2.1 SSA’s Definition of Disability Flashcards
“What is the SSA’s definition of disability for adults?”
Answer: “The inability to engage in Substantial Gainful Activity (SGA) due to a medically determinable physical or mental impairment lasting at least 12 months or expected to result in death.”
Explanation: “SSA requires claimants to prove a severe impairment that prevents substantial work activity. Temporary or short-term impairments do not meet this definition.”
Source: CFR §404.1505.
“How does SSA define disability for children?”
Answer: “A medically determinable physical or mental impairment causing marked and severe functional limitations expected to last at least 12 months or result in death.”
Explanation: “Unlike adults, children are not evaluated based on SGA but on their ability to perform age-appropriate activities.”
Source: CFR §416.906.
“What conditions automatically meet the SSA’s disability definition?”
Answer: “Certain conditions listed in the SSA Blue Book (Listing of Impairments) automatically qualify if the claimant meets all the criteria.”
Explanation: “These conditions include certain cancers, severe cardiovascular impairments, and other specified disorders.”
Case Scenario: Amy, a 48-year-old woman, is unable to work due to advanced arthritis in her knees. Her doctor diagnoses her condition as severe but believes that surgery could allow her to return to work within six months. Amy applies for SSDI benefits.
Question: Does Amy meet SSA’s definition of disability?
Answer: No, Amy does not meet SSA’s definition of disability because her impairment is not expected to last at least 12 months or result in death.
Legal Explanation: Under SSA rules, a disability must:
Be medically determinable.
Be severe enough to prevent engagement in Substantial Gainful Activity (SGA).
Last at least 12 months or be expected to result in death.
Amy’s short-term impairment does not satisfy the duration requirement, even though it is severe.
Case Scenario: Tom, a 38-year-old mechanic, suffers a traumatic brain injury in a car accident, causing severe cognitive impairments. He has been unable to work for the past six months. His doctor provides evidence that his impairments are permanent.
Question: Does Tom meet SSA’s definition of disability?
Answer: Yes, Tom meets SSA’s definition of disability because his impairment prevents him from engaging in SGA and is expected to last more than 12 months.
Legal Explanation: The SSA considers both the severity and duration of an impairment. Permanent cognitive impairments meet the duration requirement, and the inability to perform SGA establishes disability.
Definition of Disability:
Impairment must be medically determinable, severe, and last at least 12 months.
Scenario:
Linda’s SSDI application was denied at Step 3 of the evaluation process. The SSA concluded her impairment did not meet or equal a listing, but Linda argues her combined impairments prevent her from working.
Question:
Can Linda qualify for SSDI if her impairments don’t meet or equal a listing?
Answer:
Yes, Linda may still qualify if her combined impairments limit her Residual Functional Capacity (RFC) such that she cannot perform past relevant work or any other work in the national economy.
Explanation:
Step 4 and Step 5 of the sequential evaluation process consider whether a claimant’s RFC precludes past or other work, even if the impairments don’t meet a listing.
Key Resource: CFR §404.1520(e)-(g) – RFC assessment in Steps 4 and 5.
Key Takeaway:
Impairments that don’t meet a listing may still result in disability if they limit RFC to the extent the claimant cannot work.
Scenario:
Paul applies for SSI and claims his insomnia prevents him from performing SGA. SSA denies his claim, citing insufficient evidence of severity.
Question:
What does SSA require to establish severity of an impairment?
Answer:
SSA requires medical evidence demonstrating that the impairment significantly limits the ability to perform basic work activities.
Explanation:
Severity is determined by the impact on basic work activities such as sitting, standing, understanding instructions, and interacting with others.
Key Resource: CFR §404.1520(c) – Definition of severity.
Key Takeaway:
An impairment must significantly limit basic work activities to be considered severe.
Scenario:
Alice works part-time and earns $1,200 per month in 2025. She claims her income should not affect her disability determination because she receives substantial help from her employer.
Question:
Does Alice exceed the SGA threshold under these circumstances?
Answer:
No, Alice’s income may fall below SGA if employer subsidies or special conditions reduce her countable earnings below the threshold of $1,470.
Explanation:
SSA considers employer subsidies and special conditions when determining SGA. These adjustments may lower countable income.
Key Resource: CFR §404.1574(a)(2) – Subsidies and special conditions.
Key Takeaway:
Employer subsidies can reduce countable income, potentially bringing earnings below the SGA threshold.
Scenario:
Jacob applies for SSDI and argues that his disability prevents him from performing past work. SSA considers his age (56), education (high school), and RFC (light work).
Question:
How does SSA evaluate Jacob’s ability to perform other work?
Answer:
SSA uses the Medical-Vocational Guidelines (Grid Rules) to determine whether Jacob’s age, education, and RFC preclude other work. At age 56 with light RFC, he may be found disabled.
Explanation:
Grid Rules favor older individuals with limited vocational adaptability, especially when restricted to light or sedentary work.
Key Resource: CFR §404.1569a – Medical-Vocational Guidelines.
Key Takeaway:
The Grid Rules consider age, education, and RFC, favoring older individuals with limited work adaptability.
Scenario:
What is the first step in SSA’s sequential evaluation process?
Question:
What does Step 1 determine?
Answer:
Step 1 determines whether the claimant is performing Substantial Gainful Activity (SGA).
Explanation:
If a claimant is performing SGA, their claim is denied without further evaluation.
Key Resource: CFR §404.1520(a)(4)(i) – Step 1 of the sequential evaluation process.
Key Takeaway:
Step 1 determines whether the claimant is engaging in SGA.
Scenario:
What does Step 3 of the sequential evaluation process evaluate?
Question:
What is the primary focus of Step 3?
Answer:
Step 3 evaluates whether the claimant’s impairment meets or equals a listing in the Blue Book.
Explanation:
Meeting or equaling a listing establishes disability without proceeding to further steps.
Key Resource: CFR §404.1520(d) – Listings of Impairments in Step 3.
Key Takeaway:
Step 3 determines if an impairment meets or equals a listing.
Scenario:
Cindy, 45, has a sedentary RFC due to severe back pain. Her past work was as a cashier, which is classified as light work. SSA denies her claim at Step 4, concluding she can return to past work.
Question:
Why does Cindy fail at Step 4 of the evaluation process?
Answer:
Cindy fails at Step 4 because her RFC is not restrictive enough to preclude her past work as a cashier.
Explanation:
Step 4 evaluates whether the claimant can return to past relevant work. An RFC for sedentary work may still allow performance of certain light jobs.
Key Resource: CFR §404.1520(f) – Step 4 of the sequential evaluation process.
Key Takeaway:
Step 4 determines whether the claimant can return to past relevant work based on their RFC.
Scenario:
Tom, 60, has a high school education, unskilled work history, and an RFC for sedentary work. SSA evaluates his ability to perform other work.
Question:
What factors favor a finding of disability under Step 5 for Tom?
Answer:
Tom’s age, unskilled work history, and sedentary RFC favor disability under the Grid Rules for individuals over 60.
Explanation:
The Grid Rules consider age, education, work experience, and RFC. Older claimants with unskilled work history are less likely to adjust to new work.
Key Resource: CFR §404.1568(d) – Transferability of skills and vocational considerations.
Key Takeaway:
The Grid Rules favor disability for older individuals with limited education and unskilled work history.
