Disability Determination Services - How The Decision Is Made

How The Decision Is Made

The decision is made based on whether or not the applicant is able to perform work that s/he has done in the past or is trained to do, and is likely to be able to perform and find employment in given his/her disability. It is for this reason that two people with identical disabilities could have very differing outcomes in their applications.

The legal definition of a disability that qualifies an applicant for benefits is: “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” For adult applicants, Social Security Administration regulations specify a five-step process for making the decision. A modified process is used in the case of children for whom Supplemental Security Income benefits are being claimed (as children are not expected to work).

For adults, part of the disability-determination process involves assessing the applicant’s “residual functional capacity”; that is, what the applicant can do in spite of his or her disability. Factors that may be considered in determining one’s “residual functional capacity” may include:

• Known limitations caused by diagnosed medical conditions. These limitations must be documented by a physician. Many medical conditions can be debilitating in one person but not another. Almost all applications lacking a physician's documentation of a known condition are rejected.
• Symptoms of undiagnosed medical conditions documented by a physician. Like with diagnosed medical conditions, a physician must document how these are actually debilitating.
• Side effects and other limitations caused by treatment received due to medical condition(s). The need to spend a significant amount of time in one's life to continually receive care in lieu of employment can be a qualifying factor.

Contrary to what many think, simply "being disabled" by any definition does not alone qualify one to automatically be approved. While one who is able to walk, talk, and manage one's own life may be considered disabled if there is no suitable employment given his/her abilities, one with diminished mobility or mental capacity may not qualify if there is plentiful employment available to him/her with his/her abilities.

One or more diagnosed medical conditions may not automatically qualify an applicant, and the lack of one or more may not disqualify the applicant. In some cases, an applicant may qualify based on symptoms alone.

In determining a physical disability, common factors are the ability to sit, stand, lift, bend, and stoop. Mental disabilities are determined based on the ability to communicate with others, understand oral and/or written instructions from others, and to get along with others. One who is able to sit for prolonged periods of time but not stand, lift, bend, or stoop may be disqualified if s/he is able to perform some type of desk work, whereas one may qualify if s/he lacks such an ability given his/her intellectual capacity, education level, or previous work experience. Likewise, a person with limited mental capacity who has the ability to perform physical labor may not qualify as "disabled."

These skills are also used for applicants who have never worked and for whom the claim is they can never work.