SSA decides SSDI claims in five steps, and each step turns on different evidence: earnings, objective medical evidence of a severe impairment lasting 12 months, listing-level findings, and above all a function-by-function picture of what the claimant can still do. The single most useful document is usually a treating-source statement of specific limitations that is supported by the source's own findings and consistent with the rest of the record.
This is general information for representatives, not legal advice. Check the current regulations and SSA's POMS for your case.
Evidence by step
| Step | The question | Evidence to have in the file |
|---|---|---|
| 1. Work activity | Is the claimant doing substantial gainful activity (SGA)? | Earnings record; details of any current work (hours, duties, pay, special help or accommodations); failed work attempts; impairment-related work expenses. Compare earnings with SSA's SGA amount for that year, which changes annually. |
| 2. Severity and duration | Is there a medically determinable impairment that significantly limits basic work activities and has lasted or is expected to last 12 months (or result in death)? | Objective medical evidence from an acceptable medical source: diagnoses, exam findings, imaging, lab results, test results. Records showing onset and duration. |
| 3. Listings | Does the impairment meet or equal a listing in SSA's Listing of Impairments (the Blue Book)? | The specific findings the listing requires: particular imaging, test values, exam signs, or for mental disorders, longitudinal treatment records and documented functional limits. Read the listing's criteria before requesting records. |
| Between 3 and 4: RFC | What is the most the claimant can still do (residual functional capacity)? | Treating-source medical opinions on specific limits; treatment notes that document symptoms and findings visit after visit; mental status exams; therapy and functional capacity evaluations; medication side effects; function reports and third-party statements. |
| 4. Past relevant work | Can the claimant do their past relevant work with that RFC? | A detailed work history for the relevant period (currently five years under SSA's 2024 rule), with the physical and mental demands of each job as actually performed. The work history report (SSA-3369). |
| 5. Other work | Considering age, education and work experience, can the claimant adjust to other work? | Proof of age and education; literacy and English proficiency where relevant; transferable skills; the RFC limits that erode the occupational base, such as off-task time, absences, manipulative or mental limits. At this step the medical-vocational guidelines (the grid rules) and vocational expert testimony come in. |
The treating-source statement under 20 CFR 404.1520c
For claims filed on or after March 27, 2017, SSA does not defer to or give any specific evidentiary weight to a medical opinion, including one from a treating source. It decides how persuasive each opinion is. The two most important factors are:
- Supportability. The more relevant objective medical evidence and explanation the source gives to support the opinion, the more persuasive it is. An opinion on a checkbox form with no reasons is easy to discount.
- Consistency. The more consistent the opinion is with the evidence from other medical and nonmedical sources, the more persuasive it is.
The decision must explain how supportability and consistency were considered. The source's relationship with the claimant (how long, how often, what kind of treatment), specialization and other factors may also count, and they matter most when two opinions are equally well supported and consistent.
A statement that holds up usually:
- Gives specific limits in work terms: lifting and carrying, sitting and standing, walking, reaching and handling, off-task time, expected absences, and mental limits such as concentration, pace and interaction.
- Ties each limit to the findings behind it: exam signs, imaging, test results, mental status findings, observed symptoms.
- States when the limits began and how long they're expected to last.
- Matches the source's own treatment notes. If the notes say “doing well” visit after visit, the opinion will be read against them.
- Avoids conclusions reserved to SSA, such as “disabled” or “unable to work.” Those statements are neither valuable nor persuasive under 20 CFR 404.1520b(c).
The source must be an acceptable medical source to establish an impairment at step 2. The list (20 CFR 404.1502) includes licensed physicians and psychologists and, for claims filed on or after March 27, 2017, advanced practice registered nurses and physician assistants within their licensed scope. Opinions from other sources, such as therapists and counselors, are still considered when assessing severity and function.
Checklist for the file
- Treatment records from every provider from the alleged onset date forward, plus earlier records that show the condition developing.
- Imaging, lab and test results, not just the notes that mention them.
- Hospital, emergency department and inpatient psychiatric records.
- A treating-source statement of specific functional limits, supported and consistent as above.
- Medication lists and documented side effects.
- Work history for the relevant period, with job demands as performed.
- Function reports and statements from people who see the claimant regularly.
- A timeline of treatment gaps, with the reasons (cost, insurance, access) documented where they exist.
- Evidence submitted or identified at least five business days before any hearing (20 CFR 404.935).
How Zicron helps SSDI firms
Zicron scores inbound SSDI leads and medical records against the five-step evaluation with rule-based code, cites every finding to the source page, and lists the evidence gaps that would change the outcome, such as a missing treating-source opinion. The score is a triage signal for your team, not a prediction of SSA's decision. Firms can try it in a 30-day paid pilot for $2,500: up to 500 leads scored and medical-record review on up to 25cases, with no auto-renewal. Zicron works for firms and doesn't represent claimants.
For an example of page-cited output, see a sample chronology(a fictional workers' compensation case) or the SSDI pilot page.
Frequently asked questions
- How does SSA evaluate a treating physician's opinion for claims filed after March 27, 2017?
- Under 20 CFR 404.1520c, SSA does not defer to any medical source, including a treating source. It weighs how persuasive each medical opinion is. Supportability and consistency are the most important factors, and the decision must explain how both were considered. The treating relationship, specialization and other factors can also be considered.
- What makes a treating-source statement persuasive?
- Supportability: the opinion is explained and backed by the source's own objective findings and clinical observations. Consistency: it agrees with the rest of the record, including other providers, test results and the claimant's reported activities. Specific functional limits in work terms (lifting, sitting, standing, off-task time, absences) are more useful than a diagnosis or a statement that the claimant is disabled.
- Does a doctor's statement that the claimant is disabled help?
- Not by itself. Whether a claimant is disabled or unable to work is an issue reserved to the Commissioner, and SSA treats statements on those issues as neither valuable nor persuasive (20 CFR 404.1520b(c)). The statement should describe what the claimant can and can't do, and why.
- When must evidence be submitted before an SSDI hearing?
- Under 20 CFR 404.935, written evidence should be submitted, or the administrative law judge told about it, at least five business days before the hearing, unless an exception applies. Claimants also have a continuing duty to inform SSA about or submit all evidence known to them that relates to whether they are disabled (20 CFR 404.1512).