After age 60, approval rates increase even further (according to the survey results, 62% for people 60-65 years old). However, some people choose to retire early at age 62 or 63 instead of applying for disability. Even though early retirement may seem like an easier option, choosing it can reduce the amount of benefits you’re entitled to. You can get disability benefits up until full retirement age, which is 67 (as of 2024).
Because the disability process can be long and complicated (and carries a stigma for some people), you have the option to take early retirement once you turn 62. However, collecting Social Security retirement early rather than applying for disability has some drawbacks that you should consider before making this decision.
If you take early retirement once you reach the age of 62, your retirement benefit amount will be permanently reduced. The amount your benefit is reduced by depends on the number of months you have until full retirement age. This is called the “reduction factor.” Depending on how early you decide to retire, you may only be able to collect 70% of the benefits you would be owed at full retirement age.
On the other hand, if you’re awarded Social Security disability benefits (SSDI), your benefit amount is the same as what you’d get if you retired at age 67. This is because SSDI and retirement benefits are based on how much money you paid in Social Security taxes. You’ll also get the benefit of a “disability freeze,” which disregards any low (or zero) earning years you had while you were disabled for the purpose of calculating your monthly Social Security benefit.
So while you can collect early retirement sooner, you won’t get as much money as you would with SSDI. But although it’s easier to get disability at age 62, there’s no guarantee that you’ll win your case, which can take years to decide. You may want to contact an experienced attorney to discuss whether it’s better for you to retire or go on disability.
Not at 65, no. If you’re receiving SSDI, your benefits do change once you reach full retirement age, but in name only— your disability benefits simply convert to retirement benefits. Your payment amount won’t change, and your future retirement benefits aren’t reduced even though you were able to collect Social Security early.
For workers over 50 who are no longer able to do their past work—particularly those who are 60 and older—Social Security must consult the grid rules to determine disability. The grid rules take into consideration factors such as the applicant’s age, residual functional capacity (RFC), education, and work history when deciding whether a disability claim should be approved or denied.
Social Security acknowledges that it’s often harder for workers nearing retirement age to learn new skills and transition into new workplaces. That’s why claimants over the age of 60 are much more likely to be approved using the grid rules. But if your old job was skilled and the SSA thinks you can use your skills doing a less physically demanding type of job, you won't be approved for disability just because you’re 64.
Your RFC is the most physical work you can do on a regular and sustained basis. RFCs can be for “sedentary”, “light”, “medium”, or “heavy” work. If you can still do heavy work, you won’t get approved under the grid rules regardless of your age. But if you're limited to sedentary or light work, you'll be found disabled if you're over 60, don't have a high school education, and don’t have transferable skills.
Social Security divides education levels into five classifications: illiterate (an inability to read or write even simple messages), marginal (defined as finishing 6th grade or less), limited (having completed between the 7th and 11th grade), high school graduate (including obtaining a GED), and direct entry to skilled work (for example, completing a trade apprenticeship).
If you're a high school graduate with recent schooling or training that would allow you to move directly into skilled work, you can’t be found disabled under the grids—although you could still be found disabled by meeting a listing or if you have an RFC that eliminates all jobs.
People who have skills from their past work experience that they can use in other jobs (“transferable skills”) can’t be found disabled using the grid rules. To determine if you have transferable skills, Social Security looks at your work history to see if your jobs were classified as unskilled, semi-skilled, or skilled work.
Skill levels are generally based on how long it takes to learn all the duties of the job. The longer it took you to learn your job—or if your job required specialized education—the higher its skill level will be. Unskilled jobs don’t, by definition, give you transferable skills, so it’s typically easier for people who did unskilled work to get approved under the grid rules.
People who’ve worked at semi-skilled or skilled jobs will typically have learned skills they could use elsewhere, which can make it harder to get disability using the grid. But some skilled and semi-skilled jobs are so specialized—such as tailor or plumber—that the SSA won’t find that those skills are transferable. And without transferable skills, you’ll have a better chance of being found disabled.
