Accelerating sea-level rise and human impacts to the coast (e.g., altered sediment supply and hydrology, nutrient loading) influence the accumulation of sediment and organic matter, and thereby impact the ability of coastal tidal wetlands to maintain an elevation consistently within the vegetation growth range. Critical components of marsh sustainability are the marsh elevation within the vegetation growth range (elevation capital) and the rates of marsh surface elevation change and relative sea-level rise. The relationship among these factors and their combined influence on marsh integrity were evaluated by comparing trends in surface elevation change on five salt marsh sites located on three marsh islands in Jamaica Bay, NY, USA. All marsh sites were located in a similar physical setting (i.e., tidal range, sea-level rise rate, sediment supply). The structural integrity of the marshes ranged from densely vegetated (high integrity) to severely deteriorated (low integrity) with elevation capital ranging from high to low, respectively, and included a deteriorating marsh site that was partially restored. Two marshes with high elevation capital maintained their relative position high within the tidal range through a combination of surface sediment deposition and shallow subsurface expansion, and kept pace with local sea-level rise. A marsh with moderate elevation capital showed signs of flooding stress and was deteriorating, but managed to keep pace with local sea-level rise. The deteriorated marsh gained no elevation over the 14-year study and was located too low within the tidal range to support continuous coverage of salt marsh vegetation. Elevation gain in the restored marsh initially lagged behind sea-level rise for 8 years, but the elevation trend recovered and kept pace with sea-level rise for the last 5 years. A conceptual model is presented that describes the relationship among elevation capital, and rates of marsh elevation gain and sea-level rise. Note that a search for factors influencing wetland loss should focus on process changes to marsh vertical development (e.g., sediment supply, vegetation growth) and climate change effects (e.g., sea-level and temperature rise) that can cause elevation gain to lag behind sea-level rise, and these occur prior to the onset of marsh deterioration.