Oklahoma Bar Journal
Government & Administrative Law Practice
Disability Benefits: Navigating the Procedural and Substantive Processes
By Deirdre Dexter and Jessica Tait
UNDERSTANDING SOCIAL SECURITY DISABILITY BENEFITS
Disability benefits are separated into two types: Social Security Disability Insurance (SSDI), Title II of the Social Security Act,[1] and Supplemental Security Income (SSI), Title XVI of the Social Security Act.[2] The eligibility rules for each are different. Generally, to be eligible for SSDI, you must be “insured,” meaning that you have earned at least 40 work credits, 20 of which were earned in the last 10 years, although younger workers may qualify with fewer credits.[3] Work credits are determined by your total annual wages or self-employment income from a job that is covered by Social Security and for which Social Security taxes have been paid. The actual threshold for credits is low, e.g., in 2026, you will earn the maximum four credits available annually by earning at least $7,560 for the year. The purpose of Title II benefits is financial protection for workers who have contributed to the Social Security trust fund, i.e., have paid into FICA, the federal payroll tax that funds Social Security and Medicare programs, and have had their earned income interrupted by disability. In contrast, SSI benefits are for individuals who have limited income and resources.[4] While these eligibility determinations are important, the focus of this article is the actual rules regarding disability rather than eligibility, so no further discussion of the eligibility requirements is included herein.
THE SEQUENTIAL EVALUATION PROCESS
Disability is defined under both Title II and XVI as the inability to engage in any substantial gainful activity (SGA)[5] because of a medically determinable physical or mental disability(ies) that is either expected to result in death or has lasted or is expected to last for a continuous period of at least 12 months.[6] In making the disability determination, SSA’s regulations provide a procedure known as the “sequential evaluation process” for disability evaluation.[7] For adults, this is a consecutive five-step process and if the SSA can find the individual, known as the claimant, disabled or not disabled at a step, the agency will make its determination or decision and will not go on to the next step. If the SSA cannot find that the claimant is disabled or not disabled at a step, it will go on to the next step.
Step One: Is the Claimant Engaged in Substantial Gainful Activity?
Step one of the sequential evaluation process asks: Is the claimant engaging in SGA? If the claimant is working, and the work performed is SGA, they are not disabled regardless of their medical condition or their age, education, and work experience.[8] Essentially, the agency will review the claimant’s earnings records, and if there is evidence that the claimant is working or worked after the disability application was filed, and earnings exceed a certain monthly amount, which is codified in the regulations, the inquiry is finished, and the claimant is not disabled. For example, for calendar year 2025, if countable earnings average more than $1,620 per month, those earnings are SGA.[9]
Step Two: Does the Claimant Have a Severe Medically Determinable Impairment?
If the claimant is not working or is working but not at SGA, step two of the sequential evaluation process asks: What is the severity of the claimant’s impairment(s), both mental and physical? Severity has two components: duration (the impairment must result in death or last at least 12 months) and evidence that the impairment significantly limits the claimant’s physical or mental ability to do basic work activities.[10] Nonsevere impairments, in contrast, do not significantly limit one’s ability to do basic work activities.[11] Importantly, the agency only considers physical and mental impairments that are medically determinable, meaning the impairment(s) must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques, i.e., objective medical evidence from an acceptable medical source.[12] The claimant’s allegation of symptoms, as well a diagnosis or a medical opinion standing alone is not sufficient to establish the existence of an impairment(s);[13] it is imperative that objective evidence is provided to support a finding that the claimant has a medically determinable impairment (MDI). If the claimant does not provide objective evidence showing a severe, medically determinable impairment(s) (or a combination thereof), the claimant is not disabled and the analysis ends.
Step Three: Does the Impairment Meet or Equal a Listing?