Here are the specific grid rules for people who are aged 60 and older. Find the grid that describes your RFC (sedentary, light, or medium). Next, find the row that describes your education level and your previous work experience. The final column will show the decision that Social Security will make based on the previous factors.
RFC for SEDENTARY WORK
Education |
Previous Work Experience |
Decision |
11th grade or less |
Unskilled work or no past relevant work |
Disabled |
11th grade or less |
Skilled or semiskilled work without transferable skills |
Disabled |
11th grade or less |
Skilled or semiskilled work with transferable skills |
Not disabled |
High school graduate/GED or more |
Unskilled work or no past relevant work |
Disabled |
High school graduate/GED or more |
Skilled or semiskilled work without transferable skills |
Disabled |
High school graduate/GED or more |
Skilled or semiskilled work with transferable skills |
Not disabled |
Recent education that provides for direct entry into skilled work (at least high school graduate) |
Unskilled work or no past relevant work |
Not disabled |
Recent education that provides for direct entry into skilled work (at least high school graduate) |
Skilled or semiskilled work with or without transferable skills |
Not disabled |
RFC for LIGHT WORK
Education |
Previous Work Experience |
Decision |
11th grade education or less |
Unskilled work or no past relevant work |
Disabled |
11th grade education or less |
Skilled or semiskilled work without transferable skills |
Disabled |
11th grade education or less |
Skilled or semiskilled work with transferable skills |
Not disabled |
High school graduate/GED or more |
Unskilled work or no past relevant work |
Disabled |
High school graduate/GED or more |
Skilled or semiskilled work without transferable skills |
Disabled |
High school graduate/GED or more |
Skilled or semiskilled work with transferable skills |
Not disabled |
Recent education or training for skilled work |
Unskilled work or no past relevant work |
Not disabled |
Recent education or training for skilled work |
Skilled or semiskilled work with or without transferable skills |
Not disabled |
RFC for MEDIUM WORK
Education |
Previous Work Experience |
Decision |
6th grade education or less |
Unskilled work or no past relevant work |
Disabled |
7th through 11th grade education |
No past relevant work |
Disabled |
7th through 11th grade education |
Unskilled work |
Not disabled |
7th through 11th grade education |
Skilled or semiskilled work without transferable skills |
Not disabled |
7th through 11th grade education |
Skilled or semiskilled work with transferable skills |
Not disabled |
High school graduate/GED or more |
Unskilled work or no past relevant work |
Not disabled |
High school graduate/GED or more |
Skilled or semiskilled work without transferable skills |
Not disabled |
High school graduate/GED or more |
Skilled or semiskilled work with transferable skills |
Not disabled |
Recent education or training for skilled work |
Skilled or semiskilled work with or without transferable skills |
Not disabled |
It can be difficult to determine the skill level of your old job and whether any of the skills you learned can transfer to another position. You can get a sense of how your job might be classified by searching the Dictionary of Occupational Titles, a Department of Labor publication, for the definition that best describes your job. Look for the SVP (“specific vocational preparation”) number at the bottom of the job description. An SVP of 3 or 4 is usually considered semi-skilled, while an SVP of 5 or higher is skilled work. If the SVP is 1 or 2, the job is very likely unskilled.
In certain limited cases, the “work out worker” rule can be used to qualify for disability. You may get approved under this rule if you’re unable to return to your old job, you have a marginal education, and you worked for at least 35 years doing only “arduous, unskilled physical labor” (work that primarily involves strength and endurance and requires little or no training to learn).
You can apply for disability benefits right up to your 67th birthday, but it doesn’t always make a whole lot of sense to do so. Because SSDI disability converts into “regular” Social Security retirement at 67 at the same benefit amount—and because it often takes more than one year to get an approval on your disability claim—you might find it easier to wait until you turn 67 to draw your retirement benefits.
However, if you have a medical condition on Social Security’s Compassionate Allowance List—which allows for expedited approval of claims based on very serious or terminal illnesses—you might want to apply for disability after age 66. Compassionate allowance conditions can be approved in as little as a few weeks.
