Author: Attorney Desk Reference Manual
Last updated: December 2009

Overview
Durational Requirement
Five-Step Sequential Evaluation Process

Overview

SSA uses a five step sequential evaluation process to determine whether a claimant meets the definition of disability.  20 CFR §416.920, 20 CFR §404.1520.

Note: The elements of the sequential evaluation are briefly described here, since most cases require extensive interviewing and investigation in order for us to determine whether we could accept the case. If the case involves an appeal, be sure to ask a caller what stage the appeal is at, and the date, time and place of any scheduled hearing.  Take appropriate action to alert the local office if a hearing is already scheduled. 

References:

Supplemental Security Income: SSI 
Social Security Disability and Retirement: RSDI

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Durational Requirement 

There is a durational requirement that must be met in addition to the sequential evaluation.  To meet the durational requirement, the claimant must have an impairment that has lasted 12 months or will result in death.  20 CFR §416.905.

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Five-Step Sequential Evaluation

Step One:  Is the claimant engaged in substantial gainful activity?

• Substantial gainful activity is work activity that involves doing significant physical or mental activities for pay or profit. 20 CFR §404.1572(b), 20 CFR §416.971.
• SSA presumes that activity is substantial gainful activity if the earnings are more than $1000/month (2010 value). 20 CFR §416.974(b) (3).

Step Two:  Does the claimant have a severe impairment?

This is a de minimis standard. Impairments are considered "not severe" only if the impairment(s) causes a slight abnormality having a minimal effect on the claimant’s ability to perform basic work activities. 

Step Three:  Does the impairment meet or equal one of the SSA’s impairment listings?

The Social Security regulations set out listings of impairments in 20 CFR pt 404.1599, Appendix 1.  There are listings for 14 different categories of impairments.  There are separate listings for adults and for children.

Each listing sets out findings, signs and symptoms for certain impairments.  If the claimant’s condition meets the criteria for one or more of the listings, the claimant meets the medical criteria necessary to establish disability. 

Step Four:  Does the claimant have the capacity to return to his or her past work?

The client has the burden of proof at this step. This step requires two separate inquiries:

First, the claimant’s residual functional capacity must be defined.  The Residual Functional Capacity (RFC) describes what the claimant can do despite his or her impairments.  The RFC is based on an assessment of basic work functions including exertional requirements, such as lifting and carrying, standing, walking, sitting, reaching, and on exertional requirements, including vision, hearing, environmental restrictions, concentration, and ability to understand and follow instructions, accept supervision, work with co-workers, etc.  If the claimant has a mental impairment, SSA must make an assessment of any physical residual functional capacity and, using a specially designed format, of mental residual functional capacity.

The claimant’s RFC must be based on what the claimant can do on a regular and sustained basis, not what s/he can do on an isolated occasion.

Second, the claimant’s RFC is compared to the functional requirements of the claimant’s past relevant work.  This is work within the 15 years prior to the date of adjudication.  It does not include work that occurred only for very brief periods or on a sporadic basis.  The SSA evaluates the functional requirements of work both on the basis of the way the claimant performed it and as the work is generally performed.  

Step Five:  Does the claimant, given his RFC and age, education, and work experience, have the ability to perform any other work in the national economy?

SSA has the burden of proof at this step. SSA has adopted Medical Vocational Guidelines set out in the regulations at 20 CFR Pt. 404.1599, Appendix 2.  These guidelines are commonly called the grid, since they consist of three tables set out in a grid fashion.  There is a table for medium, light and sedentary work.  Each table evaluates work capacity based on age, education and work experience.  Each rule of the grid tables directs a finding of disability or non-disability for claimants who meet the exact criteria of the rule.  If the claimant does not meet the exact criteria, a vocational expert may be necessary.  To the extent that the claimant’s RFC and educational/vocational profile does not match the criteria of a medical vocational guideline, the grids are nonetheless used as a "framework" for determining whether the individual is disabled at step 5. 

For claimants with non-exertional impairments (e.g.. some pain conditions, asthma, seizures, mental impairments) the grids should not be used.  If the conditions impose limitations, a vocational expert should be used.

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