There are three strategies that disability claimants can use to win benefits. Depending on the facts and circumstances of your case, you can use one, two or all three. As you review these options, keep in mind SSA’s definition of disability – you are disabled if you are unable to perform substantial gainful activity because of a medical problem that has lasted or is expected to last 12 consecutive months or result in death.
Strategy One – meet a medical listing. Social Security recognizes that certain medical conditions are so severe that if you have been diagnosed with one of these conditions, any reasonable person would conclude that you do not and will not have the capacity to work (perform substantial gainful activity). Examples:
- if your heart is working at only 20%
- if you have damage to your spine such that you cannot walk normally
- if you are on kidney dialysis
- if you have metastasized cancer
- if you have multiple sclerosis and limited control of your arms and legs
- if your IQ is below 60
These conditions are examples of medical problems that meet one of Social Security’s medical listings. The listings divide the human body into 14 different systems and there are multiple listings for each of these systems. 1
The listings are designed to help Social Security claims reps (called Adjudicators) identify qualified applicants fast and early. Most early approvals are based on a listing but enough listing level claims fall through the cracks that I always look for an applicable listing when preparing for my hearings.
Strategy Two – meet a grid rule. Social Security recognizes that if you are over the age of 50, you will have a more difficult time finding a job. This is especially the case if you have an unskilled work background and a high school or less education. These assumptions have been incorporated into the law in the form of SSA’s Medical Vocational Guidelines (grid rules). These guidelines are called the grid rules because the different categories (age, education, work background) are set out in a table divided by lines – in other words, a grid.
The grid rules only apply if your impairment limits your physical capacity. You cannot use the grid rules for mental health problems.
I have made the grid rules easier to understand in a web site I created called GridRules.net. There you can look to see if you might fit within one of these categories.
If you fit within a grid rule category and the result is “disabled” you win automatically without needing to prove anything else.
Strategy Three – prove that your capacity to work has been so reduced by your medical problems that you would not be a reliable employee. This is called the functional capacity argument because you are asserting that your capacity to function in a work environment is less that what would be required by a simple, entry-level, sit down type of job.
Most administrative law judge hearings are decided under this approach because a judge can consider your impairments as a whole, including:
- your physical limitations
- your mental limitations
- job reliability factors that naturally arise from your condition (i.e. excess bathroom breaks, need to keep legs raised)
- side effects of medications
- your work history
- your educational history
- your credibility
- witness testimony
Whenever possible I ask one or more treating doctors to complete a functional capacity evaluation form that I will then submit to the judge. This form is based on SSA’s internal form, but I modify it to reflect your specific medical issues and likely work limitations.
My experience has been that we have a much better chance at winning (convincing a judge that you meet SSA’s definition of disability) if we can state your claim clearly, concisely and using SSA’s language. If I can be of help to you in pursuing your claim, please do not hesitate to call on me.