CHAPTER 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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