Demystifying

The Sequential Evaluation Process When evaluating a claim for Social Security Disability or Supplemental Security Income, the Social Security Administration (SSA) applies a step-by-step process involving five questions, or steps. (20 CFR §§ 404.1520a; 416.920). This is commonly referred to as the “sequential evaluation process: At step one of the sequential evaluation process the SSA inquires whether the individual applying for benefits is working. If the individual is currently working the SSA will examine how much the individual is earning per month. Typically if an individual’s monthly gross (prior to taxes being taken out) income in 2012 is greater than $1,010 he or she will not be considered disabled. There are exceptions to this rule, which will be addressed in another blog post, however, this is the general rule. If the person is not working or earnings are below the $1,010 cut-off, the SSA proceeds to step two. At step two, the SSA will determine if the individual applying for benefits has what is referred to as a “medically determinable impairment” that is severe, or a combination of impairments that are severe. An impairment, either mental or physical, is considered “severe” if it significantly limits an individual’s ability to perform basic work activities. (20 CFR §§ 404.1521; 416.921). Some of the basic work activities considered are physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling. The SSA will also consider mental work activities such as understanding, carrying out, and remembering instructions; the use of judgment; and the ability to respond appropriately to supervision, co-workers and usual work situations. If an impairment, or combination of impairments is “not severe” (i.e. there is no more than a minimal effect on an individual’s ability to work) the SSA will conclude the individual is not disabled. If the individual does have a severe impairment, or combination of impairments which are severe, the SSA proceeds to step three. At step three, the SSA will determine if the individual’s impairment, or combination of impairments, is found to “meet or equal” specific criteria found in the SSA’s Listing of Impairments. The Listing of Impairments outlines conditions which the SSA considers severe enough that they prevent an individual from engaging in gainful activity. Each impairment contained in the Listing of Impairments consists of specific criteria the SSA considers in determining if the impairments “meet or equal” the definition. In order to “meet” the criteria of a specific listing, an individual must have all of the specific requirements of that particular section. If an individual does not have all of the specific requirements of a particular listing, he or she may still “equal” the listing. An impairment can be found to be medically equivalent to a listed impairment even if it does not meet all of the specific criteria, if it “is at least equal in severity and duration to the criteria of any listed impairment.” (20 CFR § 404.1526). This analysis can be very complex and confusing and will be addressed in greater detail in a future blog post. If it is determined that an individual’s impairment or combination of impairments meets or medically equals the criteria of a listing and the impairment has lasted, or can be expected to last at least 12 months, the individual will be found to be disabled. If not, the SSA proceeds to step four. At step four the SSA will assess an individual’s residual functional capacity, or RFC. Please see the previous blog post entitled “Step 4: Determination of Residual Functional Capacity” for an in-depth look at what is considered in determining an individual’s RFC. After determining an individual’s RFC the SSA will determine whether the individual has the ability to engage in work he or she performed in the last 15 years. This is referred to as the individual’s “past relevant work,” or PRW. If the individual has the ability to do his or her PRW, the SSA will conclude the individual is not disabled. If the individual lacks the ability to perform any of his or her PRW, the SSA proceeds to the next step. At the fifth, and final step of the sequential evaluation, the SSA will determine whether an individual has the ability, or RFC, to engage in any work aside from his or her PRW. At this step the SSA will consider factors such as an individual’s RFC, age, education, and work experience. If it is determined an individual has the ability to engage in other work in the national economy, the SSA will generally determine the individual is not disabled. If this determination is made, the SSA must provide evidence that such work exists in significant numbers in the national economy. If it is determined the claimant cannot engage in any other work the SSA will determine he or she is disabled.

