Friday, December 2, 2011

Social Security Disability: The Five-Step Sequential Evaluation Process in San Francisco

The Social Security Administration (SSA) uses a five-step process to find if you are entitled to Social Security Disability benefits in San Francisco. Five questions are asked, in order. If at any time during the process they find you are not disabled, the evaluation stops – they do not advance to the next question. A person can win their case only at steps 3 or 5 of the process.

1. Are you working? If the answer to this question is yes, the evaluation stops. You are not disabled. If the answer to question 1 is no, they move on.

2. Do you have a severe impairment, expected to last at least 12 months or result in death? If the answer is no, the evaluation stops. You are not disabled. If the answer is yes, the evaluation continues.

3. Do your impairments meet listings that SSA maintains? This is your first chance to win. SSA has a list of fourteen bodily systems along with the medical-legal evidence they need to prove disability. It is difficult, but if you have enough medical evidence, the evaluation process is stopped and you win. If not, they move on to question 4.

Before asking question 4, SSA finds what you are still able to do despite your impairment. This is called your Residual Functional Capacity (RFC). SSA asks you to complete certain forms describing your activities of daily living. They want to know how you spend your day. Can you care for yourself, cook, clean, drive, walk, etc.? They also get this information from medical records and questions the judge asks.

Often, SSA will have their own consultative examiner (CE) review you medical records or examine you, and write a report. This is why it is important to have your own physician complete the RFC questionnaires we provide to you and your doctors. SSA has to give controlling weight to your treating physician over one you saw just for a report.

4. Considering your RFC, are you able to return to your past relevant work (PRW)? Here, a vocational expert (VE) is often asked if you can return to any of your previous jobs in the last 15 years. The VE finds a description of your past work along with the exertional and skill levels it requires in The Dictionary of Occupational Titles (DOT), and gives an opinion. If the answer to question 4 is yes, they stop and you lose. If the answer is no, they go on to question 5.

5. This is the second opportunity to win your case. Considering your age, education, and work experience, is there any other job that exists in significant numbers in the national economy that you are able to do? SSA has to prove other jobs exist, and the ALJ will turn to the VE for an opinion.

The ALJ asks a hypothetical question to the VE, basically describing you and your limitations. The question is not whether you can get any of these jobs, but if a person like you could get these jobs. The only relevant question is whether this hypothetical individual is able to perform the work or not. Whether you would actually apply or even be hired is not relevant.

The judge then asks the VE whether this hypothetical individual can do any of the jobs listed in the DOT. Your attorney has the opportunity to question the expert, adding in any restrictions that the judge has left out of the hypothetical situation, to get the expert to reduce the available jobs until everyone agrees that you are disabled. If the answer to question 5 is “no,” congratulations, you win your case!

With disability processing times often at well over a year, it is essential that you ensure your claim is being processed correctly. Hiring a Social Security Disability lawyer to handle your case will guarantee that no mistakes are made and no further delays are placed on your case. To find out more, visit us at www.socialsecuritylaw.com.

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