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 heart disease 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 asks if the heart disease meets or equals a medical listing. Heart disease is listed under the cardiovascular system. Satisfying the listing criteria is dependent on the type of heart disease one has, e.g., chronic heart failure, ischemic heart disease, cardiomyopathy, etc. Various studies such as angiography, echocardiography and electrocardiography are used to assess the severity of the heart disease. For example, an individual with ischemic heart disease who has a left ventricular ejection fraction of 30% or less, is precluded from performing an exercise stress test and has a marked limitation of physical activity would be found to have a listing level impairment.
STEP FOUR explores the ability of an individual to perform work done in the past despite the heart disease. 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 condition to determine what other work, if any, the person can perform. To determine disability, the SSA enlists vocational rules, which vary according to age. For example, if a person is:
- Under age 50 and, as a result of the symptoms of heart disease, unable to perform what the SSA calls sedentary work, then the SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.
- Age 50 or older and, due to the heart disease, limited to performing sedentary work but has no work-related skills that allow the person to do so, the SSA will reach a determination of disabled.
- Over age 60 and, due to the heart disease, unable to perform any of the jobs performed in the last 15 years, the SSA will likely reach a determination of disabled.
- Any age and, because of heart disease, has a psychological impairment that prevents even simple, unskilled work, the SSA will reach a determination of disabled.