If you’ve decided to apply for disability benefits—or you’re 62 and want to apply for early retirement—you can start your application in several ways:
If your application is approved and you start receiving disability benefits, it’s unlikely that you’ll undergo a continuing disability review after age 60 unless your medical condition improves significantly. While they do happen on occasion, the SSA schedules disability reviews more infrequently the closer you get to full retirement age.
Updated March 20, 2024
]]>Because Social Security defines disability as being unable to work full-time due to a severe medical condition, you’ll need to show that you have at least a 12-month period where you aren’t earning above SGA. Otherwise, your application will be denied.
For most disability applicants, the Social Security Administration (SSA) definition of substantial gainful activity means earning above a specific dollar amount. In 2024, this amount is $1,550 or more a month, or $2,590 if you’re blind. The SSA adjusts these amounts each year to account for increases in the cost of living.
The maximum substantial gainful activity amounts themselves are pretty straightforward. If you’re making more than the monthly SGA level, the SSA can’t award you disability benefits. It doesn’t matter if you made the entire SGA amount in one week and were totally bedridden for the rest of the month—the agency isn’t allowed to find you disabled.
But SGA can be more than just a number. For instance, volunteer work, running a small business, and even criminal activity can all be considered SGA—even if you're not making any money.
To understand how Social Security decides what SGA is, it helps to break down the term “substantial gainful activity” into its component parts. The SSA considers work to be substantial when it involves significant physical or mental effort, and gainful when you get paid for your effort. Work can be substantial even if you can only do it part time, and gainful even if you don’t actually get paid—as long as it’s the type of work people usually get paid to do.
Here’s an example of a case where the SSA might determine that a disability applicant is working at the level of substantial gainful activity, even when they’re earning less than $1,550 in a month:
As shown in the above example, even if you don’t get paid for your work, the SSA can still conclude that your volunteer activity counts as substantial gainful activity or shows that you have the ability to work at the SGA level.
Disability applicants who are involved volunteers are sometimes surprised to learn that their “work-like” activity can count as SGA. Examples of situations where the SSA might calculate volunteering as SGA include:
The more your volunteering resembles “work-like” activity, the more likely the SSA will find it to be SGA. For example, if you volunteer at a library stocking shelves for 20 hours a week, the SSA can take into consideration the physical demands of the job (carrying and shelving books) as well as the significant number of hours worked (half of a normal workweek) to determine that the volunteer position should be counted as SGA.
Not every activity that a person could earn money doing will count as SGA for Social Security purposes. For instance, here are some examples of activities that the SSA usually doesn’t consider to be substantial gainful activity:
Keep in mind that even though the SSA doesn’t consider these activities to be SGA for the purposes of determining your initial eligibility for disability benefits, the agency may still consider them as evidence of your functional limitations. Your limitations are an important component of your residual functional capacity, a set of restrictions that the SSA uses to determine whether you’re disabled.
If you are working, the SSA doesn’t always count all of your income towards the SGA threshold. Such exceptions are known as “income exclusions,” and are meant to encourage people who are trying to get back into the workforce.
If you apply for Supplemental Security Income—the needs-based disability program for people with a low income and few assets—and you’re earning some money from work, Social Security will exclude a portion of your income when determining whether you’re working at SGA. The SSA excludes the following:
Impairment-related work expenses (IRWEs) are costs you incur for special services or equipment related to your disability and necessary for you to work. If you have paid IRWEs, the SSA may deduct the cost from your earnings. This can help keep your income under the SGA level. Examples of items that the SSA may consider to be IRWEs include:
To have IRWEs deducted from your earnings, you can’t have already received reimbursement for them (for instance, from a vocational rehab program). You also can’t get IRWE deductions for payments for services needed on behalf of other people, such as childcare. Costs for IRWEs must also be paid in cash and not by an exchange of services.
