Substantial Gainful Activity (“SGA”) plays a critical role in the determination of one’s claim for disability benefits. The claimant has the burden to prove that he or she is disabled and not the government’s burden to prove that the claimant is not disabled. Because of this, it is important to understand the different factors that are being considered when the Social Security Administration (SSA) or Administrative Law Judge (ALJ) is determining one’s claim of disability.
What is Substantial Gainful Activity and why is it so important? The Social Security Administration will only grant benefits to those unable to perform SGA. SGA is looked at on a monthly, not annual basis. Simplifying, SGA is a hard, black line that if one earns above the line, Social Security will not find the disabled for benefits.
The Social Security Administration has an SGA value for non-blind and blind individuals. The SGA amounts for each category and by year are broken down as follows:
|Substantial Gainful Activity (SGA) Levels 2009 – 2019|
For example, Individual A was not blind and worked from January 1, 2009 through December 31, 2015 earning, $1,100 per month. Individual A fell ill in 2013 and worked through the pain and impairments until December 31, 2015, when they either quit their job or were fired. Individual A files an application for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) on January 1, 2016 with an alleged onset date of July 1, 2013, when they first became sick. Will Social Security determine that they were disabled as of July 1, 2013?
In this example, it is highly unlikely that the Social Security Administration (SSA) or an Administrative Law Judge would find them disabled as of July 1, 2013. The reason for this is due to the fact Individual A performed above the monthly SGA amounts through 2015. Although Individual A may have been in severe pain or struggled during this time, the earnings above the SGA show that they could and in fact, did perform above the threshold SGA amount. Due to the earnings, Social Security will unlikely determine them as disabled during this time.
However, let’s say after Individual A filed their disability application with the alleged onset date of July 1, 2013, they were denied and hired a lawyer to review their case. The lawyer sees the issue between the earnings history, substantial gainful activity and the onset date. The lawyer then discusses the issue with Individual A and proposes something called, “Amending the Onset Date” or changing the alleged onset date. Amending the onset date can make a case stronger, but it can also potentially cut off some back-owed benefits (the mechanics of this is outside the scope of this example, but is worth noting and should be discussed between a claimant and attorney). By changing or amending the onset date to January 1, 2016, the period of time that SSA or the ALJ is considering for disability now no longer has any earnings above SGA. Because there are no more earnings/SGA issues, Individual A’s case, if the medical information supports, is now likely to be approved.
Many claimants are only focused on the medical and do not know to be aware of earnings issues. As the example above shows, knowing all the rules that the Social Security Administration (SSA) and Administrative Law Judges (ALJs) apply to your claim for benefits can mean the difference between being approved or a denied.