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Eligibility for SSD Benefits: How the SSA Defines “Disability” and Evaluates Your Case

Many people have disabilities, but not all disabilities are entitled to benefits. Over the past 30 years as a Tampa Social Security disability attorney, Mike Murburg has learned and told his clients that “disability” in the Social Security arena is not necessarily a “medical” determination but rather a “vocational” and “administrative” one.

When the Administration evaluates a case, they use what is called their “Five Step Process.” As a side note, this process is the same process used in Railroad Retirement benefit cases as well.

In Step 1, the SSA asks whether or not the applicant is working.  If the answer is “yes,” then the SSA determines whether or not the individual is making too much money to be considered disabled.  If the answer is “no” or the individual’s earnings are beneath the amount of earnings considered to be an “SGA” or a “Substantial Gainful Activity,” then the Administration proceeds to Step 2.

At Step 2, the SSA determines whether or not your medical condition is “severe.”  This means the Administration will look at whether or not your condition prevents you from performing the basic functions of work for at least a year. This usually requires medical records and some input from your treating physician that the disabling condition has lasted or will last for at least 12 months.  If it does, then the Administration moves to Step 3.

At Step 3, the SSA determines whether your disabling conditions meets certain criteria or the “Listing” within the SSA’s own medical guidelines known as the “Disability Evaluation Under Social Security.” The almost 300-page medical guide is provided for Social Security physicians and medical evaluators to use to determine whether an individual meets a medical listing for disability. Tampa Social Security disability attorney Mike Murburg’s experience over the years has revealed that some determinations are easy to make, like in the case of a person missing two arms or legs or a combination of the two or someone with restricted mental abilities and an IQ of 50 or below.  However, things can get quite complicated in some instances.  If the individual’s condition does not meet the very strict medical guidelines for the severity of the medical condition, then the individual and his or her case becomes a “Vocational Case” and gets evaluated at Steps 4 and 5.

At Step 4, the SSA will determine whether the claimant can perform any “Prior Relevant Work” or “PRW.”  PRW is work that a claimant has done on a full-time basis prior to being unable to work.  If the SSA finds that the claimant can return to any past relevant work, not as it was actually performed at the time, but as it is performed nationally as described in the “Dictionary of Occupational Titles,” then the claimant loses the claim.  If the individual cannot return to any PRW, then the SSA and eventually an Administrative Law Judge (ALJ) will take the case evaluation to Step 5.

At Step 5, the burden is shifted to the Social Security Administration to determine based upon the claimant’s age, education, physical and mental condition, past relevant work (PRW), special training, skills and transferable job skills, whether there are there are any jobs that he or she can do that exist in sufficient numbers in the national economy (not your local area).

This determination is made by a “Vocational Expert” (VE) who works for the SSA and will testify at the hearing, should one become necessary. Both the ALJ and the VE will utilize the “Dictionary of Occupational Titles” (DOT) and “The Grids,” which are guidelines that are based on a very complicated formula that depends on a claimant’s age and sedentary, light, and medium “exertional levels” to see, based on both the physician’s restrictions and the SSA physicians of record, where the claimant fits in order to make their determination. If the SSA determines that the claimant can perform fulltime, gainful employment in some capacity (it can be something as simple as a ticket taker or ticket seller at a movie theatre, gate guard, gate checker or surveillance system monitor), then the claimant will be found to be “not disabled” under Social Security Guidelines.

Contact a Tampa Disability Attorney Today

Trying to understand your eligibility is a complicated matter, and your best option is to contact the disability attorneys at our office. When you contact us, our staff will have some questions for you, so please be ready to speak to them when you call. After we obtain some basic information from you, an experienced Tampa social security disability attorney will evaluate your claim. Thereafter, should Mr. Murburg decide that your case has provable merit, we will schedule an intake interview to evaluate and most likely try your case.

Once the Law Offices of Mike Murburg, P.A. is retained to represent you, our staff will assist you with all filings pertaining to your case. We can even help you file your initial claim at our office. Our offices are computerized and networked. All of our offices have cable internet access to the pertinent SSA websites providing court docketing information, legal research and Social Security Disability and Railroad Retirement Board offices.

Do not hesitate to contact our office today to discuss how attorney Mike Murburg and the team can help you with your Social Security disability and RRB disability needs.