Social Security Disability Eligibility in the View of the Courts

The procedure used by the Social Security Administration to determine disability is known as the "sequential evaluation of disability" process. Every claim is evaluated by addressing five questions.

1. Is the claimant working?

2. Does the claimant suffer from a severe impairment?

3. Does the medical condition meet the criteria in the Listing of Impairments?

4. Even if the medical conditions do not meet the requirements of the Listing of Impairments, do the medical conditions prevent the performance of past work?

5. If the medical condition prevents past work, does it prevent other work considering the claimant's age, education and work background?

The courts have addressed some of these steps and clarified this process in favor of the claimant. The following explains how the courts interpret the various concepts contained in this process.

When considering the first question whether the claimant is working, keep the following in mind:

The question of whether the claimant is working referred to a level of work that would be considered "substantial gainful activity" or full-time work activity. Many individuals who are working part-time jobs with accommodations from the employer are eligible for Social Security disability benefits. If a medical condition limits the ability to work to less than full-time, a claim may be granted. Social Security has determined that earnings of less than $980.00 per month can still entitle a worker to receive disability benefits. The work activity is also evaluated to determine if it shows an ability to perform full-time work. http://www.ssa.gov/OACT/COLA/sga.html

Review of the relevant case law of the 11th Circuit Court of Appeals adds the following considerations to the sequential evaluation process:

The courts have addressed the question posed in Step 2, what constitutes a "severe impairment".

Under the provisions of 20 C.F.R. section 404.1520, the question of severity is only a preliminary threshold issue, not usually used as a bar to recovery of benefits, other than in cases where the evidence shows that the claimant is virtually unimpaired. Bradv v. Heckler, 724 F.2d 914 (11th Cir. 1984).

The claimant is given an opportunity to an oral hearing. Much of that testimony concerns symptoms experienced by the claimant that prevent work. The courts have provided direction to the Administrative Law Judges on how that testimony should be evaluated. One such decision requires that the judge provide, "Specific findings regarding the claimant's subjective testimony are required where subjective pain is a critical issue. Walker v. Bowen, 826 F.2d 996, 1004 (11th Cir. 1987).

In MacGregor V. Bowen, 786 F.2d 1050 (11th Cir. 1986), the Court held that on an improper challenge to the claimant's subjective testimony, the testimony will be accepted as true, as a matter of law. See also, Hale v. Bowen, 831 F.2d 1007 (11th Cir. 1987); Cannon v. Bowen, 858 F.2d 1541 (11th Cir. 1988).

Many claims contain reports not only from treating physicians but also from non-examining doctors employed by SSA to review the claim file. The claim file may contain a report from a doctor that examined the claimant at SSA's request known as a "consultative examination". When the opinions between these sources are contradictory the "treating physician rule" applies. The case law in the 11th Circuit, with regard to the "treating physician rule", began with the case of Smith V. Schweiker, .646 F.2d 1075 (5th Cir. 1981), in which the Court stated, in pertinent part:

It is not only legally relevant but unquestionably logical that the opinions, diagnosis, and medical evidence of a treating physician whose familiarity with the patient's injuries, course off treatment, and responses over a considerable length of time should be given considerable weight. Accord Broughton v. Heckler, 776 F.2d 960,962 (11th Cir. 1985).

The basis of all disability decisions is a "residual functional capacity assessment" or a determination by the decision-maker of the limitations imposed on the claimant as a result of the medical conditions. The courts have emphasized that a claimant must be found to have the ability to perform full-time work .

An claimant who cannot perform substantially all of the requirements of full range sedentary work does not retain the residual functional capacity to perform such work. One who cannot sustain work for a full work day or a full work week cannot perform sustained sedentary work. McRoberts V. Bowen, 841 F.2d 1077, 1081 (11th Cir. 1988).

The judge is required to make specific findings concerning the claimant's ability to perform work activities.

The Secretary must correctly establish the claimant's remaining residual functional capacity (RFC), in order to make the determination as to what work the claimant can perform. The failure to make adequate findings with regard to claimant's RFC is reversible error. Schnorr v. Bowen, 816 F.2d 578 (11th Cir. 1987).

A determination as to an RFC is not merely a theoretical abstraction. The judge, in making a determination that an individual can actually function in a competitive work setting, must also consider that:

An individual must have some reasonable chance in the real world of being hired and, once hired, of keeping the job. 'A claimant must have the ability to perform . . . day in and day out in the sometimes competitive and stressful conditions in which all people work in the real world.' Winpo V. Bowen, 852 F.2d 827, 831 (5th Cir. 1988) citing AlIred v. Heckler, 729 F.2d 519, 533 (8th Cir. 1984).

The claimant's testimony should be accepted as truthful unless the judge can provide specific evidence that contradicts that testimony.

If the Secretary refuses to credit such [subjective pain] testimony, he must do so explicitly and give reasons for that decision. Walden v. Schweiker, 672 F.2d 835, 839 (11th Cir. 1982). Where he fails to do so we hold as a matter of law that he has accepted that testimony as true." MacGregor v. Bowen, 786 F.2d 1050, 1054 (11th Cir. 1986), 13 S.S.R.S. 167, 171, CCH _ 16,744

Subjective pain testimony that is supported by objective medical evidence of a condition that can reasonably be expected to produce the symptoms of which the claimant complains is itself sufficient to sustain a finding of disability. ... It is established in this circuit that if the Secretary fails to articulate reasons for refusing to credit a claimant's subjective pain testimony, then the Secretary has, as a matter of law, accepted that testimony as true.... Implicit in this rule is the requirement that such articulation of reasons by the Secretary be supported by substantial evidence." Hale v. Bowen, 831 F.2d 1007, 1011-12 (11th Cir. 1987), 19 S.S.R.S. 396, CCH 17,659

The Administrative Law Judge is required to evaluate the case in a fair and unbiased manner. Eligibility for benefits does not require total incapacity. Further, the decision must give proper weight to the medical sources that have more insight into the claimant's medical condition.