In parallel with this, the proportion of allowed claimants meeting or equaling the listings is lowest for children under age 5 and for older adults, but is above 90 percent for claimants over age 18 and under age 54 across this time period. This indicates that the youngest and oldest groups are more likely to receive favorable determinations based on vocational factors for adults or on functional equivalence to the listings for children.

Procedures for Determining Disability

SSA reviews all claims for disability benefits using its sequential evaluation process. For adults, the process has five steps; for children, a three-step process is used.

Adults

For adults covered by SSDI and for adult SSI claimants, the disability determination process follows the steps shown in Figure 1-1. The first step of the sequential evaluation process requires that the disability examiner working on behalf of SSA determine whether the claimant is engaged in SGA. Each year the SSA formally establishes an average monthly earnings level that serves to define SGA for disability. For 2004, the monthly SGA limit is $810 for disabled claimants. If the claimant is determined not to be performing SGA, the case goes on to Step 2 of the sequential evaluation process. If the claimant is determined to be performing SGA, she or he is found ineligible for benefits at this step.

At Step 2, the claimant must document through a report or medical records provided by an acceptable medical source that a medically determinable impairment is present that significantly limits his or her physical or mental ability to do basic work activities. Furthermore, medical evidence must support a judgment that the limitations imposed by the impairment have lasted or can be expected to last for at least 12 months or are expected to lead to the claimant’s death. If these criteria are satisfied, the claim progresses to Step 3. If the criteria are not satisfied, the claimant is found ineligible for benefits at this step.

Step 3 of the sequential evaluation process uses medical criteria as a screening test to identify claimants who are obviously disabled. In this step, SSA must decide whether the claimant’s medically determinable impairment(s) meets or equals in severity the specific medical criteria listed in 20 CFR Part 404, Subpart P, Appendix 1. This decision requires concurrence of a medical or psychological consultant. If the claimant has an impairment that is determined to meet or equal the listed criteria and that level of impairment severity has been demonstrated to have lasted or is expected to last for at least 12 months or to end in death, the claimant is



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement