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Martin on Social Security Treatise - Part 2-P
Part 2 � Topics Establishing Disability
� P 000. Overall Treatment of Burden of Proof and Evidence
The Act places the burden of establishing entitlement on the disability benefit claimant.� It does provide, however, for consultative medical examinations that may provide needed medical evidence of an impairment.
When a claimant has established that he or she has a serious impairment that prevents return to past relevant work, courts hold that the burden shifts to the Agency to establish that there is other work that a person with such impairments and the claimant�s vocational characteristics can perform.
These burden of proof rules are structured by a sequential evaluation process that lays out five distinct stages in the determination.� Stages one through four lie in the zone where the burden is on the claimant.� They include: (1) the preliminary question whether, despite impairments, the claimant is, in fact, engaged in �substantial gainful activity,� (2) the determination whether the claimant has an impairment of sufficient severity to interfere with the ability to perform work activities, (3) a comparison of the claimant�s medical impairments with the listing of numerous conditions warranting a conclusion of disability, and (4) a determination whether the claimant has the ability to perform past relevant work. In stage five where the issue is whether there is other work that a person with the claimant�s characteristics can do the burden is on the Agency but in any case covered by the Medical-Vocation Guidelines, the guidelines themselves may meet that burden.� In cases not governed by the guidelines, there must be other evidence.
These five stages operate in sequence.� Evidence that would be relevant or even dispositive at a later stage will not prevent a contrary decision at an earlier one.� The regulations lay out this process in great detail.� Social Security Ruling SSR No. 86-8 provides explanation.
Courts employing the substantial evidence standard have developed other more specific burden of proof or evidentiary rules, such as rules according special weight to medical testimony or reports coming from the claimant�s treating physician.
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 100. Duration of Disability
Short term disabilities, no matter how severe, do not entitle an individual to receive Social Security disability benefits.� To qualify for benefits the individual�s impairment must be expected to last for a continuous period of at least 12 months or to result in death.� This test is particularly difficult to apply to conditions that recur in periodic episodes between which the individual is able to function reasonably.
In Barnhart v. Walton, 535 U.S. 212 (2002), the Supreme Court upheld the Agency�s interpretation of the Act, which is that not only must the impairment meet the 12-month test, but it must prevent substantial gainful activity for that period.� Walton rejected the position taken by several circuits that so long as an impairment was �expected to last� for 12 months, work at the �substantial gainful activity� level within that period would not preclude entitlement.� It could qualify as �trial work.� Distinct from the duration requirement is a five-month waiting period.� Even in a case meeting the duration test (for example, a claimant with a disabling impairment expected to result in death) benefits are not available for the first five months following onset.
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 200. Claimant Engaged in Substantial Gainful Activity � In General
No matter how severe an individual�s physical and mental impairments, disability benefits are not available if the individual continues to engage in substantial gainful activity, that is, continues to work for significant compensation. Earnings above an amount set by regulation and adjusted annually ($940 per month for 2008) can establish an ability to engage in substantial gainful activity. However, short periods of work at or above that rate can be disregarded as �unsuccessful work attempts.� Social Security Ruling SSR No. 05-02 sets out a framework for determining when that should occur.
Applying the concept of engaging in substantial gainful activity to illegal income has proven particularly difficult. A 1994 amendment removed any doubt about whether illegal earnings count.
Individuals who meet the Act�s definition of blindness have their earnings treated differently. Their monthly earnings are measured against a higher amount in determining whether or not they retain the ability to engage in substantial gainful activity ($1,570 per month for 2008). Furthermore, blind claimants who are 55 or older can still qualify as disabled despite even larger earnings if they are no longer able to engage in their regular work.
Once benefits have begun, earnings above the substantial gainful activity level can cause their loss, but termination does not occur abruptly because of the recipient�s right to a period of trial work. Issues exist concerning the applicability of the Act�s trial work provisions to earnings received prior to the commencement of benefits. Rev. 11/07
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 210. Claimant Engaged in Substantial Gainful Activity � Sheltered Work Issues
Only amounts paid for productive work are counted in determining whether earnings from work establish that a claimant is not disabled. If the employment is being subsidized the amount of the subsidy is not treated as earnings.� This determination is made on an individual basis; the mere fact that a person is working in a sheltered workshop run by a charitable organization does not compel a finding that that person�s pay is subsidized.
