Disability Determination

When you apply for Supplemental Security Income (SSI), the Social Security Administration (SSA) will look at everything you submit with your application and follow a five-step process to figure out whether you meet their criteria for disability.

Steps 1, 4, and 5 of the Social Security disability determination process look at your ability to work, while steps 2 and 3 look at your medical condition.

If Social Security says you have a disability, you may qualify for SSI if your resources and income are below SSI’s limits.

Note: This article presents the rules for adults ages 18 – 64. Seniors may qualify for benefits without having a disability. Learn about the rules for children under 18 in DB101’s Benefits for Young People article.

Social Security Does Not Follow These Steps If You Are Blind

Social Security uses special rules to decide if someone is blind.

Usually, if your vision in your better eye cannot be corrected to better than 20/200 or your field of view is 20 degrees or less, you’ll be considered blind.

Learn more about Social Security’s rules on blindness.

Step 1: Are You Working at a Level of Substantial Gainful Activity?

If you are working and your monthly earnings before taxes are deducted are higher than the Substantial Gainful Activity (SGA) level, you will not have a disability according to Social Security and you will not qualify for SSI benefits. In 2019, SGA is $1,220.

If you are not working or if your earnings are less than the SGA level, Social Security will move on to the next step to decide if you have a disability.

Example

Mimi earns $22.00 per hour and works 60 hours per month. Her gross monthly earnings are $1,320 ($22.00 x 60), though after taxes are deducted, her actual paycheck is only $1,120.

Even though Mimi only gets $1,120 per month in checks, Social Security counts all of her $1,320 in gross monthly earnings. Since $1,320 is more than the SGA level ($1,220), Social Security says she does not have a disability.

Note: If you are self-employed, your income is calculated differently when it is compared to SGA.

Learn about self-employment and SGA in DB101’s SSDI article.

Some SSI deductions may lower your countable gross income below the SGA level

If you have a job, but your disability limits how much you can earn, you can still apply for SSI benefits. If your income is over the SGA level, there are some rules that might lower how much of your income Social Security counts. These are called deductions. The most common deductions during the disability determination process are Impairment Related Work Expenses (IRWEs) and subsidized earnings.

You have to document these deductions when you apply for SSI. They may help you qualify for SSI when you would not qualify otherwise.

Step 2: Is Your Medical Condition Severe?

For Social Security to say you have a disability, your medical condition must be expected to either:

  • Significantly limit your ability to perform basic work activities for at least 12 consecutive months, or
  • Result in death.

If it does not, you will not be considered disabled and will not qualify for SSI benefits.

If your disability meets this standard, Social Security will move on to the next step to decide if you have a disability.

Step 3: Is Your Medical Condition on Social Security’s List of Impairments?

Social Security’s List of Impairments includes many mental and physical disorders. If your condition is on the list, Social Security will decide that you have a disability and will skip steps 4 and 5.

If your condition is not on the list, Social Security will decide whether your condition is as severe as a condition that is on the list. If it is, Social Security will decide that you have a disability and will skip steps 4 and 5.

If your condition is not as severe, Social Security will move on to the next step to decide if you have a disability.

Step 4: Can You Do the Same Work You Did Before?

If your condition doesn’t stop you from doing the work you did before, Social Security will say you do not have a disability and do not qualify for SSI benefits.

If your medical condition does stop you from doing the same work you did before, Social Security will move on to the final step to decide if you have a disability.

Example

Luigi was a construction worker. He fell off his motorcycle one day and severely injured his knees. Because he has limited mobility and can no longer stand for long periods of time, he can’t do construction anymore.

Luigi cannot do the same work he did before and SSA will continue to look into whether he has a disability.

Step 5: Can You Do Any Other Type of Work?

If you can’t do the work you used to do, Social Security will look at your skills and your condition to see if there is other work you could do.

If your condition doesn’t prevent you from doing other work and earning at the SGA level, you won’t be considered to have a disability and will not qualify for SSI benefits.

Example

While Luigi’s injury prevents him from doing construction on site, he could still manage construction projects from a desk, so Social Security might say he doesn’t have a disability.

If your medical condition does stop you from doing other work and earning at the SGA level, Social Security will say that you have a disability, as long as you have met the other four criteria.

If you have a disability, low resources, and low income, you may qualify for SSI benefits.