If the claimant does have a severe medically determinable impairment(s), step three of the sequential evaluation process requires a finding whether the claimant’s impairment(s) meets or medically equals a listing.[14] The listings are divided into 14 separate body systems (cardiovascular – listing 4.00, neurological – listing 11.00, musculoskeletal – listing 1.00, etc.), including mental, and each body system is further sorted into specific impairments.[15] The listings contain the medical criteria that apply to the evaluation of impairments and the determination of whether a listing is met or “medically equaled.”[16] If the claimant’s impairments meet or medically equal a listing, they are considered severe enough to prevent the claimant from performing any substantial gainful activities, and the claimant is disabled. For example, if a claimant has a severe MDI of heart failure, the medical evidence will be evaluated under listing 4.02, which addresses chronic heart failure and requires certain findings on appropriate medically acceptable imaging such as x-rays, echocardiography, radionuclide studies, or cardiac catheterization. If the claimant’s impairment does not meet the specific requirements of a listing but the totality of the evidence shows that the impairment is at least equal in severity and duration to the criteria of any listed impairment, disability can be based on a finding of medical equivalence.
Step Four: Can the Claimant Perform Past Relevant Work?
If the claimant does not meet or medically equal a listing, the analysis proceeds to step four, which considers the claimant’s residual functional capacity (RFC) and past relevant work (PRW). A claimant’s RFC sets out those daily activities that the claimant can still do on a regular and continuing basis (eight hours a day, five days per week or the equivalent) despite their impairments and symptoms.[17] The RFC assessment contemplates the claimant’s ability to meet the physical (How long can the claimant stand and walk? How much can they lift? Can they climb stairs? How often can they use their hands?), mental (Can the claimant interact with the public? Can they concentrate for a full workday? Can they tolerate changes in routine?), sensory (Can the claimant communicate? Can they read print or see hazards?), and other requirements of work. Physical exertion requirements are categorized as sedentary, light, medium, heavy, and very heavy work.[18] Nonexertional limitations are categorized as mental, postural, manipulative, environmental, communicative, and visual.[19] The residual functional capacity is “based on all the relevant evidence” in the file,[20] which includes not only evidence of severe MDIs but nonsevere as well, in addition to the claimant’s report of daily activities, medical source statements, lay evidence, and more.[21]
Once assessed, the residual functional capacity is compared to the claimant’s vocational background, which is described as PRW. PRW is defined as work performed within the past five years[22] that was performed at substantial gainful activity and performed long enough to learn it, which means the worker “gained sufficient job experience to learn the techniques, acquire information, and develop the facility needed for average performance in the job.”[23] If work was started and stopped in fewer than 30 calendar days, it is not PRW.[24] The time it takes to learn a job is typically expressed using a specific vocational preparation (SVP) number, ranging from one to nine, where SVP 1 (unskilled) requires only a short demonstration, while SVP 9 (highly skilled work) generally requires the job be performed for over 10 years. For example, learning to be proficient at the job of fast-food cashier (unskilled, SVP 2) will take much less time than learning to be proficient as an attorney (highly skilled, SVP 8). If the claimant has the residual functional capacity to perform PRW, they are not disabled, and the sequential evaluation process moves to the final step.[25]
Step Five: Can the Claimant Perform Other Work?
Step five considers not whether the claimant can return to PRW, but rather if there is any other work in the national economy[26] that the claimant can perform given the RFC in combination with their age, education,[27] and work experience.[28] Age is divided into three categories: younger (under 50), closely approaching advanced age (50-54), and advanced age (55 or older).[29] In order to promote consistency in disability determinations/decisions, the agency has published medical-vocational guidelines, referred to as the “grid rules.” The grid rules are three tables representing sedentary (Table 1/Rule 201.00), light (Table 2/Rule 202.00), and medium (Table 3/Rule 203.00) exertional work, and each table is further divided into age categories, education, and previous work experience. These rules answer the question of whether the claimant can perform other work in the national economy by directing certain findings (disabled vs. not disabled) based on the combination of RFC (considering only exertional limitations), age, education, and past work experience.[30]
