Receiving Benefits - Your Medical Condition and Social Security Disability or SSI

How severe must my medical and/or mental condition be to receive an approval for Social Security Disability benefits? "Severity" is a key component to claims filed under the title II (Social Security Disability) and title 16 (SSI, or supplemental security income) disability programs.

In fact, severity is the first question addressed by the five step sequential evaluation process which is used by both disability examiners (who make decisions on claims at the disability application and reconsideration appeal levels) to make medical vocational allowances. Medical vocational allowances are a type of approval, and most claims that are approved are approved in this fashion.

That first step of the process asks the question "Does the claimant have a severe impairment?". If the physical or mental impairment that has been alleged by the claimant on their disability application is not medically determinable according to what is considered by the social security administration to be acceptable medical evidence, or the condition is simply not considered to pose any limitations that would interfere with normal activities of daily living, including work activity, then the condition will generally be classified as non-severe.

In such an instance, the claim would be denied by a disability examiner on the basis of an NSI, or non-severe impairment. Examples of non-severe impairments include minor sprains, cuts, muscle pulls, and even normal pregnancies (believe it or not, people do file for disability on the basis of pregnancy and as a disability examiner I occasionally saw applications such as this).

To receive disability benefits under SSD or SSI, your mental and/or medical condition must affect your ability to work. That is the fundamental benchmark for medical vocational allowances. And this is exactly why, when a person files a claim, the claimant is asked to provide both their medical treatment AND past work histories. The decision-maker on the claim will measure the claimant's ability to work based on how their condition currently limits them, as well as how it may limit them in the future.

If you have not been able to perform substantial work activity due to your condition for twelve months, or you expect to be unable to perform substantial work activity for twelve months, then you should contact Social Security to file for disability.

Substantial work activity is measured by how much a person is able to work and earn. This amount is set by the social security administration and it is basically a cutoff limit for how much a person can earn and still be considered disabled (or not). The actual limit is known as the SGA limit.

Does your specific condition have an impact on your ability to be approved for benefits. It can, if you meet the criteria for a condition listed in the blue book, the Social Security Disability list of impairments.

However, meeting the listing requirements can be difficult, particularly since they require a level of documentation that most claimant's medical records will not be able to provide. This is why, as previously mentioned, most claims are approved on the basis of a medical vocational allowance instead. And, of course, this is why Social Security evaluates your functional ability instead of specific conditions.

What do I mean by functional ability? Functional ability is what you are able to do (normal daily activities or work activity) in spite of your mental and/or medical condition. Therefore, any condition may be considered severe; however your chances of a Social Security Disability or SSI approval depend upon your residual functional ability.

Residual functional ability will be measured by reading and interpreting your medical records to determine what you are still capable of doing and whether or not you can return to your past work or do some form of other work. In other words, RFC, or residual functional capacity is measured based on what your doctors have said about your condition in their notes.

Most treatment notes, of course, are very sparse when it comes to listing a patients's limitations and this may account for why so many claims are denied initially. At disability hearings, however, one of the primary goals of a disability representative or disability lawyer will usually be to obtain a detailed supporting statement from a claimant's treating physician (known as an RFC statement, or medical source statement).

Continued at:

Medical Disability Requirements for SSD and SSI

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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