Some employers pay disabled workers more than the market value of their labor in order to help them overcome employment barriers and gain experience in the workforce. The SSA refers to these situations as “subsidized” or “sheltered” employment. Any amount you’re paid over the reasonable value for your services is considered a “subsidy.”
The SSA won’t include the amount of the subsidy when determining whether your work is SGA. The agency uses multiple factors to determine whether earnings include a subsidy and to calculate the approximate value of the subsidy. You can learn more about subsidized employment in Social Security Ruling 83-33, Determining Whether Work is Substantial Gainful Activity—Employees.
If you’re self-employed—doing contract (“gig”) work, odd jobs, freelancing, or running a small business—the SSA uses one of two special formulas to calculate whether your work is SGA. These formulas are called the “Countable Income Test” or the “Three Tests.” Which test the SSA uses will depend on when your business was started and why the SSA is reviewing your work activity. You can learn more about how the SSA applies these tests in our article on disability benefits for the self-employed.
Passive income, such as money from investments or retirement funds, isn’t considered SGA. But passive income can affect your eligibility for Supplemental Security Income if it’s above the income limits for the program.
Some people who qualify for disability benefits eventually have their health improve to the point that they’re able to return to work. Social Security will periodically revisit approved disability cases (called “continuing disability reviews” and, for people who receive SSI, “redeterminations”) to make sure that recipients still qualify for benefits.
If you’re already getting Social Security disability and you begin working above the level of substantial gainful activity, the SSA can terminate your benefits. But generally the agency will give you some leeway before ending your benefits altogether. For more information, see our articles on how much you can work while on SSDI and how much you can work while receiving SSI benefits.
Updated March 19, 2024
]]>In reality, the SSA can award disability benefits to claimants even if they’re currently struggling with active drug or alcohol abuse, but only if the agency determines that the claimant is disabled despite the drug or alcohol addiction.
Social Security publishes rulings (SSRs) that provide guidance for claims examiners and administrative law judges on how they should decide disability applications. SSR 13-2p is the agency’s ruling on how to evaluate claims with evidence of drug addiction or alcoholism (DAA).
The SSA can deny a disability claim if the agency determines that DAA is "a contributing factor material to the determination of disability." Material means that substance abuse plays such a significant role in your claim that the agency isn’t sure whether you’d be disabled if you stopped using drugs or alcohol.
SSR 13-2p clarifies Social Security’s procedure for deciding when DAA is material. The DAA process consists of a series of six questions.
The SSA will review your medical records for references to the abuse of drugs or alcohol. Red flags include the use of illicit street drugs such as methamphetamine, cocaine, and heroin, but the agency will also be on the lookout for signs of prescription drug abuse, such as getting a refill for opioids (like Vicodin) too quickly.
Social Security isn’t concerned with occasional or responsible use of alcohol or recreational drugs, so having a glass of wine at dinner won’t raise any eyebrows. But if you’re regularly indulging in excessive drinking to the point that your doctor diagnosed you with a substance use disorder, the SSA will likely consider that to be evidence of alcoholism.
Social Security will look at all your physical and mental limitations—including those resulting from DAA—and apply the sequential evaluation process to determine whether your impairments are disabling. If you wouldn’t be found disabled even while using drugs or alcohol, the agency will deny your claim without needing to consider if DAA is material.
The SSA no longer awards disability benefits based solely on substance abuse. (The agency used to approve claims based on addiction, but a 1996 law currently prevents Social Security from awarding benefits that way.) Later, the SSA would sometimes find claimants disabled under the listing of impairments for substance abuse, but the agency stopped that in 2017.
For people dealing with drug and alcohol addiction, no option currently exists for Social Security to award benefits on that basis alone. You’ll have to show that you have another condition that prevents you from working.
If Social Security determines that you do have disabling impairments, the agency’s next step is to determine whether they’re disabling by themselves or if they’re only disabling because of how they interact with your substance abuse.
