Obesity and Qualifying for Disability Benefits

In order to qualify for SSDI with obesity, an applicant must be able to meet a listing for another medical condition or provide evidence that their obesity causes or contributes to another listed impairment.

Obesity is a complex medical condition which may impact an individual’s employment as well as their personal life. If you are unable to work because of obesity, you may be eligible for Social Security Disability benefits.

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Obesity is a complex disease characterized by an excess of body fat and develops when a person consumes more calories than they burn through exercise and daily activities.

The body then stores excess calories as fat. Though obesity can sometimes be traced to another medical condition, its causes usually involve behavioral, metabolic, genetic and hormonal influences. Obesity can lead to depression, social isolation and low work achievement as well as life-threatening medical conditions such as diabetes, heart disease, stroke and certain cancers. The good news is that obesity is highly treatable through diet and behavior changes, physical activity, medications, and weight loss procedures.

Even though obesity leads to a variety of health issues and can make it difficult for a person to maintain employment, by itself obesity may not qualify for Social Security Disability Income.

At one time, obesity was listed as an impairment in Social Security’s Blue book, but the listing was removed in 1999 because it was thought that many people with obesity were able to lead productive lives and earn a living. However, obesity is still considered a medically determinable impairment (MDI) “that results from anatomical, physiological, or psychological abnormalities” when there is objective medical evidence from an acceptable medical source. Social Security recognizes that individuals with obesity have a higher risk for other medical disorders and that obesity, alone or in combination with another medical condition, may be as severe as a listed impairment. In order to qualify today for SSDI with obesity, an applicant must be able to 1) meet or match a listing for another medical condition; or 2) provide evidence that their obesity causes or contributes to another listed impairment.

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from Obesity. If you have been denied disability don’t give up!

How does Social Security determine that an applicant is obese?

No specific weight establishes obesity as a severe impairment.

A person is considered obese when their BMI (body mass index) measures 30 or higher. BMI is a measure of body fat calculated by dividing a person’s weight in kilograms by the square of his or her height in meters (kg/m2). Social Security will calculate an individual’s BMI based on the medical evidence in their file, not an applicant’s self-reported height and weight. Social Security will determine that obesity is an MDI if an individual’s weight, waist size and BMI show a “consistent pattern of obesity” over time. In some cases a person with a large percentage of muscle, such as an athlete, will have a high BMI but they would not be considered obese. In other instances where a person’s BMI is normal, they may still be considered obese if their waist size is greater than 35 inches for a woman and greater than 40 inches for a man.

What impairments does Social Security associate with obesity?

Obesity is generally associated with musculoskeletal, respiratory, cardiovascular and endocrine disorders, but that does not mean an individual with obesity will necessarily develop any of those disorders.

Social Security associates the following listed impairments with obesity:

•   Type II diabetes mellitus
•    Diseases of the heart and blood vessels such as high blood pressure, atherosclerosis, heart attacks and stroke
•   Respiratory impairments such as sleep apnea, asthma, and obesity hypoventilation syndrome
•   Osteoarthritis
•   Mental impairments such as depression
•   Cancers of the esophagus, pancreas, colon, rectum, kidney endometrium, ovaries, gallbladder, breast or liver.

When does Social Security consider obesity a “severe impairment” and how does Social Security evaluate obesity in relation to listed impairments?

When obesity, alone or combined with other medical disorders, significantly limits a person’s ability to perform basic work activities, Social Security determines obesity to be a “severe” impairment.

Social Security considers all symptoms that might limit a person’s physical and mental functionality such as fatigue, pain, mobility, and depression. Functional limitations resulting from obesity may increase the severity of a related medical disorder. For example, if an applicant suffers from arthritis in the knee, obesity may exacerbate their symptoms. Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book. However, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. It should be noted, however, that Social Security does not assume that obesity combined with another medical condition will equal a listed impairment. Each case is evaluated on an individual basis.

What is the role of an RFC in evaluating obesity?

If an applicant’s obesity doesn’t meet the criteria of a listed impairment or cannot be combined with another impairment to equal a listing, Social Security will conduct a residual functional capacity assessment (RFC).

An RFC evaluates an applicant’s abilities despite their functional limitations, assessing a person’s ability to perform routine movement and necessary physical activity in a work environment. Obesity puts stress on weight-bearing joints and can limit a person’s range of motion in the spine and extremities. Social Security will consider whether an individual has difficulty standing, walking, kneeling, lifting, sitting, crouching, bending, stooping, balancing, and manipulating objects. Social Security will use the RFC assessment to determine what jobs an applicant can still do, if any. If there is some type of work an applicant can still perform, their claim will be denied, but if the symptoms of obesity are so limiting that there is no job they can do, the applicant may be awarded benefits under a “medical-vocational allowance.”

Whether you qualify for SSDI under an impairment listing or go through an RFC assessment, it’s absolutely essential to provide complete records documenting all your medical conditions.

Social Security will want to see:

•   Physical exam notes
•   Body Mass Index (BMI) reports
•    Physical exam notes from your doctor
•   Lab work showing diabetes, kidney and liver values and cholesterol levels
•   Heart function and stress test results
•   Hospitalization reports
•   Imaging reports such as x-rays or MRIs to musculoskeletal problems
•   Sleep study reports and records of breathing complications
•   Psychological evaluation reports

If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.

You may also be eligible for Social Security Disability benefits if you have another medical condition; for example, diabetes or high blood pressure.

One disorder by itself may not match the requirements of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.

Social Security also has basic financial requirements.

Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements.

You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.

What if I don’t qualify for SSDI?

If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.

I have long-term disability insurance – should I file a claim?

Yes, you should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.

How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

If your initial application is denied, don’t be discouraged. Approximately 65% of initial applications are denied, but you will have the opportunity to appeal.

There are four steps to the Social Security appeal process:

1.    File a Request for Reconsideration with the Social Security Administration to completely review the case.
2.    If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
3.    If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
4.    Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.

Do I need a disability attorney for SSDI?

Qualifying for Social Security Disability benefits is problematic because the requirements of Social Security’s impairment listing are very difficult to decipher.

Your chances for approval are increased significantly if you have an experienced disability attorney who can gather your necessary medical evidence and even write a brief explaining why you qualify. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.

Do I need a disability attorney for a long-term disability insurance claim?

Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.

The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.