For example, if the claimant is 55 years of age or older, with a ninth-grade education, no PRW, and with an RFC to perform light work (defined as six hours of standing and/or walking during the workday and lifting no more than 20 pounds) then the claimant “grids” disabled under rule 202.01. If a claimant is limited to sedentary work (defined as sitting six hours during the day and lifting no more than 10 pounds) and is 50 years of age or older (but not yet age 55) with a ninth-grade education and no PRW, the grid rules will direct a finding that the claimant is disabled (Rule 201.09). When considering PRW, if that work is semiskilled or skilled, and depending on the claimant’s age, education, and RFC, an analysis of whether the claimant acquired any transferrable skills may also be necessary.[31]
When the Claimant Doesn’t Meet a Grid Rule
If the claimant does not meet a grid rule, in other words, if the claimant cannot be found disabled based on exertional limitations alone, the claim is not denied. Instead, all the claimant’s exertional and nonexertional (including mental) limitations will be considered together to determine what the claimant is still able to do functionally. The grid rules (Tables 1, 2, and 3), which again consider the claimant’s residual functional capacity, age, education, and PRW, are then used as a framework to determine if the claimant is disabled.[32]
BEGINNING THE DISABILITY APPLICATION PROCESS
To begin the disability process, an application must be submitted to the state-level local field office. This can be done by calling 1-800-772-1213 or by submitting an application online at www.ssa.gov/disability. The SSA is encouraging everyone to establish a mySSA.gov account, which provides access to services and forms and the ability to manage benefits online at any time. After the application is filed, the field office will call and interview the applicant and request certain documents be signed, such as a “Work History Report” (Form SSA-3369-BK) and an “Authorization to Disclose Information to the Social Security Administration” form (Form SSA-827). The latter will allow the office to obtain copies of medical records from the claimant’s medical providers. Once the field office determines that the claimant meets the nonmedical requirements, the claim is forwarded to the state-level agency, Disability Determination Services (DDS), which the federal government funds, where a disability examiner will review all the evidence in the file and issue a determination following the regulations under Title II and Title XVI.[33]
The DDS level is where medical evidence begins to play a crucial role in the disability process because, as noted above, the agency requires objective medical evidence from an acceptable medical source and will not rely on the claimant’s allegation of symptoms, a diagnosis, or a medical opinion to find a claimant is disabled. The best source of medical evidence about the nature and severity of the claimant’s impairment(s) will be the claimant’s own medical sources who have evaluated, examined, or treated the claimant. The claimant may have several healthcare providers depending on the nature of the medical issues involved (such as a psychiatrist, neurologist, primary care provider, surgeon, etc.). If the claimant’s own medical sources cannot or will not provide sufficient medical evidence about their impairment, the disability examiner may order a physical or mental examination, typically called a consultative examination (CE), at the agency’s expense to be performed by a qualified medical source.[34] It is important that the claimant attend a CE scheduled by DDS because failure to attend without good cause may (and often does) result in a finding that the claimant is not disabled.
INITIAL DETERMINATIONS AND RECONSIDERATION
Once all the evidence, medical and otherwise, is in the file, the disability examiner, typically along with a state agency medical and/or psychological consultant, will decide the claim using the sequential evaluation process[35] and issue the initial determination with notice to the claimant.[36] If the claimant is found disabled and awarded benefits, the disability process is generally completed unless the claimant returns to work, is later found to have medical improvement, or another disqualifying event is found to exist.[37] If the application is denied at the initial level, the claimant may request reconsideration of the initial determination generally within 60 days after the date the determination notice is received, which is the first step in the administrative review process.[38] Timely reconsideration requests are typically granted.
