How does the Social Security Administration decide that someone is “disabled”?

The Social Security Administration (SSA) enforces two sets of regulations to determine disability. Under the Listing of Impairments, if certain medical findings are present, a claimant must be found “disabled” without regard to whether a claimant can perform his or her past job(s). The other set of regulations, the Medical-Vocational Guidelines, are only looked to when a claimant cannot be found disabled according to the Listing of Impairments, and only after a claimant is able to show that he or she cannot do any past relevant work. The Medical-Vocational Guidelines prescribe whether a claimant is disabled given certain combinations of age, education level, work experience and residual functional capacity. These Guidelines directly apply to physical impairments that cause exertional limitations, but they are sometimes used as a framework in other cases, as well.

What is the Listing of Impairments?

This is a set of medical findings describing many common physical and mental impairments, as well as some uncommon ones. The Listing is available online at http://www.socialsecurity.gov/disability/professionals/bluebook/index.htm. If a claimant “meet[s] the Listings,” he or she is found disabled. A claimant may also be found disabled because his or her impairment is equally severe to a particular impairment in the Listing of Impairments. In such cases, the claimant is said to “equal the Listings.”

Does the treating doctor’s opinion play any role in deciding whether a claimant’s impairment meets or equals the Listings?

Although the SSA will consider a treating doctor’s opinion that a claimant meets the Listings, and may agree with it if the medical findings match with what is found in the Listings, the SSA insists that whether a claimant meets the Listings is an issue reserved solely for the SSA. The SSA also describes the issue of meeting the Listings as one that is a question of medical fact, as opposed tomedical opinion, and as such regards the treating doctor primarily as a source of medical evidence, and not fact. Furthermore, the SSA states that an opinion as to whether a claimant’s impairment equals the Listings requires special expertise that is not possessed by treating doctors. In practice, however, the SSA’s administrative law judges will carefully weigh any well-documented opinion that a claimant’s impairment meets or equals the Listings.

North Carolina Social Security disability lawyers Dorman & Howie can answer more of your questions about Social Security disability applications.