The process of applying for Social Security disability benefits through the Social Security Administration (SSA) can be a long, complicated process. Even people with severe impairments may struggle to qualify for benefits, given the requirements set forth by the SSA.
Under the regulations, an applicant must not only prove that they are disabled or have an impairment that limits functioning, but that they are unable to work due to their disability. This may sound relatively straightforward, but the SSA relies on its own set of definitions and standards that can make it difficult to qualify.
For older applicants, there are slightly different rules when it comes to qualifying for disability benefits. While individuals must still go through the basic five-step analysis to demonstrate that they are disabled, because they are less likely to be able to perform a new type of work, it is sometimes easier to be awarded benefits. Read on to learn more from a skilled disability attorney.
The Five-Step Process to Determine Disability
To determine eligibility for disability benefits, the SSA uses a five-step analysis. The following factors are considered as part of this process:
- Are you participating in a substantial gainful activity (SGA?)
- Do you suffer from a severe impairment?
- Is your condition either found in the SSA list of disabling impairments or equal in severity to an impairment on the list?
- Can you do the work that you did previously?
- If not, can you do any other type of work?
Step One – Are You Working?
The first step involves analyzing whether you are working. If you are gainfully employed, you are not eligible for disability benefits.
When Social Security considers this, they look at whether you are performing work at “SGA” levels. This is a monthly income amount set by the SSA. For 2019, the monthly SGA amount is $1,220 (this amount is higher for individuals claiming disability due to blindness). This means that a person can still work and be eligible for disability benefits, provided that they are working part-time and earning less than the current SGA amount.
When looking at this, it’s important to note that this is “gross” income, meaning the amount of your pay before taxes and deductions. This means that, if you are working at a job earning $10.00 an hour, you can’t work more than 28 hours a week. Even if you are under “SGA” amounts, Social Security may still use part-time work as evidence that you could do more if the work was available.
Step Two – Are You Suffering?
If the person meets this qualification, then the SSA will move on to determine if the person suffers from a severe physical or mental condition. To prove this, you must show that you suffer from an impairment that has lasted or is expected to last for a continuous period of at least 12 months or to result in your death. This impairment must have more than a minimal impact on your ability to work.
This is just a screening step though – Social Security is just looking to see if you have a condition that is worth further exploring. A finding that you have a “severe” impairment at Step Two does not mean Social Security will find you have a disabling impairment.
Step Three – Do You Meet Impairment Conditions?
In Step Three, Social Security evaluates whether your impairment meets or equals one of the conditions listed by the SSA. These conditions are those that the SSA has determined that, if you meet the very specific requirements of a listed impairment, you are entitled to benefits as a matter of law, and Social Security does not have to evaluate your work history or determine if you can do other work. Most people don’t meet or equal one of these impairments, and so for most cases, the analysis continues on to the fourth and fifth steps.
If you don’t meet a Listing, Social Security will next determine your residual functional capacity (RFC), which is the most you can do given your impairment or combination of impairments. To evaluate your RFC, SSA will review your medical records, consider your subjective reports, the opinions of your doctors, and determine your physical and mental functional capacity.
Step Four – Are Your Limits Preventing You From Working?
From there, at Step Four SSA will decide whether these limitations prevent you from performing your past relevant work, which includes any work that you have done in the past 15 years at SGA levels, or long enough to learn the job.
Step Five – Are You Able to Do Other Work?
If Social Security finds that you can’t do your past relevant work, the burden shifts to SSA only at this fifth and final step to determine whether you are capable of doing any other type of work that exists in substantial numbers in the national economy. SSA will look at your age, education, past work experience, as well as your transferable job skills. If you cannot do any other kind of substantial work then your disability benefits claim will be approved.
How the Disability Process May Change After Age 50
If you are 50 or older, the consideration of whether you can do other work at Step Five will change. Specifically, during the last step of the process, where SSA looks to see if an applicant can perform another type of work, a different set of guidelines may apply. These are known as the Medical-Vocational Guidelines or GRID rules. They are referred to as “Grid” rules because they are laid out in a grid format, as can be seen here.
For example, under the GRID rules, if you are between 50 to 54, Social Security determines you can still perform sedentary (desk work), and if you are unable to perform your past work you may be found disabled. You also need to show that you do not have skills from your past work that would transfer to sedentary jobs that are semi-skilled or skilled (meaning jobs requiring some training).
In other words, even though Social Security believes you could still perform sedentary work, you will receive disability benefits because the regulations were written to acknowledge that it is harder for individuals over 50 to adjust to new work environments if they also face significant medical impairments. If you previously performed sedentary work and you can still perform this work, then you will not be found disabled under this rule, and would still have to show you cannot do that work.
