Introduction to Social Security Disability, and Why “Disabled” Is a Term of Art You Must Understand before You File Your Claim

Welcome to Season 1, Episode 1 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. This is the inaugural episode of our Social Security Disability spinoff of Winning Isn't Easy: Long-Term Disability ERISA Claims. In this episode, we'll dive into the complicated topic of "Introduction to Social Security Disability, and Why “Disabled” Is a Term of Art You Must Understand before You File Your Claim."

Join host Nancy L. Cavey, a seasoned attorney in disability claims, as she simplifies the complexities of Social Security Disability with an easy-to-follow overview. Nancy will explain why "disabled" is a crucial legal term in your claim and bring this concept to life by exploring examples of theoretical applicants. She’ll also break down the Five-Step Sequential Evaluation test, making it clear and accessible for all. 

In this episode, we'll cover the following topics:

1 -  A Social Security Disability Overview

2 - Walking through Some Theoretical Applicants

3 - The Five-Step Sequential Evaluation Test

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:00]:
 Foreign. Hey, I'm Nancy Cavey, a Florida Social Security disability attorney, and I want to welcome you to our inaugural episode of the Social Security Disability version podcast, Winning isn't Easy. Before we get started, I've got to give you a legal disclaimer. This podcast isn't legal advice. The Florida Bar association says I have to say this. Now, I've said it, but nothing will prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that Social Security will play, and what you need to know to get your Social Security disability benefits. So off we go. Now, in this series, I'm going to be covering the ins and outs of what you need to know regarding Social Security disability claims.
 
 Nancy Cavey [00:00:56]:
 And I'm going to start with some basics. I think it's important that people who are applying for Social Security disability benefits understand the process and not what their neighbor or their best friend or their cousin told them about the Social Security disability claims process and how they got their benefits on the first try. So let's talk about the word disabled. And in doing so, I'm going to give you an overview. I'm going to radical arguments or applications that we see. So we're going to walk you through some and we're going to talk about the five step sequential evaluation, which is really the key to getting your Social Security disability benefits. So get out your pad or pencil or get out your Chromebook so that you can take notes. Got it? Well, let's take a pause before we get started.
 
 Nancy Cavey [00:01:47]:
 Okay.
 
 Speaker B [00:01:50]:
 Filing for Social Security disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:02:15]:
 Welcome back. Let's talk about a Social Security disability overview so that we're on the same page. Has your doctor told you that it's time to stop work and apply for your Social Security disability benefits? Is your employer complaining that you can't keep up with your work because of your back pain or knee pain? Is your pain preventing you from doing your job? Now, if you answered yes to any of these questions, you might be thinking about applying for Social Security disability benefits. You may have heard that it's hard and it takes a long time, but alternatively, you may have seen people collect their Social Security benefits quickly and they don't look disabled to you, so you're a bit concerned. So what I want to do again is to talk about the why you know you need to understand basic terms and concepts and how the Social Security goes about evaluating a disability claim. Now, the term disabled is a term of art in the Social Security world. The dictionary defines a disability to mean a physical, mental, cognitive or developmental condition that impairs, interferes with, or limits a person's ability to engage in certain tasks or activities or participate in the typical daily activities. Now, in my view, that's a common sense and a practical definition of the word disability.
 
 Nancy Cavey [00:03:44]:
 That's probably what you think about when you hear the word disability. But guess what? That's not the definition of disability that's used by Social Security disability and Social Security supplemental insurance income rather claims. Social Security has its own unique definition and it defines disability to mean an inability to engage in any substantial gainful act activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or has lasted or can be expected to last for a continuance period of time of not less than 12 months. So there are a lot of important words in that definition. Social Security also defines the words physical or mental impairment, and that means an impairment that's based on anatomical, physiological or psychological abnormalities that are demonstrated by medically acceptable clinical and laboratory diagnostic techniques. So you can see that this is much different than the common understanding of the term disability. Now, the Social Security Administration also will specifically exclude from the definition of disability an individual who is suffering from drug addiction or alcoholism, particularly if that's a contributing factor that's material to the determination as to whether or not the individual is disabled. You also have to understand here that it's the Social Security Commissioner's job, as given to dds, which I'll explain later, and the judge to determine whether or not you're disabled as that term is defined by Social Security regulations.
 