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 220. Claimant Engaged in Substantial Gainful Activity � Self-Employment Issues
Income from self-employment does not establish the capacity to do substantial gainful activity without consideration of the individual�s actual work activity. Income that a person receives as a share of profits or as a return on investment has no bearing on disability.� The individual�s work activity is considered in comparison with unimpaired individuals.� The compensation is compared to the salary that would have to be paid an employee for the same work, and the level of services rendered are weighed in determining whether the self-employment constitutes substantial gainful activity.
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 230. Claimant Engaged in Substantial Gainful Activity � Treatment of Impairment Expenses
Work expenses that are the result of the individual�s impairment are subtracted from any earnings before those earnings are compared to the earnings levels used to determine whether or not the individual is engaged in substantial gainful activity.� To be offset the expenses must actually be borne by the individual and not paid by some other source.� Deductible impairment expenses include equipment, drugs and medical supplies and attendant care services.
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 300. Threshold Test of Severity
The regulations provide for a determination that a claimant is not disabled on the threshold ground that the individual does not have impairments that place a significant limit on the individual�s physical or mental ability to do basic work activities.� This �de minimis� test has been the subject of extensive litigation.
In Bowen v. Yuckert, 482 U.S. 137 (1987), the Supreme Court upheld the validity of the regulation imposing this threshold test of severity.� It had been attacked on the ground that it violated the Act�s requirement that the Agency consider a claimant�s age, education, and work experience.� The Court found authority in the Act to place the burden on the claimant to establish the existence of a limiting impairment.
Social Security Ruling SSR No. 85-28 frames the test in terms of whether the claimant has a medical condition that interferes with the ability to perform basic work activities, listing examples of those activities.� SSR No. 96-3p focuses on the medical component of this threshold test and the necessity of taking account of limitations and restrictions resulting from pain and other impairment-related symptoms.
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 400. Listed Impairment or Equivalent
The regulations include a Listing of Medical Impairments, organized by body system, that provide a basis for determinations that many individuals are disabled without further evidence of their inability to work or consideration of their age, education, and work experience.� Anyone with impairments that equal the type and level specified in that listing or possessing impairments that are their equivalent is determined to be disabled.� Several different tests or listings may apply to a particular body system or condition.� Where they are set up as alternatives all that the claimant need establish is that one of them is met.
For some medical conditions, Social Security Rulings augment the listings and elaborate on how such complaints should be evaluated throughout the sequential evaluation process.� See, for example, Social Security Ruling SSR No. 03-1p dealing with the treatment of polio residuals, Social Security Ruling SSR No. 02-2p dealing with Interstitial Cystitis, and Social Security Ruling SSR No. 99-2p dealing with Chronic Fatigue Syndrome.� Obesity, for which there once was a listing, is now covered by Social Security Ruling No. 02-1p.
Social Security Ruling SSR No. 96-6p requires that ALJ or Appeals Council decisions of disability based on medical equivalence rest on updated medical expert opinion.
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 500. Claimant�s Ability to Perform Past Relevant Work
Individuals who are not found to be disabled on the basis of the listed impairments must establish that their residual functional capacity does not allow them to meet the physical and mental demands of work they have done in the past.� How recent and of what duration that past work activity must be to provide a relevant base line can sometimes be a difficult issue.� How broadly or narrowly the prior work is characterized can also prove critical.
Social Security Ruling SSR No. 82-62 notes that for past work to be considered the individual should have been engaged in it for sufficient time to learn how to perform work of that type.� The Agency takes the view, reflected in SSR No. 82-61, that the past work need not be shown to exist in significant numbers in the national economy.� In Barnhart v. Thomas, 540 U.S. 20 (2003), the Supreme Court upheld this interpretation of the Act. Rev. 12/04
[Supporting and Elaborating References] [Related Sections: Part 1 - Part 2] � P 600. Application of MedicalVocational Guidelines (Grid) � In General
For disability benefit claimants who do not have listed impairments