pain medication. Additionally, the Claimant might also miss a lot of work due to flare-ups of his or her condition. If the Claimant cannot sustain full time work, he or she would be found to be disabled.

For Claimant’s over age 50, the road is a little easier. Such a Claimant will be granted benefits if the Claimant:

  • cannot do his or her past work,
  • has a restriction to only sedentary work (i.e. desk work), and
  • does not have transferable skills to sedentary work.

For example, a 50 year old Claimant who has worked construction his entire life and now can only lift 10 pounds because of a back impairment would be found disabled. The Claimant could not return to construction work with a 10 pound lifting restriction. A 10 pound lifting restriction would only allow the Claimant to do sedentary work. Finally, during the Claimant’s years in construction, it is doubtful that the Claimant acquired skills that would transfer to a sedentary work setting (e.g., like an office).

By David Galinis

Expediting Claims At The Social Security Administration

Tuesday, January 25, 2011

The social security disability claims process is a lengthy one. About 40% of those who apply for disability benefits are granted benefits on their initial application. It usually takes 3 to 6 months for the initial decision. For those that are not granted benefits upon their initial application, the delay can be from 12 to 24 months. Given that the claimant is unable to work during those 1-2 years — the delay is most often an extreme hardship. The Social Security Administration (SSA) will expedite some types of claims. Below I describe the five situations in which the SSA will speed up the evaluation process.

1. Terminal Illness

If there are medical records indicating the diagnosis of a terminal illness, the SSA will expedite the evaluation of the claim. Examples of conditions that SSA considers terminal are metatastic cancer, if the claimant is awaiting a heart or liver transplant, or if the claimant has been comatose for more than 30 days. These are just examples only and are not by any means an exhaustive list.

2. Military Service Casualty Case

The evaluation will be expedited if the allegation of disability is as a result of an injury occurring on or after October 1, 2001 during active duty. The active duty requirement is very broad and includes injuries to reserves and does not require the injury to occur on foreign soil. The manner of the injury or disability is also not important so long as it was while the claimant was on “active duty.”

3. Compassionate Allowance

The SSA has identified certain medical conditions which are so serious that they will most likely lead to a determination that the claimant is disabled. If a claimant has one of these conditions, the case will be expedited. The list currently has 100 conditions including Lou Gehrig’s disease (ALS), liver cancer and acute leukemia. For the complete list, see http://www.ssa.gov/compassionateallowances/conditions.html

4. Dire Need

A claimant is in a “dire need” situation when they have insufficient income or resources to meet an immediate threat to health or safety. Most commonly, the “dire need” is a lack of food, clothing, shelter or medical care. The situation must be immediate and the claimant must not be able to rectify the situation. If the claimant is currently receiving food and/or shelter through a charitable organization – the claimant has rectified the immediate threat and therefore will not be considered for expeditious processing. When attempting to prove “dire need,” the claimant needs to allege the above facts with specificity and, if possible, provide documentary proof (e.g., eviction notice, foreclosure notice).

5. Suicidal/Homicidal

In any case in which there is an indication that the claimant is suicidal or homicidal, the SSA will expedite the evaluation of the claim.

6. Congressional Inquiry

A common technique for claimants who have been waiting an inordinately long time for a decision is to get their congressional representative to intervene on their behalf. Many congressional offices do this routinely. The SSA rules indicate that a prompt investigation and response is required to any congressional inquiries. However, there is no rule requiring that evaluation of the case be expedited like in the previous five situations. Of course, if the congressional inquiry identifies the case as one of the five types discussed above, that would then put the case onto an expedited track.

By David Galinis

Should I Use The Attorney Provided By My Disability Insurance Company?

Thursday, December 23, 2010

Should I Use the Attorney Provided by My Disability Insurance Company?

By David Galinis

5 Step Disability Evaluation Process

Tuesday, November 30, 2010

The Social Security Administration (SSA) uses a five-step sequential evaluation process to determine if any given Claimant is entitled to Social Security Disability benefits. SSA considers each step in this process sequentially before moving onto the next step. In this post, I describe these five steps in their most basic terms.