 Nancy Cavey [00:05:36]:
 So simply because your doctor says you're disabled does not mean that you are disabled for Social Security purposes. Now, this definition of disability is different from those who are blind or for children, and I'm not going to be talking about this during our podcast. Other factors that you need to think about in the definition is consideration of age, education, and work experience. Unfortunately, the Social Security rules don't necessarily provide any clear guidance for Social Security or judges in weighing those factors in determining whether or not a person is entitled to benefits. Now, Social Security is not going to consider necessarily the availability of work in your particular area, where you live, the number of job vacancies per se, whether or not you would be hired, whether the job pays a living wage and whether or not it's even a job that you would be interested in. So Social Security is going to consider a number of factors, including your medical records, but ultimately they are going to try to determine your entitlement to benefits in a non adversarial manner. There's no attorney representing Social Security at any level, but there are some judges who I believe inappropriately think that they are in fact representing the interests of Social Security as opposed to being impartial. So we've sort of set the framework here.
 
 Nancy Cavey [00:07:10]:
 You can see there's a practical difference between the dictionary definition or the common understanding of the definition of disability and Social Security's definition of disability. But I want that Social Security definition of disability to frame your thinking, and you need to put aside your common understanding of the word disabled. Got it. Now, after we take a short break, I'm going to give you a quiz to see whether or not you can determine based on the facts whether a Social Security applicant is in fact entitled to benefits. And as I go through each example, I'm going to be introducing concepts that are important for you to understand in the Social Security disability claims process. This is going to be the foundation for other discussions in the course of our podcast episodes. So I hope you score well, and I hope you are able to predict whether or not the person is entitled to benefits. And if you don't score well, you know, I'm not going to kick you off this podcast, but I'm going to try to be teaching you again how to change your thinking about how you go about winning a Social Security disability claim.
 
 Nancy Cavey [00:08:19]:
 Got it. Let's take a break. Welcome back to Winning Isn't Social Security Disability Claims. I'm going to be walking through some theoretical applicants to see whether or not you understand the concepts regarding disability, the definition of disability. Don't be surprised if you get the answer wrong because this is a learning process. But again, we're doing this exercise so that you understand the Social Security disability claims process and how Social Security goes about making a decision as to whether or not you're entitled to your Social Security disability benefits. Ready? Okay. Applicant number one.
 
 Nancy Cavey [00:09:21]:
 She's a 61 year old hairdresser. She's worked all of her life self employed. She never had Ficas withheld from her paycheck. Now she's limited to sedentary sit down work because of a back surgery and a failed total hip replacement. Is she entitled to Social Security disability benefits? Well, the key here is what I said about not withholding, having fica is withheld from her paycheck. She hasn't contributed to the Social Security system, and she's not insured for Social Security purposes. Now, as a rule, and depending on your age, you generally will have had to have worked 20 out of the last 40 quarters to be insured for Social Security purposes. So one of the first questions that you're going to be asked by any person you contact, including our law firm, is going to be when did you last work and what jobs did you hold in the five years before you became disabled? And generally we ask 10 years because again, we're trying to discern whether or not the person has worked 20 out of 40 quarters.
 
 Nancy Cavey [00:10:29]:
 Sometimes we don't get an answer that's clear to us. And so we will ask the person who's calling us to contact the local Social Security office to find out what's their date last insured. Now that's a term of art and that's what you we're asking for. What's the date you were last insured? Because you have to prove that you were disabled before your date last insured status expires and you can lose that insured status when you stop work and stop making contributions. So in our particular example, number one, while she may be disabled under Social Security rules or regulations, she would never be eligible for the benefits because she had never made a contribution and she had no insurance status. Let's talk about applicant two, who's a 50 year old housewife. She hasn't worked in the last five years. She stayed home to raise her children.
 