At reconsideration, a new disability examiner, typically along with a new state agency medical and/or psychological consultant, will review the evidence in the file at the time of the initial determination, along with updated medical records, if any, the latter of which could alter the outcome from a denial of benefits to an award. As at the initial level, DDS will issue a reconsideration determination and send notice to the claimant. If benefits are denied at reconsideration, the claimant may file a request for hearing[39] before an administrative law judge (ALJ) within 60 days after the date the determination notice is received, which moves the case to the hearing office.[40] The hearing office will set the case for hearing with ample notice to the claimant and representative, if any.[41] At the hearing, the ALJ will take testimony from the claimant and a vocational expert (VE), an impartial vocational professional with whom the agency contracts.[42] While ALJs are expected to be able to read and comprehend medical evidence, in certain instances, for example if the claimant has an uncommon medical impairment, the ALJ might engage a medical expert via interrogatories or hearing testimony to better understand the medical evidence in the case. A medical expert will review the medical evidence before the hearing (or when issued interrogatories) and offer both factual and expert opinion evidence based on knowledge of SSA’s rules.[43]
The vocational experts provide testimony at steps four and five. During the hearing, the ALJ will ask the claimant to describe work performed during the five-year period leading up to the hearing. This testimony, along with any work history reports in the file, will form the basis for the VE to provide testimony that characterizes that past work, if any. After that, the ALJ will propose hypothetical RFCs based on the evidence at the hearing based on both the medical records and the claimant’s testimony.[44] An example of such a hypothetical would be: “Assume a hypothetical individual who is 53 years old, with a high school education and with PRW as previously described. This hypothetical person can lift up to 10 pounds and can stand and/or walk up to two hours in an eight-hour workday. This hypothetical individual is able to occasionally climb ramps and stairs and is able to frequently stoop, kneel, crouch, and crawl. The hypothetical person cannot interact with the public.” The hypothetical is posed to the VE, who will determine if the hypothetical individual can perform the claimant’s past work given the limitations. The VE will also determine if the claimant has any transferrable skills to other work at step five. If the claimant cannot return to or has no PRW, the VE will provide jobs that exist in the national economy[45] (step five), if any, that the claimant is capable of performing despite their limitations. If the claimant is able to perform work in the national economy, despite the medically determinable impairments, then the claimant is not disabled and benefits will be denied.[46]
The Social Security disability process is long and requires the claimant’s participation throughout to provide information about medical treatment, work history, and activities of daily living, to attend CEs if ordered, to attend the hearing, and to communicate with the agency. The disability process is not an adversarial proceeding, and disability hearings do not take place in a court of law, although all participants in the hearing will be sworn to testify truthfully under penalty of perjury. While there is no requirement that a claimant have a representative assist during the disability process, disability attorneys and nonattorney representatives can be helpful in obtaining medical evidence, presenting the claimant’s allegations and arguments at the hearing, and ensuring filing deadlines are timely met.[47]
ABOUT THE AUTHORS
Deirdre O. Dexter has been a member of the OBA since 1984 and has practiced law with private firms and governmental agencies as well as serving as city attorney for the city of Tulsa and district judge for Tulsa County. Prior to retiring in June 2025, Ms. Dexter had served for more than a decade as an administrative law judge for the Social Security Administration.
Jessica Tait graduated from the TU College of Law in 2011. She has worked as an attorney advisor for the Social Security Administration since 2017.
ENDNOTES
[1] 20 CFR §404.1520.
[2] 20 CFR §416.920.
[3] 20 CFR §§404.130 et seq.
[4] 20 CFR §§416.203 et seq.
[5] SGA is doing significant and productive physical or mental duties for (or intended for) pay or profit. See 20 CFR §§404.1510, 404.1572; 20 CFR §§416.910, 416.972.
[6] 20 CFR §404.1505; 20 CFR §416.905.
[7] 20 CFR §404.1520; 20 CFR §416.920.
[8] 20 CFR §404.1520(a)(4)(i) and (b); 20 CFR §416.920(a)(4)(i) and (b).
[9] 20 CFR §404.1574; 20 CFR §416.974; see POMS (Program Operations Manual System) DI 10501.015 for the yearly SGA amounts. The POMS are operational instructions for SSA employees to process disability claims. Note, self-employment guidelines are at 20 CFR §404.1575; 20 CFR §416.975.
[10] 20 CFR §404.1520(a)(4)(ii) and (c); 20 CFR §416.920(a)(4)(ii) and (c).
[11] 20 CFR §404.1522; 20 CFR §416.922. See also SSR 85-28. SSRs (Social Security Rulings) are binding, precedential policy interpretations and decisions the agency publishes providing official guidance to SSA employees such as ALJs.
[12] See 20 CFR §404.1502 and 20 CFR §416.902 for the definition of an acceptable medical source.
[13] 20 CFR §404.1521; 20 CFR §416.921.
[14] 20 CFR §404.1520(a)(4)(iii) and (d); 20 CFR §416.920(a)(4)(iii) and (d).
[15] Appendix 1 to Subpart P of Part 404 – Listing of Impairments; see also https://bit.ly/4r33tyM, which provides information regarding the evidentiary requirements and other useful information related to impairments.
[16] 20 CFR §404.1526; 20 CFR §416.926.
