What Does it Mean to be 'Disabled' Under Social Security’s Rules in order to Qualify Medically for Benefits?

In order to qualify medically for a Social Security disability benefits, whether it is Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), one needs to prove that they are suffering from a severe medical impairment that, despite prescribed treatment, has caused them to remain (or is likely to cause them to remain) totally disabled from all forms of gainful employment for which they are reasonably suited by age, education and experience for a year or longer or is likely to result in death. As a Social Security lawyer practicing for 35 years, I can tell you that the definition of what constitutes entitlement to “disability” under the Social Security rules and regulations is complex and difficult at times even for the experienced attorney.

The Social Security Act further defines what constitutes a “disability” under the SSI and SSDI program by providing under the statute as follows:

An individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives or whether a specific job vacancy exists for him, or whether he would be hired or if he applied for work.

This definition dispels a lot of misconceptions that are widely held by individuals as to what the Social Security disability program requires one to prove in order to meet the definition of “disabled.” For example, the inability to perform the duties of one’s last job does not mean Social Security will necessarily find them disabled from doing other jobs that exist in significant numbers in the national economy (and, thus, “not” disabled under Social Security’s rules). Moreover, whether such other jobs exist locally or whether one has the ability to get to the job in terms of either having a vehicle or public transportation available to them is not relevant to Social Security’s determination of disability (but rather whether one is medically capable of either driving to a job or taking public transportation).

In addition to the statute, there are compendious regulations that detail the step by step analysis that is undertaken by the Social Security Administration (SSA) in determining whether an individual is “disabled” under the Social Security Act. The Social Security Administration will undertake a 5 step sequential evaluation process as part of determining whether one remains “disabled” under the Social Security Act and rules and regulations. One, they will ensure you are not presently earning substantial gainful activity, which is presently defined as $1310.00 per month (in 2021) on a regular and continuing basis. Two, SSA will look to see if you are suffering from a severe medically determinable impairment that has lasted or will last for a period of twelve (12) consecutive months, or will result in death. Three, SSA will look to see if the medical impairment meets or equals in severity one of the listed impairments set forth in the Social Security regulations and referred to as the Listing of Impairments. Four, assuming the condition does not meet the criteria for one of the listed impairments, SSA will look to see if the condition keeps you from working one of the jobs you’ve performed within the fifteen (15) years prior to becoming disabled (that is, whether you can perform what is called your “past relevant work.” Five, SSA will look to see if you’re able to perform work other types of work that exist in significant numbers in the national or regional economy.

It is important to note that should SSA need to proceed to step 5 of the sequential evaluation process, and the disability claimant has reached the age of 50, they will look to apply the Medical-Vocational Guideline rules, or what are called the Grid rules. In doing so, they will look to the Grid rules for guidance in determining the extent to which one’s age, education, past work experience and skills obtained, in conjunction with one’s functional limitations (both physical and mental resulting from any of the severe medically determinable impairments) impact one’s ability to transfer to other types of less exertional work.

The Social Security regulations and rules are complex and extensive. They are difficult to understand and apply to an individual case unless you’ve spent years immersed in handling such claims. If you are looking to see if you would qualify as “disabled” under Social Security’s rules and regulations, contact a Social Security lawyer who has been handling such claims throughout Maine, Massachusetts and New Hampshire for more than 35 years.