How Your Social Security Disability is Determined

If you suffer from a medical condition that prevents you from working, you should take action immediately to obtain disability benefits through the Social Security Administration (SSA).

The first step that you must take is to file an application with the Social Security Administration.  Generally, you can do this on Social Security’s website, by calling your local office, or by going to the local office in person.

A lawyer from Harrison, White, Smith & Coggins, P.C., can answer any questions that you may have about your application and represent you on appeal if your claim is denied. You can contact us to set up a free consultation about your case.

The SSA will consider you to be “disabled” if your condition prevents you from being able to engage in any “substantial gainful activity” due to a medically determinable physical or mental impairment that:

  • Is expected to result in death, or
  • Has lasted or will last for a period of at least 12 continuous months.

When our firm meets with you, we will discuss the following five-step process that the Social Security Administration will go through in determining whether your condition meets this strict definition of “disability.”

Step #1 – Are You Engaging in “Substantial Gainful Activity?”

You are considered “disabled” if you can’t engage in substantial gainful activity (SGA).  This means that you must be unable to perform a “substantial” amount of work activity.

The Social Security rules state that you are allowed to make a small amount of money and still apply for benefits. (For 2013, that amount is $1,040 a month). However, the truth is that any amount of earnings or work activity can hurt your claim for benefits.

Working with health problems is a personal decision. No one should be discouraged from working. However, ongoing work activity is inconsistent with a Social Security Disability claim. If you are able to perform any sort of continuous work activity, then a judge is unlikely to approve your disability claim.

The SGA determination is made by the local Social Security field office that received your application for benefits. Those field offices are located in and around upstate South Carolina (Anderson, Greenville and Spartanburg).

The next steps in the process involve Disability Determination Services (DDS) of the South Carolina Vocational Rehabilitation Department, which features an office in Greenville.

Step #2 – Is Your Condition “Severe?”

A two-person “adjudicative team” consisting of a DDS claims examiner and medical consultant will review your case and determine if your condition is so “severe” that it interferes with your ability to perform your basic work-related activities. Obviously, this will vary from job to job.

For instance, if you suffer from back pain that prevents you from lifting heavy objects, the condition may be “severe” if you are warehouse worker who engages in that type of activity. However, it may not be “severe” if your job involves typing at a desk.

Step #3 – Is Your Condition among the SSA’s List of Disabling Conditions?

The SSA maintains a list of medical conditions for each major body system that are considered so severe that they would prevent a person over age 18 from engaging in any gainful activity. These “Blue Book” listings include:

  • Musculoskeletal system impairments
  • Sensory impairments (including speech)
  • Respiratory system impairments
  • Cardiovascular system impairments
  • Digestive system impairments
  • Genitourinary impairments
  • Hematological disorders
  • Skin disorders
  • Endocrine disorders.

If your condition is not listed in the Blue Book, then the DDS examiner and consultant will determine whether your condition is “equal” in severity to a listed condition.

Step #4 – Can You Do the Work that You Did Before?

If your condition is listed in the Blue Book or equal to a listing, then DDS will determine that you are eligible to receive benefits.

However, if your condition is not listed in the Blue Book or equal to a listed condition, then DDS will examine whether your condition prevents you from doing the work you previously did.

To make this determination, DDS will need to know what your previous job activities involved. For instance, did it require standing for long hours, bending over, reaching, lifting or climbing?

If your condition would allow you to continue those activities, then you won’t be considered to be disabled. However, if not, the DDS adjudicative team will go to the final step.

Step #5 – Can You Do Any Other Type of Work?

When your condition prevents you from doing your previous job, DDS will look at factors that include your work experience and skills you have developed and will use this information to determine if you are able to work at another job.

If DDS determines that you are unable to do any other work, you will be deemed to be “disabled” and eligible to receive benefits if all other requirements are met.

The DDS team will forward its medical decision to the SSA field office, which will in turn notify you of its decision on your claim.

If your claim is denied, you can submit a written request for reconsideration within 60 days of the denial date (plus five days for mailing). A different DDS adjudicative team will review your case. You also will be able to present new evidence.

Talk to a Lawyer about Your Disability Determination

The SSD lawyers of Harrison, White, Smith & Coggins, P.C., can help you to compile the medical records and work records that you will need to help DDS determine if you meet the SSA’s definition of “disability.”

Our firm has represented many clients whose claims were denied for medical reasons, and we have been able to show DDS that an error was made in its initial determination.

We want to help you, too. Simply contact us today to get started on your case.

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