Do You Qualify for Disability Benefits?

Social Security does not start with the name of your diagnosis. It uses a five-step evaluation to decide whether you are disabled for SSDI or SSI. Those steps are in 20 CFR 404.1520 and 416.920. They are not the path the file takes after you apply. Application, reconsideration, and hearing are on our disability claim process page.

Two rules sit beside the five steps. First, the impairment must last or be expected to last at least 12 months, or be expected to result in death. That duration rule is separate from step 1. 20 CFR 404.1509 and 416.909. Second, SSDI still needs work credits, and SSI still has income and resource limits. Meeting a listing does not skip those nonmedical rules.

1. Are you performing substantial gainful activity?

Step 1 asks whether you are performing substantial gainful activity, or SGA. For employees, SSA generally uses countable earnings as an important guide. Certain work incentives, subsidies, impairment-related work expenses, and other rules can affect the analysis, and self-employment is evaluated differently. Being below the published SGA level does not mean the claim is approved; it allows the disability evaluation to continue to the medical steps.

Special rules apply to statutory blindness. SSA does not use the blind SGA amount to determine initial SSI eligibility based on blindness.

2. Do you have a severe medically determinable impairment?

Step 2 asks whether objective medical evidence from an acceptable medical source establishes a medically determinable impairment and whether the impairment significantly limits basic work activities. The impairment also must satisfy Social Security’s duration requirement.

3. Does the impairment meet or medically equal a listing?

Step 3 compares the medical evidence with SSA’s Listing of Impairments. Meeting or medically equaling a listing is a finding of disability at this step. It is not an automatic award of benefits. SSA still needs the listing’s own findings, the duration rule, and the SSDI or SSI nonmedical rules. If the listing is not met or equaled, that is not a denial by itself. The claim continues to residual functional capacity and the vocational steps.

4. Can you do past relevant work?

If no listing is met, SSA decides whether you can still do past relevant work given your residual functional capacity. Past relevant work is generally substantial gainful work from the last five years that lasted long enough for you to learn it. Jobs started and stopped in fewer than 30 calendar days are not past relevant work. 20 CFR 404.1560 and SSR 24-2p. The five-year period usually ends on the date of the decision. In some Title II claims it ends earlier, such as the date last insured. If you can still do that past work, the claim is denied here.

5. Can you adjust to other work?

The last step asks whether you can adjust to other work that exists in significant numbers, considering your residual functional capacity, age, education, and work experience. If other work remains, the claim is denied. If it does not, SSA finds you disabled at this step.

A diagnosis name is never the whole answer. If you want someone to review how these steps apply to your records, start with a free case evaluation. Representation does not guarantee approval.