How does Social Security determine if I am disabled or not?

The social security administration will determine a claimant's eligiblity to receive disability benefits in one of two ways (and both apply equally to the Social Security Disability or SSI disability program).

The First way - Satisfying the requirements of a listing

If a disability examiner or a disability judge (assuming the case is pending at the hearing level) examines the claimant's medical records and discovers fairly specific evidence regarding the claimant's condition or conditions, the examiner may potentially find that the claimant satisfies the approval criteria of a listed impairment.

What is a listed impairment? This is any mental or physical condition that is listed in the blue book. The blue book, sometimes referred to as the Social Security Disability list of impairments, contains a wide variety of medical conditions, both physical and mental, as well as the criteria that must be found in the claimant's medical records in order for the claimant to be approved on the basis of a listing (such as the listing for ADHD, or the listing for Asthma, or the listing for lupus).

Being approved for disability benefits on the basis of "meeting a listing" or "equaling a listing" (by "equaling", the social security administration means having a comparable level of severity even if the very specific details of the listing are not met) can be difficult. Listings tend to have very specific requirements and the truth is that a claimant's medical records will very often not contain enough detail. Additionally, most medical conditions are not actually included in the listing book, such as carpal tunnel syndrome for example.

The Second way - Being approved for disability on the basis of a medical vocational allowance

Fortunately, for those whose medical records will not be detailed enough to meet or equal a listing in the blue book, there is a second way of being approved for either Social Security Disability or SSI benefits. This way involves the five step sequential evaluation process used by the social security administration and it results in something known as a medical vocational allowance.

When a case is put through the sequential evaluation process (and this will happen unless it is fairly obvious that the claimant has a listing-level medical condition), the claimant's medical evidence will be used to determine how, and to what extent, they are functionally limited. The decision-maker, a disability examiner or a judge, will assess the severity of the claimant's conditions and then rate their functional limitations on either an RFC (residual functional capacity) form, or an MRFC (mental residual functional capacity) form. This rating will then be compared to the demands and requirements of the claimant's past work (social security will look at all relevant jobs within the past 15 years).

The goal, of course, is to see whether or not the claimant can go back to one of their past jobs. If the determination is made that they cannot return to a former job, the decision-maker will then attempt to determine whether or not the claimant can perform some type of other work. If this is also not possible, the claimant will be approved on the basis of a medical vocational allowance (which is referred to as such because the decision will involve both medical and work history information).

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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