[17] 20 CFR §§404.1545, 404.1546; 20 CFR §§416.945, 416.946. See also SSR 96-8p.
[18] 20 CFR §§404.1567, 404.1569a(b); 20 CFR §§416.967, 416.969a(b). See also SSR 83-10 and SSR 85-15.
[19] 20 CFR §404.1569a(c); 20 CFR §416.969a(c). See also SSR 83-10 and SSR 85-15.
[20] 20 CFR §404.1545(a)(1) 20 CFR §416.945(a)(1).
[21] 20 CFR §404.1545(a)(2); 20 CFR §416.945(a)(2). See also SSR 96-8p.
[22] Typically, as of the date of the determination or decision.
[23] See SSR 24-2p.
[24] 20 CFR §404.1560; 20 CFR §416.960. See also SSR 24-2p.
[25] Not all claimants will have PRW and if they do not, the analysis proceeds to step five.
[26] 2 CFR §404.1566; 20 CFR §416.966.
[27] 20 CFR §404.1564; 20 CFR §416.964.
[28] 20 CFR §404.1520(a)(4)(v); 20 CFR §416.920(a)(4)(v).
[29] 20 CFR §404.1563; 20 CFR §416.963.
[30] Appendix 2 to Subpart P of Part 404 – Medical-Vocational Guidelines. See also 20 CFR §404.1569; 20 CFR §416.969.
[31] 20 CFR §404.1568; 20 CFR §416.968. See also SSR 83-11.
[32] 20 CFR §404.1569a(d); 20 CFR 416.969a(d) Appendix 2 to Subpart P of Part 404 – Medical-Vocational Guidelines, 200.00(e)(2)s; SSR 83-12; SSR 83-14.
[33] 20 CFR §404.1601 et seq.; 20 CFR §416.1001 et seq.
[34] 20 CFR §404.1517 et seq.; 20 CFR §416.917 et seq. See 20 CFR §1518; 20 CFR §416.918 (regarding denial for failure to attend CE).
[35] 20 CFR §§404.1615, 404.1616; 20 CFR §§416.1015, 416.1016.
[36] 20 CFR §404.902 et seq.; 20 CFR §416.1402 et seq.
[37] The rules and regulations governing return to work issues, medical improvement or other disqualifying events are beyond the scope of this article on the basics of SSA disability claims.
[38] 20 CFR §404.907 et seq.; 20 CFR §416.1407 et seq.
[39] 20 CFR §404.919 et seq.; 20 CFR §416.1429 et seq. Form HA-501 is “Request for Hearing by Administrative Law Judge,” form but a written request with the individual’s name and Social Security number, spouse’s name and Social Security number, the reasons for disagreeing with the reconsideration determination, a statement of additional evidence to be submitted and the date of submittal, and the name and address of any designated representative will suffice.
[40] Over the last decade, the hearing office has had a variety of designations. For purposes of this article specific designations are ignored in favor of a general reference to the “hearing office.”
[41] Representatives can be attorneys or non-attorneys. See 20 CFR §404.1705; 20 CFR §416.1505.
[42] 20 CFR §404.1566(e); 20 CFR §416.966(e). See also SSR 24-3p and HA 01250.048.
[43] See HA 1250.034. HA, or HALLEX, is the Hearings, Appeals, and Litigation Law Manual.
[44] While the individual’s testimony cannot be relied on the establish an MDI, the testimony may be relied upon to assess symptoms such as pain in considering what it is the individual can and cannot do. See SSR 16-3p.
[45] 20 CFR §404.1566; 20 CFR §416.966.
[46] If the claim is denied at the hearing level, the claimant may appeal first to the Appeals Council, and if denied at the Appeals Council, the federal district court. See 20 CFR §404.967 et seq.; 20 CFR 416.1467 et seq.
[47] If appealed to the federal district court, an attorney will be required unless the claimant proceeds pro se.
Originally published in the Oklahoma Bar Journal – OBJ 97 No. 8 (October 2026)
Statements or opinions expressed in the Oklahoma Bar Journal are those of the authors and do not necessarily reflect those of the Oklahoma Bar Association, its officers, Board of Governors, Board of Editors or staff.