The issue most frequently comes into play when a claimant is alleging disability due to a mental health condition, because even mild use of drugs and alcohol can exacerbate symptoms of depression and anxiety. In these cases, it’s important to establish a period of abstinence so that the SSA can get a picture of your mental health baseline without the effects of substance abuse.
Many physical conditions persist regardless of whether the claimant is abusing drugs or alcohol. In these cases, Social Security is unlikely to find that DAA is material, even when the physical condition resulted from substance abuse. For example:
The trickiest part of deciding whether DAA is material is determining whether a claimant would be disabled if drugs or alcohol weren’t in the picture. Social Security claims examiners and administrative law judges have to make an educated guess based on the evidence in the medical records.
Claimants who have recently stopped using drugs or alcohol and claimants with mental health issues can get tripped up at this step. For claimants newly clean and sober, Social Security might not yet have enough information about how they’re managing without the use of substances to tell if they could return to work. And because DAA affects work performance in areas like memory, mood, and concentration in much the same way that mental illnesses do, the agency can have a hard time deciding which limitations are a result of the mental condition and which are the result of DAA.
Let's look at an example to understand how the SSA makes a determination about whether substance abuse is material to a disability claim.
It doesn’t matter that Fred’s cirrhosis was likely caused by long-term alcohol abuse. The only relevant question is whether Fred would still be disabled if he quit drinking.
Claims involving DAA are rarely approved at the initial level. Especially when the claim involves both DAA and mental conditions, it can be very difficult for the claims examiner to determine whether the impairment would exist without drug and alcohol addiction. But you can greatly increase your chances of approval by getting your doctors to write a medical source statement in support of your disability claim.
Social Security values the opinions of doctors and mental health providers who you’ve seen regularly, so having a statement from your treating doctor saying that you have an ongoing disabling condition that would exist without DAA can be very helpful to win your case. If you think your doctor would write a supporting statement, try to get the opinion in writing as early as possible.
In practice, claimants with a history of drug or alcohol abuse face an uphill battle. Examiners and judges are mindful of damaging stereotypes about the disability program and can be reluctant to feed into them. Consider hiring an experienced disability attorney to help you with your claim. As long as you are upfront with your legal representative and with the SSA, you can show Social Security that your struggle with DAA doesn’t mean that you’re not disabled.
Updated October 28, 2022
]]>Not all doctors’ letters are persuasive, however. Social Security can’t disregard a treating doctor’s opinion, but the agency can give it less legal weight if it’s inconsistent with the rest of your medical record or doesn’t describe your symptoms in enough detail. The length and frequency of your treatment history, as well as your doctor’s credentials, are also considered.
Doctor’s opinions are important whether you’re seeking state short-term disability, have a private long-term disability insurance policy, or are applying for Social Security disability benefits. But neither government programs nor private insurers will accept a doctor’s letter without question as the sole basis for paying out benefits. You’ll need to establish that your doctor has the appropriate credentials and that the opinion is supported by medical evidence.
An acceptable medical source (AMS) is a health care provider who has the authority, education, and knowledge to interpret medical evidence. An AMS is defined by Social Security as a medical provider who can provide evidence to establish the existence of a "medically determinable impairment." (A medically determinable impairment is one that results from "anatomical, physiological, or psychological abnormalities" that can be shown by "medically acceptable clinical and laboratory diagnostic techniques.
A diagnosis of such an impairment must be made by someone with high-level medical training, but Social Security recognizes that primary care is increasingly being provided by physician assistants and nurse practitioners, and that these medical professionals have the training required to diagnose the existence of an impairment.
Social Security reviews everything that you submit for your case, but they don’t have to take into consideration medical evidence that isn’t from acceptable medical sources. And in its decisions, Social Security must explain how how the agency considered the persuasiveness of a medical provider's opinion when the provider is an AMS.
Acceptable medical sources include:
Physician assistants, nurse practitioners, and audiologists were added to the list of acceptable medical sources on March 27, 2017, so if your disability application was filed before that date, they won’t be considered acceptable medical sources for your claim.
