If you don't have a medical condition that qualifies you for immediate approval of disability benefits (called a “listing”), you'll need to prove that you can't work. You don't need to prove that you can't work at all, but that you can't do a substantial amount of work. One way to prove this is to show that there is no job you can perform full time on a "regular and sustained basis." You can also be approved for disability if you prove that your condition would make you miss too much work.
Generally speaking, being able to work on a regular and sustained basis means being able to do a full-time job; that is, 40 hours a week, five days a week, without excessive absences. It can also mean the ability to do a job that has some other equivalent schedule (like shift work consisting of 10-hour days for four days a week.)
There's one exception: if your past work was part time, the SSA will consider your ability to do part-time work as evidence you can do work on a regular and sustained basis. (For more information, see our question on part-time work and disability.)
First let's look at the minimum requirement for being considered able to work, which is being able to do a sit-down job for 40 hours a week without needing special accommodations such as being able to lie down or take frequent breaks.
If you don't meet a listing, the Social Security Administration (SSA) will prepare a residual functional capacity assessment (RFC) for you to determine what level of work you can do on a regular and sustained basis. An RFC is a detailed report that states the most you can do in light of your condition; for instance, heavy, medium, light, or sedentary work. If you have psychological or psychiatric conditions, the SSA will develop a mental RFC for you that discusses your ability to do the mental aspects of work, such as following directions, getting along with others, and completing work in a normal amount of time.
If the SSA determines you don't have the physical RFC or mental RFC to sustain the requirements of a sit-down job, you will be approved for disability benefits. A sit-down (sedentary) job requires you to be able to work eight hours a day, sitting for most of the time, with occasional walking. Occasional walking is defined as walking for a total of up to two hours a day.
The claimant (applicant) filed for disability because of chronic congestive heart failure. The claimant's heart disease did not meet the SSA's listing requirements for automatic approval. Although his cardiologist was able to stabilize some of the claimant's symptoms with medication, the applicant still suffered from fatigue and shortness of breath with exertion. After reviewing the medical evidence in the claimant's file, the SSA concluded that the claimant did not have the RFC to do even the modest physical requirements of sedentary work (the ability to walk up to two hours a day) on a regular and sustained basis. He was approved for disability.
The claimant filed for disability due to chronic leukemia. The claimant was treated with a daily dose of chemotherapy that halted the progression of the disease. However, the combined effects of the medication and the leukemia caused the claimant to experience long-lasting, significant day-time fatigue. Despite her condition, the SSA determined she had the residual functional capacity to perform a sedentary job. However, at her hearing, the claimant provided evidence to prove that she had to lie down and rest every couple of hours, for at least 30 minutes, due to the fatigue. The SSA therefore concluded that the claimant's need for frequent rests indicated she could not sustain a full-time job, and the agency approved her claim.
If the SSA determines you have the RFC for sedentary work, you can still win your claim if you prove that your other symptoms make it impossible for you to do that work on a regular and sustained basis. For example, if you have non-strength related impairments (called non-exertional impairments) that prevent you from being productive for eight hours a day, you should qualify for disability benefits. Here are some examples.
The claimant filed for disability based on narcolepsy. Despite medication, the illness caused intense daytime drowsiness that interfered with her ability to focus and concentrate. However, the SSA still concluded she had the physical RFC for sedentary work since she was able to walk up to two hours a day and carry light items. At her appeal hearing, the claimant provided medical evidence including sleep studies, EEGs, and records from her neurologist that detailed her symptoms. Based on her file, the SSA decided that even if she had the RFC for sedentary work, she could not perform the “non-exertional” requirements of her job on a regular and sustained basis because of her tendency to fall asleep. She was ultimately approved for disability.
The claimant filed for disability because of significant short-term memory loss associated with a head injury. The SSA determined the clamant had the RFC to perform medium work because he had no other physical impairments and could lift up to 25 pounds regularly. On appeal, the claimant provided medical evidence that supported his claim, including MRIs and records from his doctors and therapists. Based on the evidence in his file, the SSA concluded that even though he had the physical capacity to work, he would not be able to follow or remember even simple routine instructions. Based on this finding, the SSA concluded he could not work on a regular and sustained basis and approved his claim.
For more information, see our article on combining exertional and non-exertional impairments to win your claim.
Sometimes the severity of claimant's medical condition(s) fluctuates and can cause the person to miss an unacceptable amount of work. If you can prove that your condition would make you miss too much work, the SSA may approve your claim. Often these applicants are denied because some days they are perfectly able to do their work, while other days they are out sick or hospitalized.
The claimant filed for disability based on bipolar and severe depression. Although she was being treated with both medication and therapy and was compliant with treatments, her symptoms were poorly controlled. Her psychiatrist's records noted that at least once a month the claimant experienced manic symptoms that made her behavior unpredictable and volatile. These episodes lasted for three to four days and sometimes required hospitalization. Even though the SSA determined the claimant had the physical capacity for sedentary work, the SSA concluded that her unpredictable behavior would result in a level of absenteeism that precluded work on a regular and sustained basis.
The claimant filed for disability due to benign intracranial hypertension, a condition that causes intense and debilitating headaches. His headaches occurred without warning, and even with treatment the claimant had to be bedridden during an episode. The claimant was under the care of a neurosurgeon whose records indicated the claimant experienced debilitating pain about once a month. The records also stated that the claimant was frequently incapacitated for two or three days during the headaches. The SSA found that although the claimant had the physical capacity for sedentary work, his illness would result in an unacceptable amount of absences. Because of this, the claimant was approved for benefits.
If an applicant has to stay home from work too often because of pain or take an excessive number of breaks due to pain, and doctor records support this, the SSA should find that the applicant can't sustain a full-time job. For more information on how SSA treats pain, see our article on chronic disability and pain.
If your medical condition is such that it prevents you from working five days a week, or makes you miss three or more days of work per month, you may be able to win disability benefits on appeal. An experienced disability attorney can help show that, although you have some work capabilities, you can't work on a regular and sustained enough basis to hold down a job. To find an attorney in your area, you can use our our attorney locator tool.