By: James Crytzer
The Social Security Administration uses what is known as the five-step
sequential process for determining whether an individual is disabled for
obtaining benefits. These steps include the following:
Step 1. Is the claimant working? If so, is the claimant working at the SGA (Substantial
gainful Activity) limit or over? If so, subject to some exceptions, the
claim will be denied.
Step 2. If the claimant is not working, or is earning an amount less than SGA,
the Administration will evaluate his/her level of disability.
Step 3. Does the claimant disability “meet or equal” a condition found
within the Administration’s list of impairments? If so, the claim
will be accepted. If not, the analysis proceeds.
Step 4. Can the claimant perform his/her past relevant work based upon his/her
residual functional capacity? The Administration will examine positions
held by the clamant for the past fifteen years.
Step 5. Finally, even if the claimant cannot perform his/her past relevant work
the Administration will determine whether the claimant can perform other work.
As noted above, at Step 3, the Administration applies a
Listing of Impairments to evaluate your claim. The Listing of Impairments describes impairments
considered severe enough to prevent an individual from partaking in Substantial
Gainful Activity (SGA). These impairments are mostly permanent or expected
to result in death. If you meet or equal a medical listing at this level,
you will be considered disabled, thus eliminating the need to address
Steps 4 and 5.
The Medical Listings
The medical listings are separated into two parts, Part A and Part B. Part
A contains the lists and qualifying criteria necessary for adults to be
considered disabled. Part A can also be applied to individuals under the
age of 18 if the impairment at issue has a similar effect upon adults
Part B contains
Childhood Listings, which includes additional qualifying criteria that must be met for children
to be considered disabled. In evaluating disability for an individual
under the age of 18, Part B will be applied first, and if it is considered
inapplicable, Part A will be applied.
The criteria in the Listing of Impairments apply only to Step 3 of the
multi-step sequential evaluation process. At that level, the presence
of an impairment meeting the criteria is usually sufficient to establish
disability. However, please note that the absence of a listing-level impairment
does not mean the individual is not disabled. Rather, it merely requires
that the adjudicator continue to the next step of the process.
Meeting a Medical Listing
If an individual meets a listing by
satisfying its specific requirement, they will be considered disabled. To “meet” a listing, the
claimant’s file must include medical evidence showing both the existence
of the impairment and the level of its severity.
As an example, below is a listing requirement that applies to individuals
claiming joint injuries or conditions:
Major dysfunction of a joint(s) (due to any cause): Characterized by gross anatomical deformity (e.g., subluxation, contracture,
bony or fibrous ankylosis, instability) and chronic joint pain and stiffness
with signs of limitation of motion or other abnormal motion of the affected
joint(s), and findings on appropriate medically acceptable imaging of
joint space narrowing, bony destruction, or ankylosis of the affected
A. Involvement of one major peripheral weight-bearing joint (i.e., hip,
knee, or ankle), resulting in inability to ambulate effectively, as defined
B. Involvement of one major peripheral joint in each upper extremity (i.e.,
shoulder, elbow, or wrist-hand), resulting in inability to perform fine
and gross movements effectively, as defined in 1.00B2c.
In short, a joint injury must be severe, meeting both 1.02 and subsection
A or B. If you happen to have significant right arm injury, you cannot
meet this listing, as the other has not been impacted. Similarly if you
are claiming an injury to your hip, your injury must also impact you ability to walk.
Equaling a Medical Listing
It is important to note that it is highly unlikely that the Administration
will find that you have met a medical listing. However, you may also able
use the listings by establishing that you “equal’ rather than
“meet” the listing. In fact, at the Hearing Level of your
claim (if it gets to that point), an Administrative Law Judge (ALJ) will
consider your combination of
physical impairments to determine whether you meet or equal a listing.
Lester v. Chater, 81 F.3d 821 (9th Cir. 1995)
If your impairments are similar to the listings but they fail to meet every
criterion, you may equal the applicable medical listing(s) and receive
benefits. To equal a listing, you are required to show that your impairment
is equivalent in severity and duration to a Social Security listing for
a similar impairment. Proving that you equal a listing follow one of the
following three paths:
Disability Based Upon a Listed Impairment Combined With Other Issues
In this scenario, you have a listed impairment, but your conditions fail
to meet the requirements outlined by SSA. Using the above listing, consider
the example in which you have a hip injury, but do not have issues with
ambulation. If you have other medical issues that are of equal medical
impact as the requirements of the listing, your condition may equal the
listing. Using our same example, someone with osteoarthritis of the hips
and a prior hip injury, could claim that they equal 1.02 above.
Disability Based Upon an Unlisted Impairment
It should come as no surprise that Social Security has not yet defined
every disease or impairment. Such a task would be monumental in evaluating
all impairments and dictating criteria necessary for each impairment to
be disabling. Therefore, if you have an impairment that is not listed,
you may still claim that the impairment is similar to one that is listed.
Combination of Impairments
The final option is to claim that the combination of impairments that you
are suffering from, are equal in severity to the Listing or are closely
related. To prove this, you will need to describe the impairments, their
symptoms, and any medical findings and claim that these issues are equal
to a listing. The Administration will determine whether the combination
of impairments you claim are, in fact, analogous to a listed impairment.