In order to win disability benefits from Social Security, you (and your lawyer) have the burden of proving that you meet SSA’s definition of disability – that you are unable to engage in substantial gainful activity because of a medical or mental health condition that has lasted or is expected to last 12 consecutive months or result in death.
There are three (3) ways you can prove that you meet this definition:
- meet a Social Security listing
- fit within a “grid rule”
- prove that your capacity to function at even a simple, entry-level job has been so compromised by your multiple medical issues and/or medication side effects that you would not be a reliable employee
The fastest way to get an approval is to meet a listing. There are several reasons for this:
- the listings describe very serious medical problems. SSA will assume that if you meet a listing, your capacity to work will be compromised. Thus, you don’t need to offer much in the way of proof about your work capacity issues if your medical record shows that you meet a listing.
- the adjudicators that evaluate your claim at the initial application and first appeal (reconsideration) are not judges or lawyers. Instead they are government workers who are given training similar to what an insurance claims adjuster might receive. As such, they are looking for “magic words” – statements in your medical record that match the language of the listing you claim that you meet.
Given that a non-listing case can take 3 years or longer to be scheduled for a hearing, the listing argument is very attractive since cases approve at the initial application stage are often completed within 4 or 5 months.
Currently just over 33% of disability claims are approved at the initial application stage so you should definitely try to win early if you are struggling with a serious medical issue.
Characteristics of Listing Level Cases
My experience has been that non life-limiting listing level cases are characterized by the following factors:
- a consistent treatment record with a specialist
- medical records which show that you have been compliant with treatment, but that treatment has not been successful in restoring your functioning
no evidence of part time work
- a work record which documents that you have been out of work for at least 12 consecutive months (or that you are approaching 12 months)
- support from one or more treating doctors (specialists) that track the language of the listing you are trying to meet
Note that Social Security has a list of “compassionate allowance” conditions – these are life limiting or life threatening conditions that should generate an approval immediately. However you don’t have to have a life limiting condition to meet a listing.
The starting point for analyzing your case to see if you might meet a listing would be to look at the listings. I have a website called MeetaListing.com that has links to the listings, case studies and other helpful information about the listings and I recommend that to you.
You can also view SSA’s Blue Book, where the listings are published at http://bit.ly/adult-listings.
Working with SSA’s Blue Book of Impairments – the Listings
When you visiting the Blue Book you will see that SSA has divided the human body into 14 body “systems.” Under each system, SSA has identified specific medical problems that could be listing level and they identify the medical test results needed to prove that you meet a particular listing.
Remember that the Blue Book is written for medical professionals and trained Social Security decision makers so it can get technical. However you can still use the listings by simply printing out the applicable section, meeting with your doctor and asking for his/her help in convincing SSA that you meet a listing.
Here is a sample letter you can use to request help from your doctor. In this case I was asking for help to show that my client meets Listing 4.11 – you would need to substitute the listing applicable in your case.
In addition to your doctor’s letter for support you need to encourage your doctor to supply SSA with copies of your medical records as soon as possible and you need to reference the applicable listing in the forms you fill out for SSA and in any correspondence you have with the adjudicator.
Obviously there is no guarantee that SSA will approve your “meet a listing” argument at initial or at the reconsideration appeal. But these steps will improve your chances. You are also not limited to just making this argument when you apply, appeal or appear at a hearing. You can argue that you meet a listing, that you fit within a grid rule, or that you have severely limited functional capacity at any point in the process.
If you have questions about arguing for approval based on meeting a listing, please do not hesitate to reach out to me.