If your treating provider (such as a registered nurse or chiropractor) isn't an acceptable medical source, Social Security can’t give weight to their medical opinion about your diagnosis and prognosis, but the agency can still use the provider’s notes to help determine how severe your condition is. For example, the SSA will disregard a letter from a chiropractor that says you meet the listing criteria for degenerative disc disease, but can limit you to sit-down jobs based on the chiropractor’s observations about your range of motion.
Social Security called any letter or opinion from a doctor a "medical source statement." Unless your medical source statement describes your diagnosis, symptoms, treatment history, and limitations, then your doctor’s opinion may not be persuasive. A letter from your doctor simply stating that you’re disabled isn’t going to cut it.
When writing their medical source statement, your doctor should refer to the medical tests or clinical notes that support their opinion. If there’s evidence in your file that doesn’t support your doctor’s opinion, they should acknowledge the evidence and explain how they accounted for it in their opinion.
Your doctor’s letter should also discuss 1) whether you meet a disability listing—a class of conditions that Social Security considers especially serious—and 2) your functional limitations. Make sure your doctor’s letter includes the maximum amount of weight you can lift; how long you can sit, stand, and walk; and whether you must avoid other movements (such as bending or typing). If your disabling condition is related to your mental health, the letter should discuss how well you can remember instructions, concentrate on tasks, and get along with coworkers.
Finally, your medical source statement should indicate how effective your treatments have been in relieving your symptoms. Any side effects you have as a result of medications should be included, especially if they would have an impact on your functioning at work. For example, if you’re taking medication for high blood pressure that makes you drowsy, the SSA needs to know.
Social Security usually gives more weight to medical source statements from your treating doctor—the physician or psychologist who sees you regularly. Prior to 2017, the SSA was especially deferential to statements from treating doctors, frequently giving them “controlling weight” and adopting the doctor’s opinion as the agency’s own.
Since March 27, 2017, however, all medical source statements, including from Social Security's consulative examiners, are evaluated based on how well they’re supported by and consistent with the medical record as a whole. But the SSA can still consider factors such as how long and how often you’ve seen your treating doctor when determining how persuasive the doctor’s medical source statement is.
“Well-supported” means that the doctor’s opinion is backed up by objective medical evidence, such as lab tests, MRIs, or exam results, and observable medical signs (such as the results of a straight-leg test). For example, if you have an X-ray showing severe arthritis in your hands and your doctor says that you can only occasionally use your hands to pick up small objects, Social Security will likely find that opinion well-supported. But if your X-rays don’t show anything wrong and your doctor says you can’t use your hands at all, the agency probably won’t take the doctor’s opinion very seriously.
“Consistent” means that the opinion isn’t an outlier among the evidence, including other medical opinions and your own statements. For example, if you’re seeing several providers for treatment of PTSD—including group therapy, individual counseling sessions, and medication management—a letter from your psychologist stating that you aren’t able to interact appropriately with coworkers is likely consistent with the medical record. But if your clinical notes indicate that you have an active social life with minimal PTSD symptoms, Social Security will probably find that the psychologist’s opinion isn’t consistent with the record.
Or, as another example, if a physician offers an opinion that you can sit in a chair for only 30 minutes at a time, but you report sitting on the sofa and watching movies on a regular basis, this could be seen as inconsistent. If there's an innocent explanation for this apparent inconsistency—for example, you stand up or lie down every half hour—the doctor should explain this in their opinion.
While Social Security no longer formally addresses the frequency of your doctors’ visits (your “longitudinal history”), the agency can find opinions from doctors more persuasive the longer and more involved they are in your treatment. An statement from a doctor who you’ve seen every month for the past ten years is probably going to be more convincing to the SSA than one from a doctor who you’ve seen only several times.
The medical provider's understanding of Social Security policy will also be considered, a factor that's likely to weigh in favor of Social Security's consultative examiners.
Opinions from doctors who specialize in the area of medicine dealing with your impairment are also generally more persuasive than those who aren’t. For example, having your gastroenterologist (a doctor who focuses on digestive problems) write a statement about your limitations from a traumatic brain injury wouldn’t have as much sway as a neurologist might.
