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Will You be Approved for Disability Based on Your Diagnosis?

I frequently receive emails and comments on my YouTube channel from folks who want to know if they will be found disabled due to a particular diagnosis. “Will I be found disabled by Social Security if I have a herniated disc/carpal tunnel syndrome/major depression/cirrhosis of the liver, etc., etc.

I am not the only one who gets these questions. A retired judge who I appeared before many times and who knows Social Security disability law as well as anyone answers questions on Quora and he gets this question – apparently from the same person – over and over.

The judge’s answer and mine is the same – you do not win or lose your Social Security claim based on your diagnosis. The right question to ask is whether your symptoms and medication side effects leave you without the capacity to reliably perform simple, entry level work.

Social Security defines disability in these terms. When you appear at a hearing, every question the judge or your attorney asks is focused on your work capacity.

You could have four herniated discs, congestive heart failure and uncontrolled diabetes, but if you are working or can work an 8 hour day, you will not be found disabled.

Aren’t the Listings Focused Solely on Your Medical Diagnosis?

No – this is a common misunderstanding. The Listings include descriptions of diseases that are very serious and consistent with a finding of disability. Most listing level conditions can be confirmed with imaging (MRI, CT, ultrasound) or can be diagnosed with available medical technology or tests.

But if you look closely at most of the listings, you will see a functional component. For example many of the sections contained within Listing 1 (musculoskeletal) include a requirement that the orthopedic impairment interferes with effective ambulation (walking). Listing 4 (cardiovascular system) includes requirements that your heart issues leave you unable to perform adequately on an exercise tolerance test.

One of my colleagues noted that most of the listings contain a “mini functional capacity evaluation” requirement.

There are two exceptions to this general rule. The first has to do with conditions included in the compassionate allowance list. These are medical conditions that are so severe that the diagnosis alone implies significant functional limitations. There are only about 100 diseases and conditions on this list.

The second exception are TERI cases – these involve situations where a claimant has a terminal illness and SSA wants to flag the case for early approval. Again, it is reasonable to assume that someone with an untreatable, terminal medical issue would not be able to work reliably.

Outside of compassionate allowance and TERI cases, all other listing level conditions require some proof of functional limitation along with the diagnosis.

How Much Functional Limitation Must I Show?

As a general rule, you need to prove that you have a medically documented condition that has left you without the capacity for entry level full time work.

My experience has been that the younger you are, the more serious your medical problem and associated functional limitations must be. A 25 year old with Type II diabetes is going to need stronger medical records and more robust evidence about functional limitations than a 55 year old.

The 55 year old will still need to answer the threshold question of whether the symptoms and medication side effects of his diabetes (or any other medical condition) leaves him unable to reliably perform entry level work but as a practical matter judges will be more receptive to a 55 year old with a long work history than a 25 year old.

How do the Grid Rules Change the Equation?

The grid rules water down the requirements for claimants over the age of 50, with physical limitations and a limited education. These rules reflect the reality that older, less educated laborers will have difficulty finding entry level work.

But the grid rules do not change the requirement that an applicant have functional limitations.

So, if you have made the difficult decision to pursue disability benefits, you cannot rely on your diagnosis only. You need to think about and keep notes on how your medical problems limit your capacity to function and you need your treating doctors to reference your functional limitations as much as they can.

By focusing on how your medical issues create work capacity limitations you will be better prepared to give SSA the evidence it needs to approve your claim.

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