If the Social Security Administration (SSA) finds that you don’t meet its checklist of requirements for a particular medical condition (that is, you have a severe impairment, but it doesn’t match an official SSA impairment listing), before rejecting your application for disability benefits, the SSA is required to look at your condition further. The SSA must consider the effect of your impairment on your capacity to perform daily activities and to function at work. After determining what your remaining capabilities are, if the SSA determines there is no work you can be expected to do, given your age, education, and skills, you will be granted disability benefits via a “medical-vocational allowance.”
Most applicants for disability benefits do not match one of the SSA’s listed impairments in the SSA’s “blue book,” which lists specific, severe criteria for illnesses. For instance, to qualify for disability based on blindness, you must have worse than 20/200 corrected vision in the better eye (or a limited field of vision); to qualify for disability based on asthma, you must have severe asthma attacks requiring physician intervention at least once every two months, despite being on prescribed treatment.
In fact, most applicants who are granted benefits are approved through a medical-vocational allowance.
After a disability claims examiner at DDS (Disability Determination Services, a state agency that works for the SSA) determines that your condition doesn’t match a blue book impairment listing, the claims examiner will send your file to a DDS medical consultant (a doctor, psychiatrist, or psychologist). The medical consultant will perform an RFC (residual functional capacity) assessment on your claim. That is, the consultant will evaluate your medical record, your doctor’s notes, and the results of laboratory or clinical tests to determine how much functional ability you have remaining, after considering the effects of your impairments. In particular, the consultant will look for notes from your treating doctor on the functional limitations and restrictions your medical problems cause you, to determine if your problems rise to the level of a disability that prevents you from working.
For instance, if you have poor eyesight, your doctor’s notes may show that you have been advised not to drive. If you have a herniated disc, your doctor may have restricted you to lifting under 20 pounds. These are common functional restrictions, or limitations. (Unfortunately, many doctors neglect to put functional limitations into medical records, which can really hurt a patient's chance of getting disability benefits.)
The medical consultant will use your functional restrictions or limitations to rate your ability to work. To do this, the consultant will use an RFC form to come up with a residual functional capacity level for you. The RFC level determines whether you can do sedentary work, light work, medium work, or heavy work. For instance, if your doctor has limited your standing and walking to no more than five hours per day, your RFC will be for sedentary work. If your doctor has limited you to no lifting more than 20 pounds, but doesn’t limit your standing or walking, your RFC will be for light work. If you can carry up to 50 pounds for up to one-third of the day, and up to 25 pounds for up to two-thirds of a day, your RFC will be for medium work. For more information, see our article on the RFC assessment.
Using your RFC, the DDS claims examiner will look to see if you can do any jobs that you’ve done in the past 15 years ("past relevant work"). For instance, if you are assigned an RFC for light or medium work and you have always done heavy work, the consultant will find that you can’t go back to your past work.
If you can't return to one of your prior relevant jobs, the clams examiner will look to see whether, given your RFC, along with your age, education, and skills, there is any less demanding work you can do or easily learn to do. For example, if you were given an RFC for light work, it’s likely the SSA will find that there are many sedentary and light jobs you can do. However, there are some cases in which the consultant isn’t allowed to “send” you to other work. This is mostly true for workers above age 55, and sometimes age 50.
The SSA has a grid that sets out the vocational rules that determine whether a claimant will receive a medical-vocational allowance. These vocational rules take into account a person's RFC, age, the types of job skills they have, and their education level. Here are some examples of how the grid rules work.
To see the full grid of vocational rules, as well as explanations of the vocational rules, see our section on Social Security's grid rules by age.
If you can't do the medium work, light work, or even the full range of sedentary work, your situation doesn't fall into the grid, and you should be found disabled. For more information, see our article on getting disability when you can do "less than sedentary" work.
Return to the articles in How Social Security Decides if You are Disabled.