Initial Application Submission

The first step in the disability determination process is submitting your application for Social Security Disability benefits. You can apply online, by phone, or in person at your local SSA office. It’s essential to provide detailed information about your medical condition, work history, and any other necessary documentation.

Review for Basic Eligibility

Once the SSA receives your application, they begin by reviewing whether you meet the basic eligibility requirements. These include:

• Work History: You must have worked and paid Social Security taxes for a certain number of years (this is usually determined based on your age at the time of your disability).
• Income Level: Your income must fall below the threshold for substantial gainful activity (SGA). For 2025, the limit is $1,470 per month for non-blind individuals. If you are earning above this threshold, your application may be denied.
• Age: Age can play a role in the determination process, particularly in the later steps when evaluating whether you can perform any other type of work.

If you don’t meet these criteria, the SSA may deny your application before it moves to the next stage.

Medical Eligibility Evaluation

Once the SSA determines you meet the basic eligibility requirements, the next step is evaluating the severity of your disability. This is the most critical part of the determination process. The SSA considers:

• Severity of Your Condition: Your condition must be severe enough to prevent you from performing any substantial gainful activity for at least 12 months or result in death.
• Medical Evidence: The SSA reviews your medical records, including doctor’s notes, lab results, and treatment history. They may request additional medical documentation from your healthcare providers or even an Independent Medical Examination (IME) to assess the severity of your condition.

The SSA will also assess whether your disability meets the SSA’s Listing of Impairments, which is a list of conditions that automatically qualify for SSD benefits. However, even if your condition is not listed, you can still qualify if it is severe enough to limit your ability to work.

The Five-Step Evaluation Process

To make a decision about your claim, the SSA follows a five-step process. This process helps them assess whether you are eligible for benefits. Here's how it works:

• Step 1: Are You Working? If you are working and earning above the substantial gainful activity (SGA) threshold, you will not qualify for SSD benefits.
• Step 2: Is Your Condition Severe? The SSA will determine whether your condition is severe enough to limit your ability to perform basic work activities. If your condition doesn’t significantly impair your ability to work, your claim will be denied.
• Step 3: Does Your Condition Meet or Equal a Listed Impairment? The SSA uses the Listing of Impairments to determine whether your condition is severe enough to qualify automatically for SSD benefits. If your condition matches or is equal to one of the listed impairments, you will be found disabled.
• Step 4: Can You Do Your Past Work? If your condition doesn’t meet a listed impairment, the SSA will evaluate whether you can still perform your past work. If you are unable to perform your previous job, the SSA will move on to the next step.
• Step 5: Can You Do Other Work? If you cannot perform your past work, the SSA will determine whether you can do any other type of work considering your skills, education, age, and residual functional capacity (RFC). If you can’t do any other work, you will likely qualify for SSD benefits.

Determination and Decision

Once the SSA has completed the evaluation, they will make a decision on your claim. There are three possible outcomes:

• Approval: If the SSA determines that you meet the criteria for SSD benefits, your claim will be approved, and you will start receiving benefits.
• Denial: If the SSA finds that you do not meet the necessary criteria, your claim will be denied. Common reasons for denial include insufficient medical evidence, the inability to prove the severity of your condition, or the ability to still perform some form of work.
• Request for Additional Information: Sometimes, the SSA may request more medical records, forms, or other documents to proceed with your claim. If this happens, it can cause delays in processing.

Appeals Process (If Denied)

If your SSD application is denied, you have the right to appeal the decision. The appeals process involves several stages:

• Reconsideration: You can request a reconsideration, which is a review of your case by a different SSA examiner. The SSA will look at any new evidence or information you provide and make a new decision.
• Hearing Before an Administrative Law Judge (ALJ): If the reconsideration doesn’t result in a favorable outcome, you can request a hearing before an ALJ. During the hearing, you will have the chance to present new evidence, testify about your condition, and have your case reviewed by a judge.
• Appeals Council: If the ALJ denies your case, you can request a review by the SSA’s Appeals Council. The Appeals Council will determine if the ALJ made any errors in the decision. If they deny your case, you can take the next step and file a lawsuit in federal court.