What is the Five Step Sequential Evaluation the Social Security Administration Uses in Every Case All the Time?
The Social Security Administration analyzes your claim using what is called a 5 STEP SEQUENTIAL EVALUATION process which we outline below.
1. Have you engaged in substantial gainful activity?
At Step One, the issue is whether you have worked after the date you said you became disabled. Most Social Security applicants meet test one because they have not worked since their disability began. If you have worked after the date you said you became, disabled, we can determine whether that work may disqualify you from entitlement to benefits.
2. Do you have a severe impairment?
Step 2 is designed to weed out cases that involve no medically determinable impairment or a slight impairment that imposes only minor limitations on the ability to work. Most Social Security applicants meet test two.
3. Does your medical condition meet the criteria in the Listing of Impairments?
At Step 3, the Social Security Administration refers to a Listing of Impairments which has been created for most physical and mental conditions. Each condition has a detailed list of medical signs, findings, symptoms, and functional limitations resulting from those symptoms. If the medical records show that your condition meets or is equal to a condition listed in the Social Security Administration’s Listing of Impairments, you will be found disabled based on the medical evidence alone without consideration of your age, education, or work history. Unfortunately, the Listings are very narrowly defined and thus, most cases do not meet a Listing. At The Law Offices of Nancy L. Cavey, we review the medical records to determine whether they show the necessary criteria to meet a listing and if necessary contact your physician for additional documentation to support your claim. If disability cannot be determined at Step 3, the decision process proceeds to Step 4.
4. Can you return to your past relevant work activity?
At Step 4, the question is whether you can return to the lightest job you actually performed in the last 15 years. Social Security consulting physicians normally review the medical records and render an opinion regarding your capacity to perform work activity. The consultants generally find that the claimant is capable of performing light-duty work activity. In most cases, this results in a denial of the claim. The opinion of your treating physician regarding your functional capacity and his willingness to complete functional capacity forms, are crucial to winning at this stage.
If the Social Security administration determines that you can return to the lightest job you held in the last 15 years your claim will be denied. However, if the Social Security administration determines that you cannot return to your past relevant work you still have not won your case! You must proceed to Step 5.
5. Can you perform other work that exists in the national economy in significant numbers in view of your age, education and transferable skills?
At Step 5, the burden shifts to the Social Security Administration to show that you retain the capacity to perform other work and that such other work exists in significant numbers in the national economy. In making this determination, the Social Security Administration uses Medical-Vocational Rules which are commonly called “grids”. These grids are biased against younger and more educated workers. In other words, the younger and more educated you are the less likely you will be able to prevail under the grid rules. If you do not meet the Grids, the key to winning at step five is to present evidence that demonstrates that the combined effect of your physical and/or mental impairments, chronic pain, and side effects of medication prevent you from performing even sedentary work activity on a regular and continuing basis, that is 8 hours per day, 5 days per week.
The most helpful evidence to establish such limitations is a Residual Functional Capacity Form which has been accurately completed by your treating physician. In completing this form, your physician will be asked to address whether you have exertional limitations on your ability to sit, stand, walk, lift, carry, push, and pull. Your physician will also be asked to address your non-exertional limitations including postural, manipulative, environmental, mental, and sensory impairments. These can include your need to alternate between sitting and standing, your need to elevate your legs, problems with balance, or difficulty bending, stooping or squatting, and difficulty with reaching, grasping, handling, and fingering objects. Non-exertional limitations also include difficulty relating to others, understanding or carrying out simple and structures, ability to maintain attention and concentration, and the ability to cope with stress.
There are over 30 different Residual Functional Capacity Forms which can be used to secure the correct information from your physician. It is important that the right form, that is one most suited to your medical condition, be used for your case. It is also important to understand that a Residual Functional Capacity Form accurately completed by your physician can make the difference between winning and losing your case.
Answering these broad-based questions isn't easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.