What to do if your particular disability is not
in the SSA’s list of covered disabilities.
Social Security’s Guidelines, also known as the Blue Book, lists many conditions that qualify for disability benefits. However, not everything that could possibly go wrong with the human body can be listed in a simple guide.
There are many illnesses and injuries that could prevent you from working. Adding to the confusion, some diseases are similar and can be mistaken for each other- this is especially true when it comes to mental illness. Thankfully, the Social Security Administration allows some subjectivity in the interpretation of the Blue Book listings through “Medical Equivalence”.
If your condition is similar to a Blue Book listing, you may be able to claim medical equivalence.
Medical equivalence means that your impairment is equal in severity and duration to a listed impairment. Each listed impairment has criteria that you must meet in order to be considered disabled under that impairment (For example, Asthma requires applicants to have a certain number of attacks annually). These criteria are called “findings”. There are three cases in which medical equivalence can be determined.
- If you don’t have one of the findings, or it is not as severe as the listing requires;
but you exhibit other symptoms that are as bad or worse as the listing requires.
- If you have a condition that is not listed in the Blue Book at all;
but your condition is just as debilitating as a similar listed condition.
- If you have multiple impairments, none of which are as severe as the listing requires;
but the combined ailments are as bad or worse as a listed impairment.
As you can see, determining medical equivalence is less black-and-white than determining if a condition meets a listing.
Thorough medical records will be very helpful for comparing your condition(s) to the listings. One of the best ways to help your claim is to have accurate, complete and current records. If Disability Determination Services does not have enough evidence to make a determination of medical equivalence based on your records, they may refer you to a state-approved doctor for further evaluation.
It is important to note that only health care professionals are qualified to perform medical evaluations.
When you first file your application, a “designee of the commissioner” (usually a licensed, state-approved, medical professional) will make the determination of equivalence. If your claim is denied and appealed, an administrative law judge or council will have the final say on whether or not a listing is met, but they are required to consider a health care professional’s opinion. The judge may ultimately disagree with the health care professional, but they are required by federal law to explain the impact of the expert’s medical opinion on their judicial decision.
The issue of medical equivalence can only be determined with medical evidence.
In March 2006, the Social Security Administration modified its rules regarding how medical equivalency is determined. Previous to the rule change, all evidence (age, income, previous work) could be considered in an equivalency determination. Now, the Social Security Administration keeps non-medical evidence from influencing medical determinations.
Medical equivalency is frequently an issue in claims that have been denied. If you have applied for Social Security Disability Insurance and your claim has been denied, the attorneys at Bemis, Roach and Reed can help. Contact us first, our firm has years of experience helping disabled Americans get the benefits they need and that their tax dollars paid for. Having a professional represent you can make the difference between your appeal being successful or being denied. Call us today at 512-454-4000 for a free consultation and get help NOW.
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