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 reliably perform the duties of a simple, entry-level job because of a medical problem that has lasted or is expected to last 12 consecutive months.
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, you do not and will not have the capacity to work (perform substantial gainful activity). This is called meeting a listing. Examples of listing level conditions include:
- if your heart is working at only 20% (Listing 4.02)
- if you have damage to your spine such that you cannot walk normally (Listing 1.02)
- if you are on kidney dialysis (Listing 6.03)
- if you have metastasized cancer (Listing 13)
- if you have multiple sclerosis and limited control of your arms and legs (Listing 11.09)
- if your IQ is below 60 (Listing 12.05)
These conditions are examples of serious 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. You can learn more about the listings at my web site MeetAListing.com.
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 assume that you are disabled even if you retain some capacity for work. In other words you do not have to be completely unable to work. Instead, the grid rules recognize that older, less educated workers are, in effect, disabled because there are no jobs that exist for them.
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. You can also read several case studies describing cases I have won using the grid rules – click here to read.
If you fit within a grid rule category and the result is “disabled” you win automatically without needing to prove anything else.
Strategy Three – reduced capacity to work – 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 has been reduced by your medical issues to 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. On my Georgia Social Security disability web site, I have posted dozens of case studies describing what happened at hearings I have tried over the years – click here to find your medical condition and read one or more case studies.
I regularly win cases using one or more of these three strategies work and you can win too if we have solid evidence documenting a severe level of impairment and you are properly coached about how to testify. You stand 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 reach out to me.