Keep in mind that your doctor’s area of expertise and treatment relationship aren’t as important for a medical opinion as being supported and consistent with the record. But these factors can be the “cherry on top” for your disability application, as having a good treating specialist’s opinion in the file typically strengthens your case.
Updated March 15, 2024
]]>The Social Security Administration (SSA) considers you disabled if you have a "medically determinable" severe impairment that prevents you from working full-time for at least one year. Prior to 1997, that included applicants who were unable to work solely on the basis of drug addiction, alcoholism, or both.
Following the passage of the Contract with America Advancement Act of 1996 (H.R. 3136), however, the SSA is no longer allowed to award disability benefits based only on addiction or alcoholism, or any type of substance use disorder. (So alcoholics and drug addicts can't get disability without another severe physical or mental condition.)
Instead, the agency looks to see if you have any other physical or mental conditions that keep you from working and then determines whether your substance abuse is “material” to your disability. Drug or alcohol abuse (DAA) is material to your disability when your underlying medical condition would get better or go away entirely if you stopped using drugs or alcohol.
If Social Security finds that DAA is material to your condition, your claim will be denied. But it’s important to know that “materiality” doesn’t mean that the agency can deny a claim for disability solely because the applicant is an alcoholic or has a drug addiction. Even intentional misuse of illicit substances doesn’t automatically disqualify you from receiving benefits. However, you must show that you’d be unable to work even if you were clean and sober.
Before considering whether DAA is material to your disability claim, Social Security must see evidence that you’re using drugs or alcohol in a dysfunctional way. Generally, this means that a doctor has diagnosed you with substance abuse disorder, but a claims examiner might find evidence elsewhere in the medical records (such as clinic notes or hospital intake forms).
Not every instance (or instances) of alcohol or drug use are addictive—the SSA isn’t concerned if you have a glass of wine with dinner. But if your substance abuse disorder is damaging your body or causing disruptions in your work, family life, or social activities, it’s likely that Social Security will need to evaluate whether DAA is material in your case.
Materiality evaluations are technically a six-step process, but can be boiled down to two fundamental questions about the nature of your addiction or alcoholism.
Applicants are often surprised to learn that you can get disability for a medical condition that’s caused by substance abuse, as long as the limitations from the condition persist even when abstaining from drugs or alcohol—in other words, the effects aren’t “reversible.”
For example, say you have greatly reduced liver function from advanced cirrhosis despite years of sobriety. Social Security may find that the liver damage is permanent and can’t be repaired. Therefore, your history of alcoholism wouldn’t be material in determining disability. On the other hand, if your doctor tells you that your liver enzyme and protein levels would return to normal if you stopped drinking, the agency is very likely to conclude that DAA is material to your claim.
DAA is considered material when it makes the difference between finding you disabled or not disabled. So even if your medical condition would improve with abstinence or sobriety—but not so much that you’d be able to work—the SSA won’t deny you benefits based on substance abuse.
Returning to the cirrhosis example above, if your liver enzymes improved slightly but remained abnormal after you stopped drinking—resulting in excessive fatigue that made even sit-down jobs too difficult—Social Security would likely find that DAA isn’t material in your case, since you wouldn’t be able to work full-time regardless of sobriety.
Showing that disabling symptoms aren’t affected by substance abuse is easier for some conditions than others. For example, if severe degenerative disc disease reduces your range of motion to the point that you can’t lift anything heavier than five pounds, the agency will probably conclude that your limitations would be the same whether or not DAA was involved.
But many mental disorders can be intertwined with substance use in a way that can make it hard to determine which symptoms, if any, would improve without DAA. For this reason, it’s important for people with a mental disorder to establish some period of sobriety so Social Security can get an idea of your mental health symptoms without interference from drugs or alcohol.
