Proving Disability: What Proof Do I Need for Disability under Social Security?

 

Understand the Signs that You May Qualify for Disability Benefits under the Social Security Act

 

Social Security uses a five-step sequential disability evaluation process to determine if you are eligible for disability benefits. This process applies to claims for Social Security Disability Insurance (SSDI) benefits, Supplemental Security Income (SSI) benefits, or both.

 

The person applying for disability must submit both non-medical and medical evidence to the Social Security Administration (SSA) that proves qualification for SSDI or SSI benefits. If you fail to provide proof, then you have a low chance of getting approved.

 

The purpose of this article is to give you an overview of Social Security’s Five-Step Evaluation Process for Disability Claims. And explain what medical evidence you should submit to provide yourself with the best chance of receiving a Fully Favorable Decision from the SSA. These tips will help you at every stage of the Social Security Disability process – from filing an initial application for benefits to talking with a claim examiner with Disability Determination Services (DDS) to submitting a request for reconsideration to presenting your case before an administrative law judge at a disability hearing.

 

If you want to discuss your case with a top-rated Virginia disability attorney, call me: (804) 251-1620 or (757) 810-5614. I handle claims in Richmond, Roanoke, Charlottesville, Newport News, Fredericksburg, Norfolk, and Virginia Beach.

 

Contents hide
1 Proving Disability: What Proof Do I Need for Disability under Social Security?
1.1 Understand the Signs that You May Qualify for Disability Benefits under the Social Security Act
2 Overview of the Five-Step Evaluation Process for Disability Claims
2.1 Step One: Are You Working? The Substantial Gainful Activity Evaluation
2.2 Step Two: Do You Have at Least One Medical Condition (Physical or Mental) that is Severe?
2.3 Step Three: Does Your Medical Impairment Meet or Equal a Listed Impairment?
2.4 Step Four: Are You Able to Do Your Past Relevant Work?
2.5 Step Five: Can You Do Any Other Work That Exists in the National Economy?
3 What Evidence is Needed to Prove You are Disabled under the SSDI and SSI Programs?
3.1 What is Medical Evidence Needed to Prove You are Disabled?
3.1.1 Who is an Acceptable Medical Source under the Social Security Act?
3.1.2 What Medical Evidence Should You Get from Your Treating Doctors?
3.2 What Non-Medical Evidence is Needed to Prove You are Disabled?
4 Call a Top-Rated Disability Attorney to Navigate the SSA’s Five-Step Sequential Evaluation Process

Overview of the Five-Step Evaluation Process for Disability Claims

 

Code of Federal Regulations Section 404.1520 sets forth the series of five steps that the SSA follows, in order, to decide if you are disabled under the SSDI and SSI programs.

 

Now we will take a closer look at each of these five steps.

 

Step One: Are You Working? The Substantial Gainful Activity Evaluation

 

You cannot receive Social Security Disability benefits if you are working and earning more than the Substantial Gainful Activity (SGA) amount. No matter what medical condition(s) you suffer from and how much it affects you.

 

As I write this in 2020, any employment paying you more than $1,260.00 per month, after allowable deductions for work-related and medical expenses, is considered Substantial Gainful Activity.

 

Even part-time work is SGA if you earn more than the SGA amount set forth by Social Security. It does not matter if you perform less work, get paid less money, or have a less physical job. The SSA will deny your claim for SSDI or SSI benefits if you earn more than the SGA amount. The SSA pays no attention to how your disability has changed your earning ability if you are making more than SGA. This inability to recover “partial” disability is a significant difference between Social Security Disability and workers compensation laws. In certain situations workers comp pays temporary partial disability benefits if you are earning less money because of your on-the-job injury or occupational disease.

 

If you are working and earning above the SGA amount, then the SSA will deny your claim, and you will not move on to Step Two of the Sequential Evaluation Process.

 

Step Two: Do You Have at Least One Medical Condition (Physical or Mental) that is Severe?

 

Having a diagnosed medical condition is not enough to prove you are disabled. Your medical impairment, or combination of medical impairments, must be severe. And it must be expected to last at least twelve consecutive months. An acute injury, such as a bone fracture or concussion, does not meet the duration requirement under Social Security’s Disability Evaluation Process unless it keeps you from working for at least one year.

 

Under Social Security’s rules, a single medical impairment is severe if it:

 

  • Interferes with your ability to do your past jobs and
  • Interferes with your ability to perform other jobs that may exist in the national economy, considering your age, education, and prior work experience (also called vocational expertise).

