§ 181. Disability Benefits - Disability Determination - Procedure Employed

While the overall administration of the Social Security program lies with the Social Security Administration, disability determinations are made by state agencies. Those agencies operate under agreements with the federal agency and are subject to federal law. Moreover, their determinations are ultimately subject to appeal to federal administrative law judges and the federal courts.

The regulations prescribe a sequential evaluation process to be followed in determining whether an individual meets the Act's disability test. A conclusion at any step that the individual is disabled or not disabled ends the evaluation; subsequent steps do not apply. In order, the steps of that process are as follows:
  1. Substantial gainful activity – If the claimant is, in fact, continuing to work and that work is found to be substantial gainful activity the process calls for a finding that he or she is not disabled.
  2. Severity – A conclusion that the claimant's medical impairments do not significantly limit the ability to perform basic work activities calls for a finding that he or she is not disabled.
  3. Listed Impairments – The regulations provide a catalog of impairments that are deemed severe enough to warrant a finding that the claimant is disabled. If the claimant suffers from a listed impairment or its medical equivalent, he or she is to be found disabled.
  4. Relevant past work – If a claimant's impairments do not prevent performance of relevant work he or she has done in the past, a finding of not disabled is called for.
  5. If the claimant cannot perform his or her past relevant work, the issue becomes whether or not the individual has the capacity to perform other work available in the national economy. Here, in appropriate cases, the Agency makes use of the Medical-Vocational Guidelines (also known as the grid).

When there is insufficient evidence for a finding about the claimant's past relevant work, the regulations allow the Agency's adjudicator to go directly from Step 3 to Step 5, skipping over Step 4.

Agency procedures provide a fast track for some one hundred conditions and diseases that meet the disability standard and from which an individual is not likely to recover. The grounds for such "Compassionate Allowance" treatment include certain severe heart diseases and cancers, adult brain disorders, and a number of conditions specific to children.

Rev. 9/12

  • Related Sections:
    • Part 1
      § 170. Disability Benefits - In General
      § 172. Disability Benefits - Amount
      § 173. Disability Benefits - Relationship to Prior or Subsequent Benefits Received by Worker
      § 174. Disability Benefits - Benefits for Others That Are Linked To
      § 180. Disability Benefits - Disability Determination - In General
      § 182. Disability Benefits - Disability Determination - End of Disability
      § 190. How Disability Affects Non-Disability Benefits
    • Part 2
      § N 600. Claim Resting on Initial Finding of Disability
      § N 700. Claim Focusing on When Person Became Disabled
      § N 800. Issues of Terminating Disability Benefits - In General
      § P 000. Overall Treatment of Burden of Proof and Evidence
      § P 100. Duration of Disability
      § P 200. Claimant Engaged in Substantial Gainful Activity - In General
      § P 300. Threshold Test of Severity
      § P 400. Listed Impairment or Equivalent
      § P 500. Claimant's Ability to Perform Past Relevant Work
      § P 600. Application of Medical/Vocational Guidelines (Grid) - In General
      § P 620. Claimant's Residual Functional Capacity
      § P 710. Mental Impairment, Psychological Problems
      § P 720. Mental Retardation, Limited I.Q.
      § P 730. Impaired Vision, Blindness
      § P 740. Pain or Other Subjective Complaints
      § P 750. Alcoholism or Drug Addiction
      § P 760. Multiple or Combined Impairments
      § P 800. Issues of Medical Evidence - In General
      § P 900. Establishing the Availability of Work Claimant Can Perform - In General
      § Q 700. Effect of Claimant's Being Confined to an Institution