What does the Severity of your impairment have to do with Your Disability Claim?

To be approved for Social Security Disability or SSI disability benefits, it is not enough to simply be diagnosed with a severe medical condition that is physical or mental in nature. For the purposes of the social security administration, the condition must have a certain level of severity before benefits can be awarded.

How severe must your condition be before you can be awarded disability benefits?

1. The condition must last at least 12 full months. One year's time is the minimum duration in order for the social security administration to consider a person disabled and unable to work.

2. The condition must not only last 12 months, it must be severe enough that it prevents you from being able to work and earn a substantial and gainful income for those twelve months.

3. The duration requirement does not mean that you must wait to file until you have had your condition for 12 months. If your condition has not actually prevented you from working and earning a substantial and gainful income for at least 12 months at the time of your application for disability, you can still apply for disability.

How is this? If the medical evidence in the records obtained from your various doctors and hospitals is strong enough--meaning that the disability examiner or administrative law judge can conclude that you have functional limitations which rule out a significant return to work activity--then a projection can be made that your disabling condition will last at least 12 full months.

Notes on how severity is determined by Social Security

At the first two levels of the system (disability application and the request for reconsideration appeal), severity is determined by a disability examiner, a claims specialist who gathers and reviews medical evidence.

Based on the medical evidence, the examiner will rate the applicant's limitations on a residual functional capacity form which, for most claims, must be agreed to by a medical consultant (an M.D.) who works in the disability examiner's case processing unit. If the case involves one or more mental conditions, then the examiner will also rate the mental limitations on a mental residual functional capacity form, which must then be agreed to by a mental consultant (a Ph.D.-level psychologist) who is part of the examiner's case processing unit.

The ratings that are made by the examiner, e.g. how much can the individual lift, do they have postural limitations, do they have trouble with memory, or attention, or concentration, etc, are intended to reflect the severity of the applicant's condition and their reduced ability to engage in work activity.

If, for example a claimant has a work history that involves performing medium level activity, but their residual functional capacity (RFC) assessment limits them physically to just the ability to perform sedentary or light work activity (a condition such as degenerative disc disease could account for this), they may find themselves approved for disability benefits (note: their age and the levels of their job skills would also be considerations in most cases).

Or, if a person has a cognitive or other mental disorder that eliminates their ability to mentally perform SSRTs (sustained, routine, repetitive tasks), then they might also expect to be approved for disability.

At the third level of the system, a disability hearing before an administrative law, cases are evaluated in the same manner. However, an ALJ, or administrative law judge will not perform a writeup of a case nor will the judge refer to a medical or psychological consultant to validate his decision.

Judges may, from time to time, request that expert medical or vocational witnesses appear at the hearing to provide insight and testimony, but this is completely at the discretion of the judge and usually occurs when the judge feels that such testimony may make medical or vocational (job-related) evidence more clear.

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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