Social Security’s listings can be your best argument for a quick approval but you have to know how SSA decision makers evaluate cases.
Social Security defines disability in terms of how your medical problems prevent you from performing work activities. In Social Security language, work or activities equivalent to work like attending school or volunteering is called substantial gainful activity.
Your medical condition must be diagnosed – you have to have a doctor identify what exactly is wrong with you.
Further, to be found disabled your medical condition must be long lasting, having lasted or expected to last twelve consecutive months.
So to put this all together, Social Security will find you disabled if you have a medically determinable impairment that prevents you from engaging in substantial gainful activity that has lasted or is expected to last twelve consecutive months or result in death.
The Listing Argument is One of the Three “Theories of Disability” You Can Use to Win Benefits
The listing argument is one way to meet this definition. The other two theories of disability are meeting a grid rule, and proving that your medical condition and associated issues like medication side effects or related problems leaves you without the capacity to reliably function at even a simple, entry level job. The listing argument is the one most used by SSA adjudicators at the initial application or reconsideration appeal and can be your ticket to an early approval.
If you review the listings you will see that Social Security has identified fourteen (14) body systems and within each body system there will be a variety of medical diagnoses that describe serious medical problems.
For example, listing 1.07 describes “fracture of an upper extremity” (i.e., your arm) that has not healed and function of your arms has not been restored within 12 months.
Listing 4.09 would be satisfied if you have had a heart transplant – you would be considered disabled for a minimum of one year following your transplant.
Listing Level Impairments Assume Loss of Function
When you read the listings, you may notice that the focus is on your medical diagnosis. By contrast, if your condition is not at listing level you have to produce evidence to demonstrate your loss of function.
If your medical diagnosis meets a listing, therefore, Social Security assumes that you will have loss of capacity to function. Many of the listings require some evidence of loss of function but not nearly as much as if you were using a “functional capacity” argument that judges use at most hearings.
So, if you hope to convince Social Security that you meet a listing you must have:
- a clear diagnosis of a medical condition that is described in one of the listings
- a statement from your treating doctor that all of the diagnostic requirements set out in the particular listing have been met
- a statement from your doctor that you do have functional limitations to the degree set out in the listing that applies to you.
How do You Get Your Doctor to Help You?
Your best chance at winning using the listing is to ask your doctor for his/her help. While it is possible that a Social Security adjudicator (claims adjuster) would plough through hundreds of pages of medical records looking for proof that you meet a listing, you would be wise not to assume this will happen.
Instead, you can greatly improve your chances at an early, listing level approval by doing one of the following:
– print out a copy of the listing, take it to your doctor and ask the doctor to write a narrative report explaining to Social Security how and why you meet the listing; or
– ask your attorney to create a checklist based on the appropriate listing that you can bring to your doctor to fill out. Your attorney will also need to confirm that the adjudicator or judge has all of the supporting medical records
It is also helpful to identify in big bold print your assertion that you meet a particular listing. Adjudicators and judges are busy people and there is no reason to make them guess about what you are asking.
What About Compassionate Allowances and TERI Cases?
You may have heard that Social Security has special categories of diseases that qualify for a “quick disability determination.” Both compassionate allowance cases and TERI (terminal illness) cases are listing level cases, but they refer to medical conditions even more serious than what otherwise appear in the listing.
Once such category are the compassionate allowances – here is a link to SSA’s compassionate allowance page. Diseases in this category are chronic, permanent conditions that are permanent, life limiting or life threatening. If your diagnosis falls within a compassionate allowance, SSA doesn’t ask for any evidence about loss of capacity – it is assumed.
The second quick determination category are TERI cases. This list of conditions describes terminal illnesses where death is likely. For example metastatic cancers, AIDS, ALS, or a person who is in a coma for 30 days or longer all fit within the TERI defintion.
Here, too, it is wise to point out clearly on your disability application paperwork that your case fits within the list of compassionate allowance conditions or the list of TERI cases.
Assuming the medical record clearly documents compassionate allowance or TERI status you most likely do not need a lawyer for a fast approval.