Likewise, if you are between 55 to 59, you may be found disabled even if Social Security assigns an RFC limited to the light level (which generally means that you are capable of lifting 20 pounds occasionally, 10 pounds frequently, and standing and walking 6 hours out of an 8-hour day). Once again, this means that your past work is more strenuous than light work and you don’t have skills that would readily transfer to this kind of work. Additionally, once you’re over 55, if you are limited to sedentary work, you must be able to adjust directly to “skilled” work to be found not disabled.
These guidelines are advantageous to older applicants. Typically, if an applicant is able to do sedentary work, they will not be awarded disability benefits. In contrast, applicants aged 50 and older may be deemed disabled even if SSA believes they can perform sedentary or light work.
The GRID rules are complicated and contain many exceptions. An experienced disability benefits lawyer can advise you as to whether they will apply in your case.
What Is a Continuing Disability Review?
After you qualify for Social Security disability benefits, you are not guaranteed to receive them for the rest of your life. The Social Security Administration (SSA) performs periodic evaluations to assess whether you are still unable to work due to a disability. These are known as continuing disability reviews or CDRs.
Federal law requires the SSA to perform a medical continuing disability review at least once every 3 years. However, if you have a medical condition that is not expected to improve, then the SSA will review your case every 5 to 7 years. For children, the SSA may perform a CDR at least once every 3 years if they expect the child’s condition to improve. Judges can also set different timelines for review when awarding a case after an appeal, requesting that the SSA re-review a case in as little as twelve months after an award.
During a CDR, the SSA will review information about your disability. If your condition is not expected to improve, then the SSA will send you a document known as the Disability Update Report when your claim is being reviewed. This is a short 2-page report that you are required to complete and return to the SSA.
If you don’t fall into this category, you will be sent the more detailed “Continuing Disability Review Report,” which is 10 pages long. In this report, the SSA will request a range of information about your disability, such as:
- Whether you have seen a doctor or been hospitalized in the past year;
- If you have had any recent tests;
- If you have been working;
- Any new or updated medical evidence over the past 12 months.
The CDR will typically cover the previous year, although the SSA can go back to the point when you were initially granted benefits. If you are receiving SSI benefits, then the SSA will also ask questions about your income, living arrangements, and assets.
How Do Continuing Disability Reviews Change After Ages 50, 55, and 60?
As discussed above, the SSA acknowledges that older Americans may be less able to perform different jobs as they get older. They also recognize that as you get older, you may be more affected by a disability. For this reason, the frequency of CDRs will change as you get older.
When you turn 50, the SSA will reschedule CDRs to occur every 5 to 7 years – even if you would previously have to undergo a CDR every 3 years because your medical condition is expected to improve. Similarly, when you are 55 or older or 60 or older, you will only undergo a CDR every 5 to 7 years.
When it comes to Social Security disability benefits, being older often makes it easier to be approved for benefits. It can also make it easier to keep your benefits because your CDRs will be less frequent. If you have questions about a CDR or how your age will affect eligibility for benefits, reach out to our law firm to schedule a free claim review with a seasoned New Jersey disability benefits lawyer.
Work with Our Disability Attorneys
If you are considering filing for disability benefits, you may be overwhelmed by the complexity of the process, particularly when you are already dealing with a medical or mental health issue. The regulations surrounding the Social Security disability benefits system can be confusing. A social security disability attorney can help to increase the likelihood of a favorable outcome.
At Bross & Frankel, we have dedicated our practice to helping individuals in New Jersey and Pennsylvania obtain disability benefits. We offer free claim reviews, where we help you understand your rights and options for moving forward with an application. To learn more about how we can help you or to schedule a no-cost, no-obligation consultation, call our office today at (866) 708-3985, or contact us online.
Learn more about How Long Will a Continuing Disability Review Take?
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Rich Frankel is the managing partner of Bross & Frankel. He is a member of the New Jersey and Pennsylvania bars. He has focused exclusively on disability and social security benefits since 2005.
Mr. Frankel joined what is now Bross & Frankel after having watched his father struggle with disability, fighting a lengthy illness. Mr. Frankel founded the firm’s veteran’s law practice and substantially grew the social security disability practice, focusing Bross & Frankel’s ability to fight for all of the disability benefits available to his clients.
Mr. Frankel additionally fights for clients in court, obtaining frequent victories in Social Security appeals and against insurance companies in Federal court.