Presumption of Disability

Medical Evidence as Basis for Decision of "Disabled" -- Listing of Impairments

When is medical evidence alone enough to establish your disability?

Medical evidence alone may establish that you are disabled if:

A.     The evidence shows that you have an impairment as described in Part A of the Listing of Impairments; this is called "meeting" a listing; or

B.     The evidence shows you have an impairment or combination of impairments that is medically as severe as a listed impairment; this is called "medically equaling" a listing.

You must not be engaging in any substantial gainful activity.

How is the Listing of Impairments used to establish disability?

The Listing of Impairments (the listings) is set out in Social Security regulations. The listings are in two parts. There are listings for adults (part A) and for children (part B). For claimants over 18, Social Security uses part A and for those under 18, SSA uses part B. The listings are examples of common impairments for each of the major body systems that Social Security considers severe enough to keep an average adult from doing any gainful activity.  See appendix 1 of subpart P of part 404 of Social Security's regulations for the Listing of Impairments.

The listed impairments are of such a level of severity that Social Security considers a person whose impairment(s) meets or equals the Listing of Impairments to be unable to do any gainful activity, that is, the impairment(s) is expected to result in death, or to last for a specific duration, or the evidence must show that the listed impairment has lasted or is expected to last for at least 12 months in a row.

Is the diagnosis of an impairment in the Listing enough to establish your disability?

Generally, a diagnosis alone does not meet the guidelines of the Listing simply because it is the same diagnosis as a listed impairment. To be considered as "meeting" a listing, the impairment must have the symptoms, clinical signs, and laboratory findings specified in the Listing.

Comments

[Disability Team]

After you complete your disability application, social security will review it to see if you meet the requirements for Supplemental Security Income (SSI or Title XVI) or Social Security Disability Insurance Benefits (SSDI or Title II or DIB). If you meet these requirements, social security sends your application to the disability determination services (DDS) office in your state. Under contract with the Social Security Administration, each state DDS determines if your medical condition is considered a disability under the Social Security law.

The disability decision is made in the DDS office, with a 2-person team that consists of a physician (or psychologist) and a disability examiner who will consider the facts in your case and decide if you are disabled. They will use the medical evidence from your doctors, hospitals, clinics, or institutions where you were examined or treated. If the DDS team needs more medical information to decide your case, DDS will send you to have a special examination called a consultative examination.

When DDS receives your claim, it is assigned to a disability examiner who works directly with a medical consultant to determine if you are disabled and, if so, the date that your disability began (or, in the cessation or termination of benefits, the date the disability ended). Disability examiners prepare the case file and perform most of the evaluation but they must consult with the medical consultant on medical equivalence and residual functional capacity (RFC).

The medical consultant is a physician who is retained on a consultative basis to review files and assess the level of severity in each case. Medical consultants determine whether you meet or equal the level of severity set out in the Listings of Impairments.

[Denise]

Who decides if an impairment meets the Listing?