Demystifying: Credibility Many disability claimants who receive a written decision from an Administrative Law Judge are surprised to find a paragraph in the decision discussing whether the claimant is “credible.” This part of the decision often seems like a personal attack. This article explains what this “credibility analysis” is, and what judges have to consider in each case. A symptom is something the claimant experiences personally. Pain, anxiety, sadness, tiredness, and even things like rashes or vomiting are all symptoms: they are the outward signs of the sickness the claimant believes makes them disabled. No symptom can prove a claimant is disabled, no matter how genuine the individual’s complaints are, unless there are medical signs and laboratory findings demonstrating “medically determinable physical or mental impairments that could reasonably be expected to produce the symptoms.” 20 C.F.R. §§ 404.1529 and 416.929; Social Security Ruling (SSR) 96-7p. After the SSA decides that medical evidence proves a “medically determinable impairment,” the judge examines the intensity, persistence, and pace of symptoms to determine how the symptoms might limit the claimant’s ability to work. The judge must consider “all the available evidence.” 20 C.F.R. §§ 404.1529(c) and 416.929(c); Social Security Ruling (SSR) 96-7p. There are seven specific credibility factors the judge should consider: (i) Daily activities; (ii) The location, duration, frequency, and intensity of pain or other symptoms; (iii) Precipitating and aggravating factors; (iv) The type, dosage, effectiveness, and side effects of any medication taken; (v) Treatment other than medication for relief of pain or other symptoms; (vi) Any other measures used to relieve pain or other symptoms (e.g., standing for 15 to 20 minutes every hour, sleeping on a board, etc.); and (vii) Other factors. 20 C.F.R. §§ 404.1529(c) and 416.929(c); Social Security Ruling (SSR) 96-7p. The judge will consider all the observations and opinions of doctors, teachers, counselors, nurses, and other sources about the claimant’s attitude, behavior, symptoms, test results, and remarks. The judge also considers the claimant’s testimony at their hearing, and all the written responses the claimant submitted on SSA forms throughout the application process. The credibility analysis is not intended as a personal attack. The purpose is to examine symptoms as they are recorded by third parties and remembered by the claimant, and to determine how the intensity, persistence, and pace of symptoms might limit the claimant’s capacity for work. This analysis is required by SSA regulations, and is part of every decision.  

When evaluating a claim for Social Security Disability, or Supplemental Security Income, the Social Security Administration (SSA) has a specific analysis it follows in every case. If the claimant has a “severe impairment” by SSA’s rules, but the impairment does not meet the requirements of a specific impairment in the Listing of Impairments, the SSA will then assess the claimant’s residual functional capacity, or RFC. The claimant’s RFC is a determination of what work-related activity the claimant can still do despite any limitations caused by their impairments and the symptoms of their impairments, like pain and fatigue. In determining the claimant’s RFC, the SSA will look to several factors such as: • Physical abilities for work-related activities (standing, sitting, walking, lifting/carrying, pushing/pulling); • Manipulative and postural abilities for work-related activities (reaching forward or overhead, handling large objects, use of fingers, feeling, stooping, balancing, climbing stairs or ladders, kneeling, crouching, crawling); • Tolerance of environmental conditions (such as temperature extremes, wetness, humidity, noise, hazardous working conditions like moving machinery or heights, dust, fumes, odors, gases, poor ventilation, vibrations); • Visual, hearing and speech limitations; • Maintaining concentration and attention at work; • Ability to maintain adequate production levels; • Ability to understand, remember, and carry out instructions of varying degrees of complication and detail; • Ability to respond appropriately to contact with supervisors, co-workers and the general public; • Ability to respond appropriately to routine work stressors and to cope with changes in the work place. (Social Security Ruling 96-8p) To assess the claimant’s RFC, Social Security may send the claimant to a consultative exam with a doctor of the SSA’s choosing. The SSA will also look at the medical records submitted as evidence from the claimant’s treating doctors. Based on the evidence obtained in the consultative exam and contained in the medical records, the SSA will make a determination of the claimant’s RFC. Often, conclusions reached by SSA doctors in consultative exams are not favorable to the claimant’s SSDI case. The best way to combat these conclusions is to submit a medical source statement that evaluates the claimant’s RFC, authored by the claimant’s treating doctor. The claimant can argue that the medical source statement is a more accurate reflection of the claimant’s RFC. The medical source statement is based on numerous visits with the claimant over a longer span of time; compared with the short, single exam the doctor authoring the Consultative Exam performed.