 Nancy Cavey [00:11:29]:
 She's got fibromyalgia with body wide pain, fibro fog. She sleeps 16 hours a day. Is she entitled to Social Security disability benefits? Now you should know the answer to that one based on our first example. And the answer is no, because she is not insured for Social Security disability purposes. However, she might be entitled to supplemental Security Income SSI if she meets the applicable asset and income limitations for ssi. And I will be discussing SSI and those requirements in upcoming episodes with a special guest. Applicant number three, a systems engineer for Verizon, 50 years old, high school education. He's worked for Verizon for 20 years as a systems engineer, which is a position that requires him to sit all day and have bilateral manual dexterity doing keyboarding.
 
 Nancy Cavey [00:12:22]:
 He has a cervical neck fusion and has tingling and numbness in his hands. Now he went back to work in 10 months. Is he entitled to Social Security? Well, the answer is it sounds like he's insured, but he went Back to work in 10 months. And he wasn't disabled for at least one year, so he won't be eligible for his Social Security disability benefits. Example number four, a doctor. Now this doctor has been practicing medicine for 15 years, 45 years old. He was involved in a motor vehicle accident, a motorcycle accident in fact, and that resulted in an amputation of his right leg. Now, because of complications with the stump, he has difficulty using a prosthetic device and he can't stand for more than 30 minutes at a time.
 
 Nancy Cavey [00:13:14]:
 And he does use a cane, but when he goes, for example, to the grocery store, he has to use an electric cart and use hand controls on his car. Now, is he entitled to Social Security disability benefits? And you would think, well, you know, he's a doctor, he should be able to go back to work and do some other stuff. Well, the answer is yes, he is entitled to Social Security because he meets what's called a listing at step three, which involves in part and amputation. And we're going to talk about the five step sequential evaluation and listings at step three. Let's talk about applicant number five. She's a housekeeper. She's 61 years old. She's worked as a housekeeper for the last 10 years and in the past she worked as a phone solicitor.
 
 Nancy Cavey [00:14:03]:
 She has a high school education and she's limited to sedentary work because of back, knees and hip problems. So the question is, is she entitled to her benefits? And the answer would have been no, because up until recently, Social Security has looked at a work history going back 15 years and because she had worked as a phone solicitor, which is a position where you sit, Social Security would have said no, you're not entitled to benefits because you can go back to your past work. But because of the change, because we're only looking back five years now, she could not probably go back to work as a housekeeper because that's a job that requires her to stand. How about applicant 6, an auto repair person, 50 year old auto repair person, done heavy lifting of equipment and car parts, high school education, he's limited, excuse me, to sedentary work because of a cardiac condition. Is he entitled to Social Security? The answer is probably yes because he can't at step four go back to his past relevant work and he doesn't have any skills that he can take to other work and he potentially is going to grid out. Alternatively, if he doesn't grid out, he probably can't do sedentary work because of problems with shortness of breath, the need to take a nap. And he would be absent at least two days per month. So he would be disabled, probably as step five, which is an inability to go to do other work in the mythical, hypothetical, not real world national economy in view of a person's age, education and skills.
 
 Nancy Cavey [00:15:44]:
 And we're going to talk about this in greater detail. The last example that I gave you or the example I gave you at step three, we'll talk about the listings, we're going to talk about step four, past relevant work, and of course we're going to talk about step five, which is this mythical hypothetical work in the national economy in view of your age, education and skills. And I'm hammering this right now because these three areas are really where cases are decided. So let's see if we can apply this applicant number seven, a nurse. She's a critical care nurse for 30 years. She has long Covid with pulmonary complications, neurological complications and fatigue issues. She's limited to sedentary work, but in the course of her employment as a nurse, she's done case management work, which is sedentary in nature. So is she entitled to her benefits? She probably can't go back to work as a critical care nurse because that requires standing, moving patients, lifting things.
 
