The Social Security Administration (SSA) administers two programs that provide benefits to disabled individuals who are unable to work. Eligibility for the two programs differs. The Social Security Disability Insurance (SSDI) program is available to people who are “insured” because of their work history. Most workers who paid Social Security taxes for the equivalent of ten full years are “insured.”
The Supplemental Security Income (SSI) program is a means-tested benefit program that is available to disabled individuals (and some older nondisabled individuals) who have limited income and assets. In 2022, most people who make more than $841 a month are not eligible for SSI.
Both programs use the same legal definition of the term “disability” when SSA decides whether an applicant should receive benefits. That definition focuses on the applicant’s ability to work for wages.
How Does the SSA Define a Disability?
Different people, organizations, and government agencies have different definitions of the term disability. Broadly speaking, any impairment of the body or mind that makes living more challenging is a disability. Workers’ compensation and veterans’ benefits generally base disability benefits on the severity of the disability. Other disability benefits, including some private insurance benefits, focus on whether the disability affects an individual’s ability to earn income.
Only disabilities that prevent an individual from earning a living meet the legal test of a disability under the rules that govern SSDI or SSI benefits. To be eligible for SSDI or SSI, an applicant must meet two legal tests. First, the applicant must have a “medically determinable impairment” that will probably last for at least 12 months if it does not cause death in less than 12 months. Second, the impairment must prevent the applicant from engaging in substantial gainful activity.
The SSA applies that definition to applicants for SSDI of all ages, including disabled children of insured individuals. Applicants for SSI who are under the age of 18 do not need to establish an inability to engage in substantial gainful activity. Instead, they must prove that their impairment causes marked and severe functional limitations.
What Is a Medically Determinable Impairment?
An impairment is a diminishment or loss of an individual’s physical or mental functioning. Impairments must be severe before the SSA will recognize the impairment as causing a disability.
The SSA maintains a Listing of Impairments that it regards as sufficiently severe to make an applicant eligible for disability benefits. If a disability is on the list or is of equal severity, the SSA will presume that the impairment prevents the applicant from engaging in substantial gainful activity. In all other case, the SSA will make a “residual functional capacity assessment” to determine if the impairment is so severe that it prevents the applicant from engaging in substantial gainful activity.
The phrase “medically determinable” means that medical evidence supports the existence of the impairment. Telling the SSA “I can’t stand or walk” will not prove the existence of an impairment. Medical records must establish the loss of those functions. Successful applicants typically need to have a thorough assessment by medical professionals and the opinions of those professionals must be documented in medical records. If medical records do not demonstrate an impairment of an ability to function, the applicant will not be eligible to receive disability benefits.
What Is Substantial Gainful Activity?
The inability to work is a key factor that qualifies applicants for SSDI and disabled applicants for SSI. Any applicant who is currently engaged in substantial gainful activity is not eligible for the SSA’s disability benefits.
In simple terms, substantial gainful activity means work that pays wages. The term also includes the kind of work that usually pays wages, even if it is performed for free. Part-time work qualifies as a substantial gainful activity, although sporadic employment that the applicant cannot sustain might not be. Self-employment that is intended to earn a profit meets the definition of a substantial gainful activity even if no profits have yet been earned and no income has yet been generated.
On the other hand, cleaning and maintaining your own home does not count as a substantial gainful activity, even if you would be paid to perform cleaning work for someone else. Attending school, pursing a hobby, and participating in social or recreational activities are not substantial gainful activities even if they might use the same skills that are required for work.
Does Unemployment Prove the Inability to Engage in Substantial Gainful Activity?
The SSA begins every case by asking if the applicant is currently working and earning more than the threshold income. Employment and earnings above the threshold automatically disqualify an applicant from the SSA’s disability benefits.
While employment makes an employee ineligible, unemployment is not enough to prove that an employee is eligible. Assuming the applicant can provide medical evidence to establish the existence of a severe impairment, the applicant must also prove that the applicant is incapable of substantial gainful activity because of the impairment. Not working does not prove an inability to work.
The applicant’s Social Security Disability attorney will want to assemble evidence to prove that unemployment is not a matter of choice but is caused by the disability. For example, the lawyer will want to present evidence that the applicant’s former job requires physical or mental abilities that are inconsistent with the functional limitations that are established in the medical records.
It is not enough, however, to prove that the applicant cannot perform a former job. The applicant must be unable to perform any job that exists in substantial numbers in the national economy. If there are a large number of jobs the applicant would be capable of performing, it does not matter that no employers are currently hiring for those jobs in the applicant’s community. It does not even matter that all the possible jobs are located far from the applicant’s home.
The SSA will often rely on a vocational expert to determine whether jobs exist that the applicant can perform. If the expert believes such jobs exist, the applicant’s Social Security Disability lawyer must be prepared to point to gaps in the expert’s knowledge of the applicant’s limitations that undermine the expert’s opinion.