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Are You Guaranteed a Disability Approval if you Meet a Listing?

Are you guaranteed a favorable decision from Social Security disability if your diagnosis is included in Social Security’s Blue Book of Listed Impairments? Not necessarily, and here’s why.

Social Security’s Blue Book identifies fourteen “body systems.” For example, listing 1 discusses the musculoskeletal system and within this listing are a number of diagnoses that reflect impairments to your spine, bones and joints. Listing 4 discusses the cardiovascular system and listed within are diagnoses related to heart and circulatory functioning.

Visit my website to look at all of the listings and explanations about how to use the Listings to win.

I regularly get emails and comments on my YouTube channel from claimants who are upset that they were denied even though they feel strongly that they met a listing. Why were these cases not approved.

Each Listing Requires Two Things

First, when you look at almost every listing, you will see two elements. First, there is a diagnosis, and secondly there is a requirement for some level of functional limitation. For example, listing 1.04 references a herniated disc, but it also includes a requirement that you no longer have the capacity to walk effectively, or that you have loss of reflexes, or that you have to constantly change position.

In other words, having a herniated disc is not enough – you have to produce evidence that the herniated disc negatively effects your functioning.

The functional limitation requirement is much more limited that what you would need if you were arguing for disability under a reduced functional capacity theory of disability. If you meet the medical requirements of the listing, Social Security assumes that you have a significant and severe medical problem. But you cannot forego proof of how this significant diagnosis impacts you on a day to day basis.

At the administrative level (initial application and reconsideration) adjudicators are looking for listing level impairments. If, however, your record does not clearly show both a clear and definitive medical diagnosis and a discussion of functional impairment over time, the adjudicator will not approve your case.

Sometimes, the problem arises from the wording of your medical records. Your doctors are focused on treating you, not on identifying functional limitations that Social Security needs. This is why I advise applicants to make it very clear in their application and appeal forms that a specific listing appears to apply, and I advise them to bring a copy of the listing to their doctor and ask the doctor to write a report stating that all elements of the listing are met.

If you do not highlight your argument that you meet a listing, it is very possible that a busy adjudicator will not deduce it from your records.

Even the Strongest Cases May Not Meet a Listing

Second, understand that the listings are very difficult to meet. This is intentional. One reason that SSA published the listings is to identify cases involving terminal or untreatable illnesses or severe congenital conditions.

SSA wants to avoid situations where a claimant waiting for a heart transplant or someone with liver cancer is denied.

But if your condition is not life threatening or life limiting, you need to prove a very significant level of improvement. Adjudicators are busy and their decision making scope is limited. If your medical record is even slightly unclear, or if you are young with the possibility of improvement, or even if records are not received, the adjudicator is directed to deny your claim and let someone else further along in the process make a decision.

False Narrative that Disability Claimants are Committing Fraud

Finally, there is a narrative in Congress and among some administrators within Social Security that the disability benefits system is rife with fraud and that denying claims will weed out those less serious and encourage claimants to return to work if they can. Social Security’s first level of appeal, called “reconsideration” results in a 10% approval rate (vs. 33% at the initial application and 45% at hearings). As a practical matter, the reconsideration step adds 6 months to the process but doesn’t do much to speed processing of benefits to deserving claimants.

If you are denied at the initial application, your next realistic chance at getting approve will be at a hearing, but that may take another 18 to 30 months.

So, the message I give to disability applicants is this – do not be surprised if Social Security turns you down even if you appear to have a listing level claim. And you should also not give up – if you really cannot work, you will eventually have your opportunity to present your case to an administrative law judge who will take a much closer and open minded look at the evidence in your file.

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