Social Security Disability – The Sequential Evaluation Process

The ALJ must follow a sequential evaluation in order to determine whether a claimant is eligible for benefits.  20 C.F.R. §§ 416.920, 404.1520.  Mastro v. Apfel, 270 F.3d 171, 177 (4th Cir. 2001) (citations omitted).  The first step of the sequential evaluation is to determine whether the claimant was working at the time of the application and, if so, whether the work constituted “Substantial Gainful Activity” (SGA).^[1]  20 C.F.R. §§ 416.920(b), 404.1520(b).  If a claimant was engaged in SGA, the analysis ends and the claimant must be found “not disabled”, regardless of any medical condition.  Id.   If the claimant establishes that she was not engaged in SGA, the evaluation proceeds to step two.

Step two of the analysis requires the claimant to prove she has “a severe impairment…or combination of impairments which significantly limit[s] [her] physical or mental ability to do basic work activities.”  20 C.F.R. §§ 416.920(c), 404.1520(c).  In order to qualify as a severe impairment under the Act, the impairment must cause more than a minimal effect on one’s ability to do basic work activities.  20 C.F.R. § 404.1520(c).  The ALJ considers the claimant’s physical and mental impairments both severally and in combination.  20 C.F.R. § 1520(a)(4)(ii).  Only if a claimant has a severe impairment will the ALJ proceed to step three. 

At step three, the ALJ must consider whether the claimant has an impairment that meets or equals an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1 (listing of impairments).  If the claimant has an impairment that meets or equals a listing, and if the impairment lasts, or is expected to last, for twelve months or result in death, it constitutes a qualifying impairment and the analysis ends.  20 C.F.R. §§ 416.920(d), 404.1520(d).  If the impairment does not meet or equal a listed impairment, then the evaluation proceeds to the fourth step.

At step four, the ALJ is required to determine whether the claimant can return to her past relevant work^[2] based on an assessment of the claimant’s Residual Functional Capacity^[3] (RFC) and the “physical and mental demands of work [the claimant] has done in the past.”  20 C.F.R. §§ 416.920(e), 404.1520(e).  If such work can be performed, then benefits will not be awarded.  Id.  However, if the claimant cannot perform her past work the evaluation continues to the final step.

At step five, the burden shifts to the Commissioner to show that, considering age, education, work experience, and RFC, the claimant is capable of performing other work that is available in significant numbers in the national economy.  20 C.F.R. §§ 416.920(f), 404.1520(f); Powers v. Apfel, 207 F.3d 431, 436 (7th Cir. 2000) (citing Bowen v. Yuckert, 482 U.S. 137, 146, n.5 (1987)); Hall v. Harris, 658 F.2d 260, 264 (4th Cir. 1981).  An ALJ will generally obtain testimony of a vocational expert to support a decision at step five.  It is the vocational expert’s response to a properly formulated hypothetical question that guides the ALJ decision as to whether a claimant is entitled to benefits under the Act.

[1]  SGA is work that is both substantial and gainful as defined by the Agency in the C.F.R. Substantial work activity is “work activity that involves doing significant physical or mental activities.  Your work may be substantial even if it is done on a part-time basis or if you do less, get paid less, or have less responsibility than when you worked before.” 20 C.F.R. § 404.1572(a).  Gainful work activity is work activity done for “pay or profit, whether or not a profit is realized.”  20 C.F.R. § 404.1572(b).  Taking care of oneself, performing household tasks or hobbies, therapy or school attendance, and the like, are not generally considered substantial gainful activities.  20 C.F.R. § 404.1572(c).

[2] Past relevant work is defined as SGA in the past fifteen years that lasted long enough for an individual to learn the basic job functions involved.  20 C.F.R. §§ 416.965(a), 404.1565(a).

[3] RFC is defined as “an assessment of an individual’s ability to do sustained work-related physical and mental activities in a work-setting on a regular and continuing basis.  A ‘regular and continuing basis’ means 8 hours a day, for 5 days a week, or an equivalent work schedule.” SSR 96-8p.  When assessing the RFC, the adjudicator must discuss the individual’s ability to perform sustained work activities in an ordinary work setting on a regular and continuing basis (i.e., 8 hours a day, 5 days a week, or an equivalent work schedule), and describe the maximum amount of each work-related activity the individual can perform based on the evidence available in the case record.