Step One – Has the Claimant been Unable to Work for 12 Months?

SSA first looks at whether the Claimant has not engaged in substantial gainful activity for at least 12 months. In simpler terms – has the Claimant been out of work for 12 months? If so, move on to step 2. If the Claimant is still working, SSA will not even consider your medical impairments and will deny the claim at step 1. But what about those Claimants who are not working but it has not been 12 months yet? In my experience, SSA will deny the claim at this step. On rare occasions, if there is evidence in the record that the impairment is likely to cause an inability to work of at least 12 months, the SSA may proceed to step 2.

Step Two – Does the Claimant have a Severe Medical Impairment?

The Claimant’s alleged medical conditions must be considered to be a “severe medically determinable impairment.” This is not much of a road block in the evaluation. Most Claimants will have in their medical records some type of diagnostic testing or examination findings that support their doctor’s diagnoses. This will normally be enough to satisfy step 2.

Step Three – Does the Severity of the Claimant’s Impairment Meet the Listings?

The Code of Federal Regulations contains an exhaustive list of medical conditions called the Listing of Impairments (Listings). The Listings contains such impairments as 2.02 Loss of Visual Acuity and 1.04 Disorders of the Spine. Under each listing there is a description of a certain severity of that impairment. For instance, for loss of visual acuity — the Claimant meets the listing if the corrected vision in the Claimant’s best eye is 20/200 or worse. If the medical records show that level of severity the Claimant is entitled to disability benefits at step 3. Please note that the level of severity described in the Listing of Impairments describes only the most seriously disabled of Claimants. Most Claimants do not meet the Listings and SSA proceeds to step 4.

Step Four – Can the Claimant Perform Their Past Relevant Work?

If the Claimant can still perform their past relevant work — they are not entitled to disability benefits. The Claimant’s past relevant work is work that has been done in the last 15 years. SSA will examine all of the jobs the Claimant has had over the past 15 years and categorize them as sedentary, light, medium or heavy work. These categories describe, in general terms, the physical requirements of the jobs. For instance, in a sedentary job, the Claimant would not be required to lift more than 10 pounds.

The SSA will then determine the Claimant’s residual functional capacity (RFC). The RFC is a description of what types of things the Claimant can still do despite his or her impairment. One element of the RFC is often how much weight the Claimant can still lift. If the Claimant can lift no more than 10 pounds, his RFC will be at most sedentary. If the Claimant has prior work at the sedentary level and has an RFC for sedentary work — the Claimant is not entitled to benefits. If the Claimant’s RFC is less than all the Claimant’s past relevant work — SSA proceeds to step 5.

Step Five – Can the Claimant Perform Other Work?

In this final step, the question is whether there are any other types of jobs, besides the ones the Claimant has performed int he past, which the Claimant can do. SSA performs its analysis by examining the Claimant’s RFC in conjunction with his or her age, education and skills to determine if there are any other types of jobs the Claimant can still do. Note that the analysis here is whether such jobs exist – not whether the Claimant could actually get hired. If there are no other types of jobs the Claimant could do, the Claimant is granted disability benefits at Step 5.

By David Galinis

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"I just got off the phone with Craig and let him know how thankful we are to you, him and Ken for all your efforts – you are all really terrific to work with!"

Val K.


Locations Throughout Maryland, Virginia & Washington DC

Gaithersburg Office

481 N. Frederick Avenue, Suite 300
Gaithersburg, MD 20877
301-670-7030 / 800-248-3352
Fax: 301-670-9492

Lutherville Office

1301 York Road, Suite 600
Lutherville, MD 21093
410-769-5400 / 800-248-3352
Fax: 410-769-9200

Frederick Office

30 W. Patrick Street, Suite 105
Frederick, MD 21701
301-668-2100 / 800-827-2667
Fax: 301-668-2000

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