How Does the SSA determine If You Are Eligible for SSDI

How Does the SSA determine If You Are Eligible for SSDI Featured Image

Confused about qualifying for Social Security Disability Insurance (SSDI)? We break down the process involved in determining eligibility for SSDI, as well as some key factors the Social Security Administration (SSA) considers, from medical conditions to work history. Learn what you need to know about SSDI eligibility in this easy-to-understand guide.

SSDI and Its Purpose

Before submitting an SSDI application, it is important to understand first what Social Security disability is and how it works. Social Security Disability Insurance, or SSDI, provides vital support for individuals who cannot work due to disability. This program acts as a financial lifeline, offering monthly payments to eligible workers, bridging the income gap between their disability and retirement years. 

The monthly SSDI payment is calculated based on an individual’s earnings record. Generally, higher lifetime earnings result in a higher benefit amount. This means that those who earned more during their working years typically receive a larger monthly payment.  

For many SSDI beneficiaries, the monthly benefits they receive are not just a supplementary income but often their sole financial support. This reliance underscores the critical importance of receiving these payments regularly and on time. 

The Five-Step Sequential Evaluation by the SSA

The Social Security Administration determines every applicant’s eligibility for SSDI benefits through a structured evaluation process that involves these five steps:

Step 1: Are you working?

If you are currently working, the SSA will immediately deny your application. They will not even consider the severity of your alleged disability because your work income disqualifies you from receiving benefits. Work income is disqualifying if it is above substantial gainful activity (SGA) levels. In the year 2024, work in which you gross over $1,550 per month in income is the performance of substantial gainful activity. For the SGA amounts in previous years, consult Social Security’s SGA chart.

On the other hand, if you’re not working, the SSA will proceed to step 2 of the evaluation.

Step 2: Do you have a severe impairment?

Is your condition severe? As defined by the SSA, a severe condition is a physical or mental condition that impacts your ability to perform basic work-related activities for at least 12 consecutive months. This is typically considered by Social Security to be a low threshold to meet. However, if your condition imposes no more than a minimal impact on your ability to perform basic work activities, your case will be denied at step 2 of the sequential evaluation. 

A foundational principle of Social Security disability law is that your disability must last 12 continuous months or be expected to last 12 continuous months. This is called the 12-month or duration rule. There are certain limited exceptions to this rule: for instance, a liver transplant automatically entitles the claimant to disability as of the date of the surgery, and the SSA will review the progress of the recovery 12 months after the transplant. Another example is the existence of a condition that is expected to result in death, which is approved as a “compassionate allowance”. But in the majority of claims for disability, the 12-month duration rule applies. This is because Social Security disability is intended to be a long-term disability program for people who are unable to work due to a disability. There are other programs such as workers’ compensation and State Disability Insurance that are intended for short-term conditions.

Why is the 12-month rule important? Due to the SSA’s long average application processing times and, in addition, the general principle that disability claimants cannot simultaneously work and retain eligibility for disability benefits, you must be both not working and disabled under Social Security rules for at least 12 months in order to be approved for the benefit.

Moreover, the 12-month rule significantly impacts the ideal timing of a disability application. For example, assume disability applicant Carly stops working in January 2024 in order to undergo lumbar fusion surgery in February 2024. She submits a claim for Social Security disability before her surgery, only one month after the date she stopped working. The SSA sends her a durational denial in August 2024. The denial decision states that, although the SSA agrees that she is disabled from work as of August 2024, she is expected to recover from her surgery and return to work prior to January 2025, 12 months after she stopped working initially. 

Because Carly filed her application too early after stopping work, her claim was denied on the basis that she was not both off work and disabled for 12 continuous months.   Now, assume disability applicant Stephen also stops working in January 2024 in order to undergo a spinal fusion surgery in February 2024. Unlike Carly, Stephen waits to file his Social Security disability application in July 2024. Due to SSA application processing times, a Social Security adjudicator finally reviews Stephen’s medical records in January 2025, and notes that his recovery from the surgery was longer and more challenging than anticipated. He is still having radiating pain and spasms, and requires a walker for ambulation. The SSA approves Stephen’s application in February 2025, while Carly’s case isn’t approved until February 2026 before an administrative law judge on appeal. By waiting six months after his work stoppage to file, Stephen avoided a lengthy appeals process, and got the benefits he deserved while recovering from his surgery.

It cannot be overstated that every case is different, so you should consult a trained Social Security lawyer prior to filing an application to review your specific work and disability timeline. Be like Stephen and arm yourself with all of the information before embarking on the Social Security disability claims process.

Step 3: Does your impairment meet or equal a listing?

