Disability Determination

To get Supplemental Security Income (SSI) or Adult Public Assistance (APA), you must have a disability that meets standards set by the Social Security Administration (SSA). When you apply for either benefit, Social Security, together with Alaska Disability Determination Services (DDS), looks at everything you submit with your application and follows a five-step process.

Steps 1, 4, and 5 of the disability determination process look at your ability to work, while steps 2 and 3 look at your medical condition.

If Social Security says you have a disability, you may qualify for SSI and APA if your resources and income are below APA’s limits.

Note: This article presents the rules for adults ages 18 – 64. Seniors may qualify for benefits without having a disability.

You only need one disability determination

You have to apply for SSI and APA separately. However, Social Security only needs to do one disability determination for both programs. That means that if Social Security already determined you have a disability for one program, you do not need to get another disability determination if you apply for another benefit. For example, if you already get SSI benefits, you do not need another disability determination when you apply for APA.

Social Security Does Not Follow These Steps if You Are Blind

There are special rules to determine if someone is blind:

Usually, if your vision in your better eye cannot be corrected to better than 20/200 or your field of view is 20 degrees or less, you are considered blind.

Learn more about Social Security’s rules on blindness.

Step 1: Are You Working at a Level of Substantial Gainful Activity?

If you are working and your monthly earnings before taxes are deducted are higher than the Substantial Gainful Activity (SGA) level, you do not have a disability according to Social Security and you do not qualify for SSI or APA benefits. In 2019, SGA is $1,220.

If you are not working or if your earnings are less than the SGA level, Social Security moves on to the next step to decide if you have a disability.

Example

Mimi earns $22.00 per hour and works 60 hours per month. Her gross monthly earnings are $1,320 ($22.00 x 60), though after taxes are deducted, her actual paycheck is only $1,120.

Even though Mimi only gets $1,120 per month in checks, Social Security counts all of her $1,320 in gross monthly earnings. Since $1,320 is more than the SGA level ($1,220), Social Security says she does not have a disability.

Some deductions may lower your countable gross income below the SGA level

If you have a job, but your disability limits how much you can earn, you can still apply for SSI and APA benefits. If your income is over the SGA level, some rules might lower how much of your income gets counted. These are called deductions. The most common deductions during the disability determination process are Impairment Related Work Expenses (IRWEs) and subsidized earnings.

You have to document these deductions when you apply. They may help you qualify for SSI or APA when you would not qualify otherwise.

SGA if You Are Self-Employed

If you are self-employed, your work is evaluated differently when it is compared to SGA:

If you’re self-employed, Social Security looks at more than just your income, because the amount of money you actually get from your business may depend on many different factors. Instead, they use three tests.

If Social Security decides that you are not doing Substantial Gainful Activity using all three tests, you may qualify for SSI and APA.

Note: If you are self-employed and either blind or over age 55, there are special SGA rules. For more information, talk to a benefits planner.

Self-Employed: Test 1

If you perform services that are significant to the operation of your business and you get substantial income from the business, Social Security likely decides that you have done SGA and you do not qualify for SSI or APA.

Social Security considers the services you perform significant if:

  • You operate a business (other than a farm) all by yourself, or
  • You and at least one other person run the business and you do more than half of the management time. For example, if it takes 60 hours a month to manage your business and you manage it for 45 of those hours, your services are significant.

Social Security considers your income substantial if:

If Test 1 does not show you are doing Substantial Gainful Activity, Social Security moves on to Test 2.

Self-Employed: Test 2

Social Security examines the work you do to see if it counts as SGA. They look at things like hours worked, skills needed, responsibilities, and effort involved.

If the work you do is about the same as the work of nondisabled people who are in similar businesses in your community, Social Security decides that you are doing SGA and you do not qualify for SSI or APA.

If Test 2 does not show you are doing Substantial Gainful Activity, Social Security moves on to Test 3.

Self-Employed: Test 3

Social Security looks at your monthly work. If your work is worth at least $1,220 per month in its impact on your business, or if you’d have to pay someone at least $1,220 per month to do that work, you are doing Substantial Gainful Activity.

If Test 3 does not show that you are doing Substantial Gainful Activity, Social Security moves on to the next step of the disability determination process and you may qualify for SSI and APA.

Step 2: Is Your Medical Condition Severe?

For Social Security to say you have a disability, your medical condition must be expected to either:

  • Significantly limit your ability to perform basic work activities for at least 12 consecutive months, or
  • Result in death.

If it does not, you are not considered to have a disability and do not qualify for SSI or APA benefits.

If your medical condition meets this standard, Social Security moves on to the next step to decide if you have a disability.

Step 3: Is Your Medical Condition on Social Security’s List of Impairments?

Social Security’s List of Impairments includes many mental and physical conditions. If your condition is on the list, Social Security decides that you have a disability and skips steps 4 and 5.

If your condition is not on the list, Social Security considers whether your condition is as severe as a condition that is on the list. If it is, Social Security decides that you have a disability and skips steps 4 and 5.

If your condition is not as severe, Social Security moves on to the next step to decide if you have a disability.

Step 4: Can You Do the Same Work You Did Before?

If your condition doesn’t stop you from doing the work you did before, Social Security says you do not have a disability and do not qualify for SSI or APA benefits.

If your medical condition does stop you from doing the same work you did before, Social Security moves on to the final step to decide if you have a disability.

Example

Luigi was a construction worker. He fell off his motorcycle one day and severely injured his knees. Because he has limited mobility and can no longer stand for long periods of time, he can’t do construction anymore.

Luigi cannot do the same work he did before and SSA will continue to look into whether he has a disability.

Step 5: Can You Do Any Other Type of Work?

If you can’t do the work you used to do, Social Security looks at your skills and your condition to see if there is other work you could do.

If your condition doesn’t prevent you from doing other work and earning at the SGA level, you are not considered to have a disability and will not qualify for SSI or APA benefits.

Example

While Luigi’s injury prevents him from doing construction on site, he could still manage construction projects from a desk, so Social Security might say he doesn’t have a disability.

If your medical condition does stop you from doing other work and earning at the SGA level, Social Security says that you have a disability, as long as you have met the other four criteria.

If you have a disability, low resources, and low income, you may qualify for SSI and APA benefits.