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5-Step SEP used to determine one's eligibility for Social Security disability

The next item on the agenda, Social Security Administration (SSA): Presentation on Disability, was provided by John Federline, the (Alternate) Deputy Director for the Office of Medical Listings Improvement with the SSA. Since seeking disability status is a very involved, complicated process, as well as one which has not changed all that much, this article provides only a cursory explanation of this process. The eligibility of an applicant (also known as a claimant) for Social Security disability is determined by whether he or she meets certain criteria during a stringent evaluation process called the Sequential Evaluation Process (SEP). "The 5 steps of SEP" was the title of a flowchart used by Mr. Federline during his presentation.

Briefly, the evaluation of an applicant follows a set order of 5 steps; each step comes with its own criteria; each step requires a decision; and the claim for an applicant will move to the next step only if the criteria at each preceding step can be satisfied. The first three steps are:

1. a determination whether the applicant is engaged in substantial, gainful activity (which is checked against SSA guidelines for maximum income limits)

2. an examination of the severity of the applicant's impairments or combination of impairments (to determine if these indeed are severe enough to affect his or her ability to work)

3. a determination whether these impairments meet or equal the SSA listing of impairments.

The last two steps evaluate the applicant's ability to do his or her prior work and determine if he or she can do any other kind of work. The SEP is carried out by disability examiners who adhere to multiple guidelines, listings, rulings, and manuals published by the Social Security Administration.

In response to a question asked by one of the panelists, Mr. Federline assured the committee that all SSA adjudicators are trained in a consistent manner across the country and are able to process ME/CFS claims with the same degree of accuracy and consistency. Besides their training, he pointed out consistency is also achieved and maintained by use of the same Social Security Rulings (i.e., SSR 99-2p issued in April 1999 explicitly for the evaluation of CFS impairments and SSR 96, specific parts of which help to identify other relevant impairments, and the role of various medical opinions) as well as use of the Program Operations Manual System (POMS). POMS was defined as "SSA's official vehicle for issuing program instructions" on another one of Mr. Federline's slides.

In conclusion, he believes the SSA determination of disability process is thorough, fair and impartial. [Editorial note 2015—SSR 99-2p has been superceded by a new ruling in 2014.]

Another question was raised about whether ME/CFS could be listed as an impairment in the Blue Book (the listing of impairments described above in step 3), with the idea that the disability evaluation process could be satisfied by the third step during the SEP. Federline explained that although the SSA rewrites and updates the Blue Book about every 5 years and periodically adds new impairments, the requests for additional impairments are numerous and SSA can consider only a limited number.

Furthermore, he felt that just having an impairment listed in the Blue Book, on that alone, may not improve nor shorten the evaluation process. Mr. Federline explained, "If some of their impairment contributes to it [the disability] with CFS, such as the mental impairment, the whole person has to be considered. It would still be there even if it is in the Blue Book."

When applicants file for disability benefits due to CFS, the primary impairments will usually be post-exertional malaise and fatigue, cognitive dysfunction and/or other primary manifestations of the illness. It is possible that an applicant could have a mood disorder or reactive depression (as a result of the illness), and these impairments might be listed as secondary ones. But there are also times when patients have seen physicians who don't understand the illness and report their patients' illness/ impairments as being mental disorders. Dr. Nancy Klimas felt this continues to be a huge problem for considerable number of patients.

Another situation brought up by Dr. Klimas was how veterans often have their impairments "added up"—a percentage for multiple physical impairments, plus a percentage for mental problems and so on. It is not unusual to end up with a veteran who is considered as being 180% disabled. It does not work this way with the SSA—disability is determined to be "all or nothing".