Social Security uses a five-step sequential evaluation process to determine a claimant’s eligibility for benefits. First, the agency considers whether the claimant is presently working, and doing so at the level of what is known as “substantial gainful activity.” If so, the claimant will be found not disabled; if not, the agency moves onto step two. At step two, the agency asks whether the claimant has a severe medically determinable physical or mental impairment (or combination of impairments) which will last for twelve months or end in death. If so, it will move onto step three; otherwise the claimant will be found not disabled.
The third step is the focus of this post. At this step, the agency considers whether a claimant has an impairment that meets or equals one of the descriptions of conditions posted at appendix 1 of CFR §404.1520. (Adult listings (Part A) can be found at http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm. Childhood listings (Part B) can be found at http://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm.) This appendix addresses with specificity a number of medical conditions, and details various aspects of each condition that must be present and documented for a claimant to meet or equal the listing. If a listing is met or equaled, the claimant is found to be disabled. If not, the agency moves onto the next step.
Although not the focus here, the last two steps of the process are worth noting. At the fourth step, the agency considers a claimant’s functional capacity despite their documented limitations and asks whether that claimant could perform the work they have performed in the last fifteen years. If a claimant would be able to perform past work, he or she will be found not disabled. If a claimant is unable to perform his or her past work, the agency moves onto the last step, which asks whether the claimant could perform other work, given their age, education and work experience. If a claimant can perform other work, they are not disabled; if step five yields no jobs that a claimant could do despite their impairments, then benefits are generally awarded.
Returning to step three and the listing of impairments, there are fourteen categories of impairments in the appendix, including musculoskeletal system, special senses and speech, respiratory system, cardiovascular system, digestive system, genitourinary impairments, hematological disorders, skin disorders, endocrine disorders, impairments that affect multiple body systems, neurological, and mental disorders. Within each category are various impairments.
As a claimant enters the Social Security disability process, it is wise to consult the listings and consider whether his or her condition (and its severity) is described in the listings. This is somewhat rare, as the standards are difficult to meet. Furthermore, even if a claimant’s condition does meet one of the listings, he or she must be able to prove it with documentation.
A great example is epilepsy, which is addressed in sections 11.02 and 11.03 under the category “Neurological.” To meet the listing for convulsive epilepsy (grand mal or psychomotor), the condition must be documented by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once a month, in spite of at least 3 months of prescribed treatment; with daytime episodes (loss of consciousness and convulsive seizures) or nocturnal episodes manifesting residuals which interfere significantly with activity during the day. Though the severity of a claimant’s epilepsy may meet this description, it may not be documented. However, a claimant who is aware of these requirements would know to carefully document and report to their treating neurologist specific information about each seizure occurrence. This type of documentation could allow for much quicker resolution of a claim.
Remember, documentation is the key. A claimant must report disabling symptoms to their doctors so that the information appears in their medical records, especially when trying to prove listing-level severity.
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