SSDI: Understanding Medical Listings and Work Assessments

There are a variety of ways to establish disability within the guidelines set forth by the Social Security Administration. Terminal diseases and complete blindness often have quicker turnaround times due to the severity of conditions and general obviousness that such illnesses will not allow an individual to work. The determination of disability is often decided by an analysis of an individual’s ability to work. In addition to senses such as sight and sound, individuals are evaluated based on their ability to tolerate the demands of a competitive work environment. The basic physical demands of competitive employment include, but are not limited to sitting, standing, walking, lifting, and carrying. For individuals with psychiatric conditions, the demands of a work setting often require the ability to understand directions and instructions, complete tasks at a consistent pace, interact with others, and adapt to changes. The ability to perform those activities is considered within the context of an 8-hour workday. With respect to physical activities, if an individual were unable to sit, stand, and/or walk for 8 hours, cumulatively, in an 8-hour workday, the person would be disabled as they are unable to meet the demands of a regular work schedule. Likewise, if an individual’s psychiatric illness interfered with the ability to perform activities for over ⅓ of an 8-hour workday, that person would likely be unable to sustain a full-time work schedule.

The reports of an individual are crucial in obtaining an understanding of a particular illness or the symptoms experienced, but such reports alone will not usually guarantee that a person is, in fact, disabled. In turn, Binder and Binder works tirelessly to develop the medical record for individuals pursuing Social Security disability benefits. Such development includes contacting your treating providers to obtain medical records, as well as opinions regarding the impact of your illness on the performance of work activities. When a response is received and submitted to the Administration, analysts and/or Administrative Law Judges will ultimately consider the consistency of any abnormalities present during treatment and the symptoms cited as the basis for providing a medical opinion. Accordingly, it is extremely important to not only provide your case worker with up-to-date treatment information, but to also follow up with your providers to confirm that they have received our requests and if they will be responding. If your treating source provides an opinion reflecting your inability to sustain the physical and/or psychiatric demands of a work environment, and it is determined to be consistent with the medical record, there is a stronger possibility of obtaining a successful determination that an individual is disabled.

Given the busy schedules and hectic duties endemic to any medical profession, some providers choose not to provide an opinion simply because they are unable or the facility with which they are affiliated will not allow them to do so. While this presents a significant hurdle in presenting a claim before the Social Security Administration, it does not necessarily make success impossible.

Disability through the Medical Listings:

The Social Security Administration has categorized medical conditions, and set forth criteria that when met can also result in a finding of “disabled.” These categorizations are openly available on their website located at: Listings of Impairments – Adult Listings. There are two ways in particular for an individual to be found disabled through consideration of the Medical Listings. The first is that the medical evidence reveals symptoms that are entirely consistent with the criteria specified in the listing. However, since medical records document your symptoms without consideration of the Medical Listings, at times there can be instances where the specific symptoms enumerated by the Social Security Administration are absent from the evidence. In that case, more than one condition can be considered within the context of the Medical Listings. “Equaling a Listing” requires the record to reflect some of the symptoms associated with a condition and some of the symptoms associated with another condition. In turn, an individual’s illness would not meet one particular Medical Listing, but would instead equal at least two Medical Listings. In such scenarios, the Social Security Administration will often call in a Medical Expert to provide testimony regarding the equaling of a Medical Listing.

The consideration of the Medical Listings further emphasizes the need to develop the record as completely as possible. The Medical Listings can only be met or equaled if the symptoms and illness consistently appear throughout the established medical record. While an individual may think or feel that their condition meets or equals a Medical Listing, without objective evidence confirming as much, a finding of disabled would be highly unlikely.

Examples:

In light of the foregoing, let’s take a look at a few examples. Georgetown University’s Health Policy Institute writes that 65 million Americans experience an episode of back pain. With that in mind, let us consider the criteria of the Medical Listing concerning spinal disorders. Medical Listing 1.15 requires the medical record to document symptoms consistent with the compromise of an affected nerve root, which include pain, paresthesia, or muscle fatigue. An affected nerve root could be confirmed by a study such as an MRI or nerve conduction study. Such testing is also a requirement of Medical Listing 1.15. While symptoms such as pain, paresthesia, and/or fatigue could be considered subjective and based on an individual’s report, clinical testing and abnormalities are also needed to meet the criteria. Range of motion and/or straight leg raise testing could confirm pain while sensory testing could shed light on issues with paresthesia. Likewise, an exercise and/or functional capacity evaluation would provide insight regarding fatigue. However, those issues are only a portion of the criteria that an individual would need to experience in order to meet this particular Medical Listing. The Medical Listing also requires an individual to require the use of a walker, two canes, crutches, or a wheelchair (or other seated mobility device) involving the use of both hands. The inability to use one arm while the other is occupied by an assistive device or the loss of using both arms would also satisfy this portion of the criteria.

Turning to psychiatric difficulties, Mental Health America found that more than 21 million adult Americans are affected by depression each year. The pertinent criteria for such a condition can be found in Medical Listing 12.04. With respect to a depressive disorder, the medical record would need to establish that an individual have at least five of the following: depressed mood, diminished interest, change in weight or appetite disturbance, sleep deficits, psychomotor agitation/retardation, diminished energy, feelings of guilt/worthlessness, concentration difficulties, and/or suicidal ideation. Such findings can often be found in the mental status examination portion of treatment notes. Some psychiatric health networks impose additional restrictions on the confidential information contained in such evidence. In turn, it may be helpful to contact your provider to confirm such information can and will be released to requesting parties such as a disability advocacy group or law firm. There are times that the additional requirements can be satisfied by the completion of a waiver. Nevertheless, in addition to confirming at least five of the above symptoms, the disorder would also need to result in an “extreme” limitation in one or “marked” restriction in at least two of the following functional domains: understanding, remembering, or applying information; interacting with others; concentration, persistence, or maintaining pace; and adaptation. We have developed proprietary questionnaires for providers to complete that are contextualized to inquire about these specific functional fields. There are times when providers never see these requests, as their facility uses a copy service or the doctor is simply too busy. In such scenarios, we ask that individuals hand deliver such documents to their provider for completion. A more difficult alternative to meeting Medical Listing 12.04 is providing medical documentation that an illness has existed for at least two years while resulting in your inability to function outside of a highly structured setting and having a minimal ability to adapt to changes in your environment.

Conclusion:

Again, there are many ways to obtain a successful determination that an individual is disabled, virtually none of which guarantee that a person will ultimately be entitled to receive benefits. Above, are several pathways to pursuing the ultimate goal of being found disabled by the Social Security Administrations. However, as all cases are different and no two claims are the same, there will certainly be new, astonishing determinations that no one has even thought about yet. But, at Binder and Binder, we are always trying to find new ways to provide our clients with the best possible representation while also pursuing the paths of least resistance in an effort to get individuals the benefits they not only deserve, but depend on.

If you have any questions or concerns regarding the pursuit of Social Security disability benefits, please feel free to contact our office at your convenience.