 Nancy Cavey [00:16:53]:
 And so while she can't do the past work as a critical care nurse, the case is going to be decided at step five. And step five is, you know, can you do other work in the mythical, hypothetical, not real world national economy in view of your age, education, skills and whatever your restrictions are? Now, what's key here is going to be developing the restrictions because many times the key to winning the claim is what are your functional, physical, cognitive and psychological restrictions and limitations. If, for example, she has difficulty sitting, standing, has difficulty because she has to alternate sitting and standing, she has problems because of fatigue, has difficulty concentrating, those are the kinds of things would limit her ability to do a sedentary job. And that's the key here, because ultimately at step five, it comes down, in my view, to a person's ability to do a sedentary job with bilateral manual dexterity. In other words, using both of your hands and meeting the pace, production and attendance requirements. Now, just because you may not have problems with your upper extremities doesn't mean that you won't meet step five. There are ways that we can develop the functional restrictions and limitations that you have because of your medical condition or conditions. I've introduced these concepts because during the course of this podcast we're going to talk about these and we're going to Talk about these in great detail and we'll give real life examples of how these have applied in particular cases.
 
 Nancy Cavey [00:18:42]:
 So we're going to take a quick break and I'm going to talk about that five step sequential evaluation in greater detail so that you understand that that is the disability test that Social Security is going to be using. Five steps, the five ways that or things you need to meet to be entitled to your Social Security benefits. So let's take a break and then we'll come back and educate you some more. Got it. All right.
 
 Speaker B [00:19:15]:
 Struggling with your Social Security disability case? The right attorney can make all the difference. Get our booklet the key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will find, fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:19:47]:
 Welcome back to Winning Isn't Easy, the Social Security Disability Edition. Let's talk about the five step sequential evaluation test. And when people call my office, I tell them the first thing we're going to talk about, first thing I want them to understand is this five step sequential evaluation because that's the framework of our proof. So the first question is, are you working? And if so, are you earning more than the applicable SGA monthly amount? What is sga? Significant gainful activity is a money limit that is basically a cutoff. And currently right now it's about 1550 per month. I tell my clients it's that, that if they're working and they're earning more than that, it doesn't matter how disabled you are, you're just not eligible for benefits based on those earnings. If you're working and you can work, I like to have my clients keep their earnings consistent with their medical conditions and limitations so that they're earning something less than 1550. Why? Because the first question Social Security is going to ask is, well, why couldn't you work more hours and earn more than that 1550? So we want to keep it under that number.
 
 Nancy Cavey [00:21:05]:
 Now that SGA number changes every year and there are ways that we also can argue potentially that some of the work may not necessarily B S g A and I'll talk about that in later episodes. The next question they ask is, is your medical condition severe? In other words, are we dealing with a condition that has lasted or will last a year or will result in your death and one that is permanent in nature? In other words, it's not temporary. The Next question they ask is, step three is, does your medical impairment or impairments meet or equal a Social Security listing? Now, the Social Security Administration has a big book. It's called the Listing of Impairments, and it's based on anatomic systems. You remember high school biology, you learned about the cardiovascular system, the digestive system, all the other body systems. So Social Security has this big book called the Blue Book or the Listing of Impairments. And you can open it up to the applicable section based on your disabling medical condition. And what you're going to see is a laundry list, literally a laundry list of findings that Social Security wants to see in your medical records.
 
 Nancy Cavey [00:22:20]:
 It's very difficult to meet a listing because doctors didn't take a class in medical school to learn how to write a report for Social Security purposes. That ticks off all of the elements. Now, there are some conditions that just based on their severity alone are going to meet a listing. I gave you an example in an earlier segment about a physician who had an amputation. An amputation is potentially one of the listed conditions. Cancers are potentially can be listed conditions. Back conditions can be listed conditions. But again, it all comes down to having the right documentation in your medical records.
 
 Nancy Cavey [00:22:59]:
 I would say to you that at least 90% of people do not meet a listing. Now, if you do meet a listing, your benefits are automatically awarded based on the severity of the impairment. And you don't have to go on to steps four and five. But as I've said, at least 90% of cases go on to steps four and five. This is where the rubber meets the mat at step four. The issue is, can you go back to the lightest and simplest demanding job you held in the five years before you became disabled? Now that's becoming sort of a term of art because of some recent emergency changes to the Social Security rules. It basically used to be 15 years before you stopped working, but now it seems to be five years from the time an adjudication or decision is made on your claim. And what happens is that a lot of jobs fall off.
 
