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 purposes of 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 and adolescents.
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:
1.02 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 joint(s). With:
A. Involvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle), resulting in inability to ambulate effectively, as defined in 1.00B2b;
OR
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 mental and 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.
DIRECTIONS