Does your condition meet the requirements of Social Security’s Listed Impairments? In general, a listing level impairment is viewed by the SSA as a steep burden of proof since the medical criteria usually requires strict objective medical findings in the treatment evidence. If the SSA finds that you meet one of the medical listings, they approve your case. They end the evaluation at step 3 without proceeding to the next step. On the other hand, if they do not find that your condition meets a medical listing, the evaluation proceeds to the next step.

Step 4: Can you do your past work?

Past relevant work is any job you’ve performed in the past five years. (In June 2024, the SSA passed a new regulation decreasing the lookback period from 15 years to 5 years). The five-year period for past relevant work “looks back” five years prior to the date of the adjudication. The burden of proving you cannot perform your past relevant work is on you, the disability claimant. If you can return to your past work, your claim for disability is denied at step 4. If Social Security agrees that you cannot perform any of your past relevant work, the claim proceeds to step 5.

Pro Tips
  • To ensure your SSDI application accurately reflects your abilities, avoid exaggerating your role in past jobs. Job titles that sound impressive but don’t match your actual duties can confuse SSA reviewers. For instance, retail clerks labeled as “manager” might only handle opening and closing duties, not hiring or management. Similarly, someone in building maintenance called an “engineer” might be seen as a desk` -bound software coder by mistake. Using accurate job descriptions helps prevent delays or denials in the SSDI evaluation process.
  • Describe the role you performed for the majority of the course of your employment. Do not describe a light-duty job that your employer accommodates after the onset of your illness or injury (i.e., a short-term flagger on a construction site assigned by your employer to accommodate your injury). The SSA would not consider such a position as past relevant work.  
  • In your SSDI application, don’t forget to check the box for “Heavy Lifting” if it was required in your past job, even if you only had to lift heavy objects once or twice per week. The question is whether the job involved ANY heavy lifting, even if this lifting was only occasional.

If you had more than one job in the past five years, the Social Security Adminstrationwill send you a Work History Report. Fill this in with more details about your job duties, including the lifting and carrying requirements of the job, how long you had to sit, stand, and walk on the job, whether you managed other employees, etc. If you only had one job in the past five years, this information can be submitted on the initial online application. You should provide as much detail as possible in response to the work history questionnaire.

Step 5: Can you do any other work?

In order to qualify for Social Security disability benefits, you must prove that your medical condition prevents you from returning to your past relevant work. If you can do this, then the burden of proof shifts to the SSA — they need to prove there are other jobs in the national economy that you can perform. If they are unable to do so, then they will approve your application and you will start receiving SSDI benefits. This is the fifth and final step in the sequential evaluation. 

It should be noted that age plays a critical factor here. If you are under the age of 50, the SSA must agree that you cannot perform the easiest full-time job in the national economy. This is viewed as a steep burden of proof. However, if you’ve already reached age 50, the SSA must take into account the transferability of your work skills when considering whether there is other work in the economy you can perform. For some workers, this is a favorable analysis. Heavier-duty jobs offer less transferable skills to light or sedentary jobs. But someone with past relevant sedentary work has transferable skills to other sit-down jobs, which is less favorable on the disability evaluation. The SSA guidelines pertaining to step 5 are called the GRID Rules. 

Ensuring that you have all the information and documents you need for your SSDI application will help you avoid delays and secure an approval. For guidance on how to navigate the SSDI application process, contact the experts at LaPorte Law Firm. Our lawyers specialize in Social Security disability law and have years of experience securing benefits for countless clients in the Bay Area. 


A disability under Social Security Administration regulations is a physical or mental condition that meets the requirements of a medical listing (see the SSA’s Listings). If a condition does not meet the requirements of a listing, the SSA will determine whether the combination of all of your medical impairments prevent you from performing substantial gainful activity on a full-time (eight hours per day, five days per week) basis. 

Many people wonder how much they’ll receive in Social Security Disability Insurance each month. The amount varies for each person because it’s based on your individual work history. When your application is approved, the SSA calculates your monthly disability benefit using a complex formula, not a percentage of your previous salary.

As of January 2024, the average monthly disability payment is around $1,537.03. It’s important to note that SSDI payments are either approved in full or denied; there are no partial benefits.

Before you apply, it’s helpful to check your estimated disability amount. You can do this by creating your own My SSA account on the SSA website. Log in to your account to review your earnings records and use the benefits estimator. This way, you can plan your finances and understand what to expect if you rely on SSDI as your main source of income.

With Social Security disability applications, sometimes it is best to hope for the best but expect the worst. Nationally, the average wait time on the initial application is seven months. Since the SSA denies almost two-thirds of disability applicants, most people who apply for disability must then undergo a lengthy appeals process. To learn more about the average current wait times of appeal in your area, read our blog about wait times at the hearing level before the administrative law judge. 

Yes! You have 60 days from the date of the denial to submit your appeal. It is a good idea to consult a trained Social Security attorney if your application is denied to discuss your right to appeal. 

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