Friday, September 14, 2012

What happens if my medical condition does not meet a medical listing?

A few weeks ago, I posted a blog article about the medical listings for back impairments. As I mentioned in the post, a medical listing is a collection of medical criteria that need to be met and documented in order for the Social Security Administration (SSA) to deem you disabled from a medical standpoint and grant you Social Security Disability (SSD) benefits (either Social Security Disability Insurance Benefits or Supplemental Security Income benefits). But what if your medical condition does not meet all of the criteria necessary for a medical listing but still prevents you from performing your existing job or finding new employment? Don’t worry, all is not lost. In this post I will explain how you can still qualify for SSDI benefits even if your condition does not qualify for a medical listing.

Meeting a medical listing is not the only way to prove that you are disabled per SSA regulations. Many people applying and obtaining SSD benefits do not meet a medical listing. As I discussed in a previous article, if your condition does not meet a medical listing, you can still prove that you are disabled by demonstrating that you are both unable to work at your previous job(s) or at any other jobs on a full time sustained basis.

If you do not meet a medical listing, the SSA will assess your Residual Functional Capacity (RFC). Simply put, an RFC is a determination of what you can still do despite your medical condition. In basic terms, the SSA will determine if you are still capable of performing heavy, medium, light, or sedentary work. This determination will be based on a medical opinion about your physical restrictions. At this point, your treating physician’s opinion is crucial because you want to present the most compelling evidence possible demonstrating your ability (or inability) to perform certain work functions. As such, documentation by your physician can be the difference between getting approved or denied SSD benefits.

As I mentioned, the RFC will determine the extent of physical and mental exertion that you can still take on in the context of your medical condition and/or disability. However, a given RFC may prevent you from doing one type of job but not another. For example, an RFC that restricts you to sedentary work may qualify you for SSD if you were a trained lumberjack but may not qualify you for benefits if you were a data entry clerk. As such, once the SSA determines your RFC, they will then look at your past relevant work. Employing the expertise of vocational experts, the SSA will then determine if your RFC will allow you to continue performing your usual job activities. If the SSA determines that your RFC does not preclude you from performing this past relevant work, then your application for SSDI benefits will be denied.

Conversely, if you are not capable of performing your past relevant work with this RFC, the SSA will move on to the next step of determining whether, given your age, education, and past work experience you would be capable of performing other work. For example, if you are a lumber jack but your RFC limits you to sedentary work, the SSA will determine if you can perform a sedentary job like that of a data entry clerk. This determination, as I previously mentioned, is made based on how old you are, what level of schooling or training you completed, your education background, and your past work. If the evaluation then determines that this combination of factors prevents you from performing another type of job, you will be granted SSD benefits.

This is a very general description of the process for determining whether you are disabled despite not having met a medical listing. As you can imagine, in reality, the decision making process is more complex and labor intensive. Multiple factors contribute to the determination of whether you are able to return to past relevant work and/or to perform a new type of job. Nonetheless, the main take home message remains the same: if your medical condition prevents you from being able to perform your job, you still may be able to qualify for SSD benefits despite not meeting a medical listing.

This is NOT legal advice.  This blog provides general information about Social Security Disability cases.  To discuss your particular circumstances and claim, please contact a lawyer in your area.

1 comment:

  1. Thanks for the info. This is very helpful information.