If we establish that the claimant is not performing substantial gainful activity (SGA) at step one of the sequential evaluation process, next we must determine whether they have a medically determinable physical or mental impairment.

Once we establish the existence of an MDI, we will determine whether that MDI is medically severe and meets the duration requirement. 

If the evidence is insufficient to establish the existence of a medically severe MDI (or multiple concurrent impairments that, when considered in combination, are severe) the sequential evaluation process ends at step two, and we will find that the claimant is not disabled.

For information on the sequential evaluation process, see DI 22001.001.

For information on establishing a severe MDI in a Title XVI disabled child claim, see DI 25220.005.

For information on the duration requirement, see DI 25505.025.

An MDI must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.  Further, an MDI must be established by objective medical evidence from an acceptable medical source (AMS), as explained in DI 22505.003. We do not consider non-objective medical evidence sufficient to establish an MDI, such as: medical opinions, judgments about the nature and severity of an impairment(s), medical history, diagnosis, prescribed treatment, or prognosis.

Objective medical evidence consists of signs, laboratory findings, or both, as defined in this section:

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  Signs are anatomical, physiological, or psychological abnormalities that can be observed, apart from the claimant’s statements (description of symptoms). Signs must be shown by medically acceptable clinical diagnostic techniques.

  Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception. Psychiatric signs must be shown by observable facts that can be medically described and evaluated.

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  Laboratory findings are anatomical, physiological, or psychological phenomena that can be shown by the use of medically acceptable laboratory diagnostic techniques. Diagnostic techniques include chemical tests (such as blood tests), electrophysiological studies (such as electrocardiograms and electroencephalograms), medical imaging (such as X-rays), and psychological tests.

As part of the medical evaluation of the claim, the medical or psychological consultant (MC/PC) determines whether the objective evidence establishes an MDI and, if so, what MDI the evidence establishes, as explained in DI 24501.001B.3.c.

Only after the MC/PC establishes the existence of an MDI (as explained in DI 24501.020B in this subsection), will we consider other medical and nonmedical evidence to evaluate the severity and duration of the MDI, such as:

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  Symptom(s), as explained in Social Security Ruling 16-3p and DI 24501.021;

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  Medical history and documented response to prescribed treatment;

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  Diagnosis and prognosis, as explained in DI 24503.015;

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  Evidence about the claimant's functioning; and

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  Medical opinion(s); as explained in DI 24503.005B.2.

For information on objective medical evidence from medical sources that are not AMS, see DI 24503.010B.

For the definition of a medically severe MDI, see DI 24505.001.

For the definition of a non-severe MDI, see DI 24505.005.