A Guide to Key Terms and Definitions Commonly Used in a Disability Claim
This webpage provides valuable information categorized into different sections to help you navigate the complex world of disability benefits. Below, you will find an overview of each term and concept, along with links for further information.
Appeals Process and Decisions
Appeals Council: the body responsible for reviewing decisions made by Administrative Law Judges
Reconsideration: The first step in the appeals process if a claim is initially denied, involving a review of the case by a different examiner
Administrative Law Judge (ALJ): a judge that conduct hearings and issues decisions on disability claims
Administrative Review: The process of reviewing a decision by the Appeals Council or a federal court after a hearing has taken place
On-the-Record Decision: A decision made based on the evidence in the claimant's case file without the need for a hearing
Fully Favorable Decision: A decision in favor of the claimant, stating that they are disabled and entitled to receive benefits
Disability Criteria and Determination
Disability: the inability to engage in Substantial Gainful Activity(SGA) due to any medically determinable physical or mental impairment that has lasted or is expected to last 12 months or result in death
Disability Determination Services (DDS): a state agency responsible for making disability determinations on behalf of the Social Security Administration (SSA). DDS evaluates medical evidence and other relevant information to determine whether an individual meets the criteria for disability benefits under the SSA's guidelines
Disability Determination: The process of evaluating medical evidence and other relevant information to determine if an individual meets the criteria for disability benefits
Dictionary of Occupational Titles (DOT): a publication created by the U.S. Department of Labor that provides detailed information about various occupations. It includes descriptions of job duties, physical and mental demands, required skills and abilities, and other relevant information about different types of work
Onset Date: The date when a claimant's disability is determined to have begun, affecting the eligibility for benefits
Residual Functional Capacity: an administrative assessment of a claimant's maximum remaining capacity for work on a sustained basis
Medical Evidence: Documentation such as medical records, test results, and reports that substantiate a claimant's disability and its severity
Consultative Examination: A medical evaluation requested by the Social Security Administration to obtain additional information about a claimant's condition
Impairment Listing: A list of medical conditions and criteria established by the Social Security Administration that automatically qualify as disabilities
Substantial Evidence: The standard of proof required to support a decision, indicating that there is enough valid and reliable evidence to justify the conclusion
Medical-Vocational Guidelines (Grid Rules): A set of guidelines used to evaluate disability claims based on a claimant's age, education, work experience, and residual functional capacity
Overpayment: When a claimant receives more benefits than they are entitled to, resulting in a debt owed to the Social Security Administration
Work-Related Factors
Vocational Expert: An expert who assesses a claimant's work-related abilities and provides insight into job availability and requirements
Work Experience: experience that a claimant has acquired from past relevant work
Past Relevant Work(PRW): previous employment that was performed in the claimant's relevant work period, was performed at sustainable gainful activity(SGA), and lasted long enough for the claimant to learn the skills, information, and facilities to perform the job at an average level
Transferable Skills: skills that a claimant has acquired performing past relevant skilled or semi-skilled work that can be applied to meet the requirements of other work that falls within a claimant's residual functional capacity
Skilled Work: work that requires high levels of judgement and adaptability, involves setting realistic goals or making plans independently, requires understanding, carrying out, remembering complex instructions, and often encompasses abstract ideas and problem solving
Unskilled work: work that requires little to no judgment to do simple duties that can be learned on the job in a short period of time
Personal Factors
Age
Younger Individual: Under age 50
Closely Approaching Advanced Age: Age 50-54
Advanced Age: Age 55-59
Closely Approaching Retirement Age: Over age 60
Education
Illiterate: the inability to write in English, the inability to read in English, or the inability to speak or understand English, or any combination of the above
Marginal Education: has completed 6th grade education or less
Limited Education: has completed 7th-11th grade education
High School Education: has a GED equivalency or has completed 12th grade or higher
Recent Education: has completed recent education that allows the claimant to work a semi-skilled or skilled job
Functional Limitations and Exertional Levels
Sedentary Work: can occasionally lift up to 10 lbs
Light Work: can occasionally lift up to 20 lbs, frequently lift up to 10 lbs
Can walk or stand for 6 hours of an eight hour day
Medium Work: can occasionally lift up to 20 to 50 lbs, can frequently lift up to 10 to 25 lbs, can constantly lift up to 10 lbs
Heavy Work: can occasionally lift 50 to 100 lbs, can frequently lift 25 to 50 lbs, can constantly lift 10 to 20 lbs
Very Heavy Work: can occasionally lift over 100 lbs, can frequently lift over 50 lbs, can constantly lift over 20 lbs
Never: not once during an eight hour day
Occasionally: 1/3 of an eight hour day
Frequently: 1/3 to 2/3 of an eight hour day
Constantly: over 2/3 of an eight hour day
Maximum Sustained Work Capacity: the highest functional level a person can perform work
Exertional Limitation: a limitation that is related to an impairment that reduces a claimant's capacity to sit, stand, walk, lift, carry, push, or pull
Non-exertional Limitation: a limitation that is related to an impairment and affects work activity that is not one of the seven strength factors (sitting, standing, walking, lifting, carrying, pushing, or pulling)
Restriction: something a claimant should not do, whether exertional or non-exertional, due to an impairment-related risk to yourself or others
Accommodation: a modification or an adjustment that is made to allow an individual with a disability to perform work duties
Programs and Thresholds
Compassionate Allowances: A program that expedites the approval process for certain severe medical conditions that clearly meet the disability criteria
Substantial Gainful Activity (SGA) Threshold: The monthly income limit set by the Social Security Administration, above which a person is considered capable of engaging in substantial gainful activity
Trial Work Period: A period during which a disability beneficiary can test their ability to work without losing their disability benefits
Ticket to Work Program: A voluntary program that offers disabled individuals access to employment services, vocational rehabilitation, and other support to help them enter or reenter the workforce
Continuing Disability Review: a periodic review to determine if a person's disability still meets the required criteria
Cost-of-Living Adjustment (COLA): An annual adjustment to Social Security benefits to account for the increased cost of living
Unsuccessful Work Attempt: A brief period of work performed by a disabled individual that is not considered substantial gainful activity and does not affect their disability status