Meeting a Social Security Disability Listing
Meeting a Social Security listing is one strategy you can use to win your case. Other strategies include arguing that your functional capacity for work has been so reduced by your medical condition or conditions that you cannot work, and arguing that you meet a “grid” rule. The advantage to proceeding with a listing argument is that you are more likely to be approved earlier in the process by a State Agency adjudicator.
When you file your application for SSDI or SSI benefits, your case file is organized and worked up by someone called an Adjudicator who works for an office called the DDS or DAS (Disability Determination or Disability Adjudication) office. These adjudicators are typically employees of the State where you live, not the federal government, and these adjudicators have limited discretion to make decisions about your case.
State Agency adjudicators are trained to look for cases in which a claimant meets a listing. Medical listings are detailed descriptions of medical impairments as set forth by the Social Security Administration in a federal government publication called the Code of Federal Regulations (CFR). Social Security Listings for adults are available online for your review. The collection of listings is known with the Social Security Administration as the blue book.
If you review the listings, you will see that listing level medical problems are divided into 14 categories. Each of these categories is further broken down into specific descriptions of medical problems. If your medical diagnosis is equal to the description of a medical problem shown in the listing, then you are automatically disabled per Social Security law.
State Agency Adjudicators are trained to review your medical records to see if you meet a listing. If your records suggest that you do meet a listing, then the adjudicator will ask for confirmation from a staff physician, then issue a notice to you that your case has been approved. Most listing level cases are approved by adjudicators within one year of your application.
Unfortunately, not all listing level cases are caught by the State Agency adjudicator. If your doctor is not familiar with the listings and does not clearly spell out how you meet the listing, your case will end up in the denial pile. Therefore, if you think you meet a listing, you should print out the appropriate listing text, take it to your doctor and ask that the doctor write a narrative report confirming that you meet the listing and describe how you meet it. Also, you will want your doctor to identify the earliest date on which your condition meets the listing.
If you have a complicated medical condition, or multiple conditions, it may make sense to retain the services of a disability lawyer to create a listing checklist that will track the requirements of the listing. Ultimately, your goal should be to enable your doctor help you win your case.
If you review just about any listing, you will note that most of the listings contain both a lab test element as well as a functional capacity element. In other words, even if your medical diagnosis is so severe that you meet one of these listings, SSA wants some comment or observation from your doctor about your capacity to work.
You will also note that the majority of the listings require some form of objective testing - whether it is the pumping capacity of your heart, MRI records of your spine or the composition of your blood, Social Security will not rely on your doctor’s opinion alone when it comes to finding your disabled on a listing.
Do not assume that your doctor knows about Social Security’s listings - ask him if he knows and provide him with copies of the appropriate listing printout.