Monday, October 28, 2013

socialNsecurity Chap 1


The 5 Step Disability Evaluation Process

Merely citing rules and regulations or policies and procedures without examples will not demonstrate how the system works. We will take a couple of specific case and follow them through from the initial application for benefits to the final decision of the Circuit Court of Appeals. We will closely look at what decisions were made and why.
The President of the United States has given the Commissioner of Social Security (Commissioner) the duty to determine whether a claimant is eligible to receive disability benefits. The Commissioner has directed the Agency’s twelve hundred or so administrative law judges (ALJs) to conduct hearings in accordance with the Administrative Procedures Act (APA) to determine whether the claimants appealing the DDS’ denials are eligible for disability benefits. In a nutshell, a person must be younger than the full retirement age, and have earned enough quarters of insured coverage to acquire special disability insured status. Insured benefits are rightful entitlements. They are based on the taxed earnings of workers. They are not welfare. Supplemental Security Income (SSI) is welfare. It is paid to needy elderly, disabled, and blind claimants. A disabled claimant whose insured benefit amount is low may be eligible to receive additional payments under the SSI program.
The Commissioner has established a five step sequential evaluation process for determining whether a person is disabled.

1.       First, it is determined whether the person is engaging in substantial gainful employment (SGA). Is he working? If so disability benefits are denied.

2.       Second, if the person is not so engaged, it is determined whether the person has a medically severe impairment or combination of impairments. If the person does not have a medically determinable impairment or combination of impairments, benefits are denied.

3.       Third, if the person has a severe impairment, it is determined whether the impairment meets or equals one of a number of "listed impairments". If the impairment meets or equals a "Listed Impairment", the person is conclusively presumed to be disabled.

4.       Fourth, if the impairment does not meet or equal a "Listed Impairment", it is determined whether the impairment prevents the person from performing past relevant work (PRW). If the person can perform PRW, benefits are denied.

5.       Fifth, if the person cannot perform PRW, the burden of proof shifts to the Commissioner of Social Security to show/prove that the person is able to perform any other kind of work.

The person is entitled to disability benefits only if he is unable to perform other work. (20 CFR Sec. 404.1520; Bowens v. Yuckert, 482 US 137, 140-142 (1987).

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