legitimate medical condition diagnosed by an acceptable medical source,
like a physician or psychiatrist, can be disabling if it is severe
enough. The condition must have lasted, or be expected to last, for
twelve months or be expected to result in death. 20 C.F.R. § 404.1509.
This is known as the "durational requirement." If you have an
impairment that meets the durational requirement, and is so severe that
it meets certain "medical listing" criteria set forth by SSA, then SSA
will find you disabled. 20 C.F.R. § 404.1520(a)(4)(iii). This is known
as a step 3 case. Most of these medical listing cases are approved at
the initial or reconsideration level, and do not require a hearing.
However, some slip through the cracks and will need a hearing.
your medical impairment, or combination of impairments, does not meet
the automatic "medical listing" criteria, then SSA will further evaluate
your case and determine whether you can return to any past relevant
work or to other work available in the national economy. 20 C.F.R. §
404.1520(a)(4)(iv)-(v). These are known as step 4 and 5 respectively.
In determining whether you are disabled at step 4 and/or step 5, SSA
will also consider your age, education, work history, and acquired work
skills in determining whether you are disabled. 20 C.F.R.
§404.1560(b)-(c). Most of these types of cases, which represent the
majority of disability cases, will have to be decided at hearing by an
Administrative Law Judge.
Some types of medical conditions are
evaluated used special rules. For example, obesity is examined using
Social Security Ruling (SSR) 02-1p. In determining whether an
individual qualifies as obese, SSA will first examine the medical
records from your treating doctors to determine if a diagnosis has
already been made. If no diagnosis of obesity has been made, or if SSA
thinks the diagnosis is questionable, they will examine things like your
height and weight to see if they think you qualify as obese.
Additionally, obesity does not have its own medical listing for
automatic approval at step 3. Rather, it is evaluated by comparing it
to the limitations caused by other impairments. For example, if your
only impairment is obesity, SSA can find you disabled at step 3 by
finding that it imposes the same physical limitations as the medical
listing for another condition, such as a back impairment.
and chronic fatigue syndrome (CFS) are highly litigated areas. In July
2012, SSA issued a new Social Security Ruling (SSR) regarding
fibromyalgia and CFS callsed SSR 12-2p. Pursuant to this new listing,
SSA will find that a valid diagnosis of fibromyalgia is present only
when it is diagnosed by a physician (MD or DO), and is consistent with
physical examination findings and prior treatment notes. The physician
must use proper, generally accepted medical criteria to make the
diagnosis, such as the 1990 American College of Rheumatology (ACR)
Criteria or 2010 ACR Criteria. If they do not, SSA may not accept the
diagnosis. It is important that you have a good relationship with your
doctor and ensure that he or she is properly documenting your condition
in the treatment notes. Your medical records are crucial evidence in
your Social Security disability case.
There are some special
rules for evaluating mental health impairments as well. In every case,
SSA is required to evaluate the limitations in broad areas of
functioning cause by the impairment(s). These broad areas include:
activities of daily living; social functioning; concentration,
persistence, and pace; and episodes of decompensation. 20 C.F.R. §
404.1520a(b)-(c). SSA will then translate these broad limitations in
functioning in to specific functional limitaitons in determining the
residual functional capacity. Inconsistencies between the broad
limitations in the "paragraph B" findings and the specific limitations
set forth in the residual functional capacity are common and are a great
basis for appeal.
As you can see, SSA disability determinations
are quite complex. There are a variety of special rules and policies
adopted by SSA for different medical conditions. Ultimately, it is
crucial that you provide good medical records supporting your claim.
You should seek medical treatment. Additionally, SSA makes a lot of
mistakes because the rules are so complex. Therefore, it is important
that you keep appealing your case if you are truly disabled. You have
to fight for your benefits, you can't rely on the government to do the
right thing. An experienced attorney can help.