DI 10105.065 Disability Requirement
A. Inability to engage in Substantial Gainful Activity (SGA)
To meet the definition of disability (for impairments other than blindness) a number holder (NH) must be unable to engage in any SGA based on medically determinable physical or mental impairment(s). (See DI 10105.065A.1.)
SGA means the performance of significant physical and/or mental activities in work for pay or profit, or in work of a type generally performed for pay or profit, regardless of the legality of the work. For a full discussion of SGA see DI 10501.000.
IMPORTANT: If an individual is working and the work is determined to be SGA, we will find that the individual is not disabled regardless of his/her medical condition, age, education, or work experience.
1. For applications filed in or after 7/65
Disability means inability to engage in any SGA by reason of any medically determinable physical or mental impairment which can be expected to result in death, or has lasted or can be expected to last for a continuous period of not less than 12 months.
The 1967 amendments specified that workers shall be determined to be under a disability only if the physical or mental impairment or impairments are of such severity that the individual is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy. This is regardless of whether:
such work exists in the immediate area in which the claimant lives, or
a specific job vacancy exists, or
the claimant would be hired if he or she applied for work.
The statute also specifies that “work which exists in the national economy means work which exists in significant numbers either in the region where such individuals lives or in several regions of the country.”
2. For applications filed before 7/65
Disability meant the inability to engage in any SGA by reason of any medically determinable physical or mental impairment which could be expected to result in death or to be of long-continued and indefinite duration. In addition, the individual had to be under a disability at the time the application was filed.
B. Statutory blindness
1. NH’s under age 55
An individual who meets the statutory definition of blindness meets the disability requirement for purposes of the freeze regardless of ability to engage in SGA. Such blindness alone does not necessarily constitute disability for a Disability Insurance Benefit (DIB) (i.e., cash benefit) purposes. To be eligible for DIB, blind persons under age 55, like those with other impairments, must be unable to engage in any SGA. (See DI 10105.065B.2. below for a special definition of disability for blind persons age 55-full retirement age (FRA).
a. Applications filed after January 2, 1968
Statutory blindness is defined in DI 26001.001. See DI 10105.065B.2. for a discussion of the definition of disability for purposes of the DIB, in cases where the NH is blind and age 55 or older.
b. Applications filed before January 3, 1968
Statutory blindness was defined as central visual acuity of 5/200 or less in the better eye with the use of a correcting lens. An eye in which the visual field is reduced to five degrees or less concentric contraction was considered as having a central visual acuity of 5/200 or less.
2. NH's age 55 to FRA
The 1965 amendments introduced a special definition of disability for DIB purposes for NH's who are:
statutorily blind, and
at least 55 years of age
For these persons, disability is defined as inability by reason of such blindness to engage in SGA requiring skills or abilities comparable to those of any gainful activity in which they have previously engaged with some regularity and over a substantial period of time. Where a blind NH is 55 or older and cannot qualify for DIB under this provision, the disqualifying SGA is referred to as “comparable” SGA. Payments to persons who qualify under this provision and to any auxiliaries entitled on their earnings record (E/R) will be suspended for any months in which the NH is engaging in any type of SGA (See DI 41005.020, DI 10105.095, DI 26005.001D, DI 13050.001, and DI 26001.010). Payment may be initiated or reinstated for any month in which it is determined the NH is not engaging in SGA. A person is not considered to be under a disability unless he or she furnishes such proof of its existence as may be required. (See DI 10105.065)
C. Prisoner provisions
On October 19, 1980, H.R. 5295 (P.L. 96-473) was signed into law and contained provisions which imposed restrictions on Title II disability determinations and payments to prisoners who are convicted of felonies. A summary of these “prisoner” provisions can be found in GN 02607.000, DI 10105.100, and DI 10105.105. (These provisions do not apply to Title XVI.)