 

An example of a non-severe impairment is hypertension (high blood pressure) that is controlled by medication. If you have no symptoms because the medicine is working, then the SSA will find that your hypertension is not severe.

 

Another typical example is depression or anxiety. If you take medication that limits your symptoms to the point you can function at work, then the SSA will find that your mental health condition is not severe. A severe impairment is one that affects your ability to perform basic work-related tasks such as concentrating, focusing, and following instructions.

 

Even if considered non-severe on their own, unrelated physical and mental impairments may be severe in combination.

 

In my opinion, it is easy to meet Step Two of the Five-Step Evaluation process. If your medical records and reports state a diagnosis and indicate that you require long-term treatment, then the SSA will likely find that you have a severe medical impairment and move to Step Three.

 

Step Three: Does Your Medical Impairment Meet or Equal a Listed Impairment?

 

The Social Security Administration has created a Listing of Impairments. This document, often called “The Listings,” breaks your body and mind into 14 categories:

 

  • Musculoskeletal System
  • Special Senses and Speech
  • Respiratory Disorders
  • Cardiovascular System
  • Digestive System
  • Genitourinary Disorders
  • Hematological Disorders
  • Skin Disorders
  • Endocrine Disorders
  • Congenital Disorders
  • Neurological Disorders
  • Mental Disorders
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders

 

Within each category are different medical conditions. The specific listing, or listings, under which your claim will be evaluated depends on the severe medical impairments you have.

 

You meet a listing for a given impairment if you have been diagnosed as suffering from the impairment and meet the listed criteria. Your age, education, and vocational experience do not matter.

 

It is not possible for the Listing of Impairments to cover every possible mental or physical impairment. Because of this, the law will find you disabled if you suffer from a condition that is the medical equivalent of a listed impairment. You “equal” a listing if:

 

  • Your medical impairment is not recorded, but is as severe as a listed impairment; or

 

  • You do not match the exact criteria for a listed impairment. Still, your medical findings show the same thing as the criteria. For example, the listing may call for a specific showing on a particular diagnostic test. You may have a similar result from a different diagnostic test. The SSA may find this sufficient to determine that you are disabled; or,

 

  • You have a combination of impairments that do not meet a listing on their own but, in conjunction, satisfy one of the listings. For example, you may have back problems and depression that render you disabled under a listing.  

 

If your medical condition is not found on the list and does not “equal” a listing, the SSA will proceed to Step Four of the Disability Evaluation Process.

 

Many of my clients who receive SSDI or SSI benefits do not meet a listing but are found disabled at Step Four or Step Five of the Five-Step Sequential Evaluation Process.

 

Step Four: Are You Able to Do Your Past Relevant Work?

 

To satisfy Step Four, you must prove that you are unable to perform your past relevant work.

 

Under Social Security’s rules, past relevant work is any work that was substantial and gainful considering the amount of money you earned in the job, the length of time you performed the role, and how recently you completed it.

 

The general rule is that any work you performed within fifteen years of your alleged onset date of disability is past relevant work. Though if you did not work in a particular job long enough to acquire the specific job skills, the SSA may exclude that job.

 

The SSA will then compare your Residual Functional Capacity (RFC) with your past relevant work requirements to determine if you are still able to perform any of that work. Your RFC is the most you can do physically and mentally in a work setting, taking into consideration all your impairments, symptoms, and limitations. It addresses much you can sit, stand, walk, lift, carry, push, pull, handle, grasp, reach, concentrate, and maintain time, attendance, and concentration.

 

If the SSA finds you can do any of your past relevant work with the RFC it gave you, it will deny your claim. If it finds that you are not capable of doing any of your previous work, then it will move your application to Step Five of the Disability Evaluation Process.

 

Step Five: Can You Do Any Other Work That Exists in the National Economy?

 

At Step Five, the SSA must consider if you can do any other jobs that exist in significant numbers in the national economy. It decides based on your RFC, age, education, and acquired job skills. To deny your claim, the SSA only needs to find a job that exists somewhere in the country. It does not have to find a specific job to refuse your request. Nor does it have to find a job that paid close to what you made.

 

Step Five is where the Medical-Vocational Guidelines, also called the Disability Grid Rules, are used. The general rule is that the older you are and the less education you have, the higher the likelihood that you will be found disabled. Special disability rules apply if you are age 50 or older.

 

What Evidence is Needed to Prove You are Disabled under the SSDI and SSI Programs?

