STEP ONE simply determines if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $830 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.
STEP TWO implies that the spinal disorder disability must be severe enough to significantly limit one’s ability to perform basic work activities needed to do most jobs. For example, the SSA must be able to determine that some or all of the activities below have been compromised as a result of the disability:
- walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling;
- seeing, hearing or speaking;
- understanding/carrying out and remembering simple instructions;
- use of judgment;
- responding appropriately to supervision, co-workers and usual work situations;
- dealing with changes in a routine work setting.
STEP THREE has back conditions evaluated under disorders of the spine – medical listing 1.04. The criteria for 1.04: Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With:
- Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine); OR
- Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours; OR
- Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively as defined in 1.00B2b*.
Inability to ambulate effectively means an extreme limitation of the ability to walk, i.e., an impairment(s) that interferes very seriously with the individual’s ability to independently initiate, sustain, or complete activities. Ineffective ambulation is defined generally as having insufficient lower extremity function to permit independent ambulation without the use of a hand-held assistive device(s) that limits the functioning of both upper extremities.
STEP FOUR explores the ability of an individual to perform work done in the past despite the spinal disorder disability. If the SSA finds that a person can do past work, benefits are denied. If the person cannot, then The Process proceeds to the fifth and final step.
STEP FIVE looks at age, education, work experience and physical/mental disorder to determine what other work, if any, the person can perform. To determine spinal disorder disability, the SSA enlists vocational rules, which vary according to age.
Social Security Rulings 85-15 and SSR 96-9p both describe how an individual must, on a sustained basis, be able to understand, remember and carry out simple instructions; make simple work-related decisions; respond appropriately to supervision, coworkers, usual work situations and to deal with changes in a routine work setting.
A substantial loss of ability to meet any one of these basic work related activities would severely limit the potential occupational base for all age groups and justify a finding of disabled. A person who has a medically determinable severe spinal impairment and is unable to unable to understand, remember or carry out simple instructions would be found disabled based on his/her mental residual function capacity.