 Nancy Cavey [00:23:56]:
 And practically speaking, I'm seeing in the new application of this rule that a lot of people relevant work which can be helpful. We go on to step five and the step five is this crazy cockamamie, not real world test, and that is, is there other work in the mythical hypothetical, not real world national economy that you could hypothetically do, even though it doesn't pay a living wage and you have no interest in it, and it may not necessarily exist in your area in Significant numbers in view of your age, education, skills, and your restrictions and limitations. So you can understand that this is a crazy, cockamamie, not real world test. And that may explain, in part, why people you see walking down the street who don't look like they're disabled, in fact are disabled under the terms of this five step sequential evaluation. Now, let's quickly talk about the claims process. And I'm going to use some legal words here. It's a pain in the ass. It's a pain in the ass because unfortunately, the Social Security claims process is behind.
 
 Nancy Cavey [00:25:07]:
 And right now, depending on where you live, it can take as long as one year from the time your application is filed until they assign a claims examiner. Wow. Now, 2/3 of the claims are denied, and you do have 60 days in which to file an appeal. And I'll explain some of the things that we do to improve our win rate. But you need to understand that, as I said, at least 2/3 of these claims are denied. If you don't timely file an appeal by filing a request for reconsideration, then you have to start all over again. Now, in most states, that process of appeal is called a request for reconsideration. And as a Social Security lawyer, I'm really hoping at some point they get rid of this, because in my view, it just adds a time deadline delay.
 
 Nancy Cavey [00:26:05]:
 The request for reconsideration goes back to Disability Determination Services. They assign a new claims examiner, and unfortunately, two thirds of the time, claims get denied again. And this process, at least in the Tampa Bay area, is taking about another eight months. Don't hold me to it, because this is like a moving target. If your claim gets denied, you have to file an appeal called a request for a hearing. And you get out of dds and then you get into the Office of Disability Adjudications and Reviews, where the judges are housed. Now, I know that people get discouraged because of denials. You're disabled.
 
 Nancy Cavey [00:26:50]:
 You're having financial problems. You can't understand why Social Security isn't paying the benefits because your doctor said you were disabled. Your employer said, go home, we can't work with you. But you got to hang in there. You got to be a bulldog about this. You need to give up. Because at the hearing stage, you have the opportunity to present medical evidence, testify about your medical conditions and limitations, and explain to the judge why you meet the five step sequential evaluation. And again, these are things that I tell my prospective clients right out of the box.
 
 Nancy Cavey [00:27:23]:
 We talk about the five step sequential evaluation. We talk about the claims process because the strategy for winning the case starts, in my view, before you file that application. And if you come to us at the denial stage or the hearing stage, we will still explain this five step sequential evaluation process to you and talk about the strategy and things we want to do to implement to try to get your benefits and certainly to try to get your benefits if we have to go to the hearing. So let's do a quick review. How does the five step sequential evaluation impact the determination of entitlement? So think about this in a step process. If this then that if you are gainfully employed earning more than sga, are you entitled to benefits? No, because you exceed that earnings amount. So the question have a severe impairment and if you don't have a severe impairment, then you're not disabled. Do you have an impairment that will last at least 12 months or result in death? If the answer is no, you're not disabled, does the impairment meet or equal the severity as defined in the medical listings? If the answer is yes, you're disabled.
 
 Nancy Cavey [00:28:46]:
 If the answer is no, you don't meet a listing. The question is, can you do your past relevant work? And if the answer is yes, you're not disabled. If you are able to do if you're unable to do your past relevant work, the question becomes, well, can you do other work? And if the answer is yes, you're not disabled. If the answer is no, you're disabled. So you can see that this is not a common sense definition of disability. But you need to understand this so that we are very clear about what needs to be proven and the kind of evidence that needs to be provided to win your case. I hope you've enjoyed this week's episode of Winning Isn't Easy. If you enjoy this episode like our page, leave a review, share it with your family or friends, and subscribe to this podcast.
 
 Nancy Cavey [00:29:44]:
 Please tune in to next week for another insightful episode of Winning Isn't Easy. SA.