 

Now that you know what you must prove to receive disability benefits let us discuss what evidence to use

 

What is Medical Evidence Needed to Prove You are Disabled?

 

Many disability claims are determined based on medical evidence from your doctors. Failing to submit enough medical evidence from acceptable medical sources is one of the most common reasons claims for SSDI and SSI benefits are denied.

 

Who is an Acceptable Medical Source under the Social Security Act?

 

To prove you are disabled, you must submit objective medical evidence from an acceptable medical source.

 

The following health care providers are considered acceptable medical sources under Social Security’s regulations:

 

  • Licensed physicians (medical or osteopathic doctors such as internists, orthopedic surgeons, psychiatrists, physical medicine and rehabilitation doctors, neurologists, rheumatologists, pain management doctors, and neuropsychologists).

 

  • Licensed or certified psychologists

 

 

  • Licensed optometrists if you are seeking disability for blindness or vision loss

 

  • Licensed podiatrists if you are seeking disability for impairment of the foot or ankle

 

  • Qualified speech-language pathologists if you are seeking disability for a speech or language impairment

 

  • Licensed physician assistants for medical impairments within their licensed scope of practice only

 

  • Licensed audiologists for impairments involving balance disorders, hearing loss, and auditory processing disorders

 

  • Licensed Advanced Practice Registered Nurses (APRN) for impairments within their licensed scope of practice. This includes Certified Nurse Midwives (CNMs), Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), and Clinical Nurse Specialists (CNSs).

 

If you treat with a chiropractor or physical therapist, and no one else, you will have a difficult time proving you are disabled under Social Security’s rules. You can overcome this difficulty by asking the SSA to send you for a consultative examination if you do not have private health insurance or Medicaid and cannot afford additional medical treatment.

 

What Medical Evidence Should You Get from Your Treating Doctors?

 

Your treating medical providers are in the best position to give a detailed view of how your medical impairments affect your ability to work and do activities of daily living. This is because they have examined and treated you over a more extended period, particularly compared to doctors who treat you during brief hospitalizations or see you during a one-time consultative examination.

 

The SSA wants you to submit all available medical records related to any medical impairment you think contributes to your disability. Under Social Security’s regulations, you cannot choose what information you submit to support your claim. You have to provide all medical records and reports – even the ones that are not helpful.

 

I recommend requesting copies of your medical records from one year before you allege you became disabled through the date you are making the request. You can use my HITECH Act letter to reduce the costs of getting these records.

 

Make sure the medical records include:

 

  • Your medical history

 

  • All clinical findings

 

 

  • Your doctor’s diagnosis of your medical condition

 

  • Your doctor’s prescribed treatment

 

  • Whether you need to use an assistive device such as a cane or wheelchair

 

  • Operative Reports if you have undergone surgery such as a lumbar discectomy, spinal fusion, or joint replacement

 

 

 

 

 

In addition to your medical records, I recommend that you ask each of your treating doctors and medical providers to complete a treating source statement. A treating source statement provides your doctor’s opinion about what you can do despite your medical impairments. Depending on the medical impairments you have, the treating source statement should describe your ability to perform activities such as sitting, walking, standing, lifting, carrying, handling objects, speaking, traveling, handling stress, and socializing and interacting with coworkers, supervisors, and the general public.

 

If your doctor’s treating source statement is helpful, your attorney will argue that it should be used to determine your Residual Functional Capacity.

 

What Non-Medical Evidence is Needed to Prove You are Disabled?

 

In addition to medical records and reports, I recommend submitting the following types of documents to the SSA to prove disability:

 

 

 

 

 

  • A copy of your employer’s documents stating it is unable to accommodate your disability if you were fired because of your medical condition.

 

 

 

  • A journal that describes your symptoms (pain, numbness, tingling, etc) and how your medical condition affected your ability to do daily activities.

 

  • Written statements from friends, family members, clergy, and former coworkers who have observed your disability and how it affects your ability to function.

 

  • School records if you are alleging an intellectual disability.

 

Call a Top-Rated Disability Attorney to Navigate the SSA’s Five-Step Sequential Evaluation Process 

 

If you are unable to work because of your health and want help winning your Social Security Disability claim, email me at cpollardjba@gmail.com or call me at (804) 251-1620 or (757) 810-5614 today. I have helped hundreds of people who were in your situation prove disability under Social Security’s Five-Step Evaluation Process, and I am ready to help you. 

Corey Pollard
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