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What does it take to be eligible for Social Security Disability?

September 11, 2013

For Social Security disability or SSI purposes, to be considered disabled, individuals must have an impairment, either medical, psychological, or psychiatric in nature, that keeps them from being able to do substantial gainful activity.  In addition, the disabled person’s impairment must have prevented the individual from doing substantial gainful activity for at least 12 months, or be expected to prevent the individual from doing substantial gainful activity for at least 12 months.

To be considered a disabled person for Social Security purposes, an applicant must be unable to perform substantial work. Generally, this means working and earning above a certain amount. But for the self-employed, there are other tests Social Security uses to determine if someone is doing substantial gainful activity.

Applicants cannot be working above the substantial gainful activity level when they apply for benefits (some applicants keep working with the intent to quit if they qualify for benefits).  A person earning more than the substantial gainful activity level who applies for Social Security disability or SSI benefits will be denied immediately without having their impairments or medical records even considered. However, disabled individuals may be working part-time when they apply for Social Security disability.  This can backfire though because often it can lead Social Security to think you could work a full-time job and therefore perform substantial gainful activity.

To qualify for disability benefits, a disability applicant’s medical records must contain evidence of the physical or mental impairment and exactly how it prevents the applicant from working (“functional limitations”). The evidence must be up to date (for example, the records must include doctors’ notes or lab tests from within 60 to 90 days).

Unless Social Security can tell from your medical records that your medical condition is so severe that it meets the requirements of a Social Security impairment listing (which means automatic approval for benefits), Social Security will assess what type of work you are capable of.

For a physical impairment, Social Security will decide whether an applicant can do medium, light, or sedentary work by looking at the functional limitations in the applicant’s medical. For psychological, psychiatric, or cognitive impairments, Social Security will assess whether the person can understand and remember instructions, maintain attention and concentration, interact appropriately with others, and respond appropriately to changes or hazards in the workplace. After this assessment (called a residual functional capacity, or RFC, assessment), Social Security will decide whether the person can do semi-skilled work, unskilled work, or less than unskilled work.

After that, Social Security will use the RFC assessment to decide whether the disability applicant can perform their past job (full-time). If not, Social Security is required to use a medical-vocational grid, to determine if there are other jobs that the applicant can still do (or be expected to learn to do, if young and has the skill set to do so). If an applicant is older and has limited education or no transferable job skills, the system may not expect the person to learn a new job, and will consider the person disabled.

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