The Second Step in Social Security’s 5-Step Disability Analysis – Severe Impairments

Social Security reviews cases using a five-step sequential evaluation process to decide when an individual a person is disabled under the agency’s rules. Previously we looked at these five steps in brief and at the First Step (Substantial Gainful Activity) more deeply.

Here is a longer look at the Second Step in the 5 questions that make up the sequential evaluation process: Severity

Step 2: Severity

For an impairment to be severe, it has to cause more than a minimal effect on one’s ability to perform daily activities. For Example: many people have asthma. However, asthma is not always disabling. Asthma is often well controlled with medications. When it is not well controlled, it may be a severe impairment. Having a “severe” condition is a pretty low standard and it is usually fairly easy to show that a condition has more than a minimal effect on daily activities.

One need not be receiving current treatment for an impairment to be considered severe, of course it certainly helps if one has a current treating doctor. The impairment merely be considered a “medically determinable impairment (MDI)” – this does not even mean that one has to have a medical diagnosis of the condition – it simply means that the condition must be one that can be diagnosed. Thus, a condition like a back problem or depression would be considered an MDI. However, a symptom such as “pain” would not be an MDI no matter how severe as pain is considered a symptom and not an impairment. The underlying condition causing the pain – Fibromyalgia, Degenerative Disc Disease, Osteoarthritis, etc. – would be the impairment and the functional limitations resulting from the intense pain levels would make it severe.

The second part of this may be more difficult. The condition has to be expected to remain severe for 12 months or longer, or be expected to result in death. So, a back injury, i.e. a back strain, that would be expected to resolve in six months would not be considered severe as it is not expected to last more than 12 months. Whereas, a bladder cancer diagnosis with a prognosis of six months to live would be considered severe as it is expected to result in death.

We will discuss Step 3 – Meeting a Listing (also known as the shortcut step) in a future post.

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