Under Social Security Ruling SSR 13-2p, “Evaluating Cases Involving Drug Addiction and Alcoholism,” if you’re taking your prescription medication as prescribed—even highly addictive medications such as opioids or other narcotics—Social Security doesn’t find that drug use material, or even DAA. In the agency’s eyes, if you’re using your prescribed medication the way your doctor wants you to, you’re not abusing it, so DAA doesn’t come into play. In fact, the SSA takes into consideration any side effects you have from these potent painkillers when deciding whether you could work full-time.
But if you’re taking your medication at a higher dosage or greater frequency than your doctor prescribed, or you’re using prescription drugs meant for somebody else, Social Security can perform a DAA materiality determination and deny your claim if your prescription drug use is material.
Your medication is “taken as prescribed” when you follow the instructions of a licensed medical doctor with whom you have a doctor-patient relationship and who appropriately directs you to take a reasonable amount of medication for legitimate purposes. This means that you can’t ask your cousin the nurse to give you a fentanyl patch for a sprained ankle and expect that Social Security will ignore any DAA issues.
Any medication taken outside the scope of a doctor-patient relationship (or when the doctor-patient relationship has been “broken”) isn’t considered to be prescribed and is a potential contender for a DAA evaluation. Some examples may include:
Keep in mind that the SSA is aware of the addictive properties of these medications, and understands that disability applicants might make an undesirable or ill-advised decision when faced with a lack of availability. But the agency also recognizes the difference between somebody who takes a Vicodin pill from a friend to deal with an unexpected surge of pain and somebody with few doctors’ visits who buys large amounts of morphine off the internet. The former is less likely to need a DAA determination than the latter.
The most difficult, yet effective, method of proving that you’re disabled despite substance addiction or abuse is to establish a period of sobriety. If you have several months where you weren’t drinking or using, but you still experienced physical or mental symptoms from your underlying condition, that’s a strong indicator that DAA isn’t a material issue in your case.
Another persuasive method is to get a doctor’s note from a physician or psychiatrist who’s seen you on a regular basis. Social Security values the opinions of treating doctors, and if your doctor thinks that your drug or alcohol use doesn’t contribute to your medical condition and can provide a written letter to that effect, the agency will likely be persuaded that DAA isn’t material.
Depending on the specifics of your claim, showing that substance abuse doesn’t have an effect on your physical or mental health can be challenging. And even if the SSA doesn’t consider drug or alcohol use material to your case, you still need to prove that your medical condition keeps you from working. Consider contacting an experienced disability attorney to get help with your claim and gather the records needed to show the SSA that you’re disabled.
Updated January 30, 2024
]]>Social Security will assess the combined effects of your medical problems during its five-step sequential evaluation process, specifically during steps two, three, four, and five. (At step one, SSA simply asks whether you're performing "substantial gainful activity," or SGA, which generally occurs when you have monthly earnings over $1,550 (in 2024).)
Assuming you're not engaging in SGA, your case advances to step two, where Social Security examines the medical evidence in your file and determines whether you have a severe impairment or a severe combination of impairments.
A severe impairment is one that substantially interferes with your ability to perform work-related physical and mental tasks such as lifting, bending, walking, paying attention, following directions, and dealing with co-workers and supervisors. A non-severe impairment, on the other hand, is defined as a "slight abnormality" having a "no more than minimal effect" on a person's ability to work. Although it cannot be disabling on its own, a non-severe impairment can exacerbate the symptoms of other conditions, both severe and non-severe, and ultimately lead to a finding of disability.
Even if you don't have an impairment that is severe on its own, you will still proceed past step two to be considered for disability if you have a severe combination of impairments. For example, an individual with COPD, hypertension, sleep apnea, and mild depression may not have a single impairment that is severe by itself, but the combination of those conditions will be found severe if together they substantially limit a work-related activity.
To show that your impairments are severe, you must obtain consistent medical treatment and make sure that Social Security has all your relevant medical records. In addition, if your doctor is willing to provide a written opinion as to your work-related limitations, SSA is much more likely to be persuaded of the legitimacy and severity of your condition.
If you're not earning SGA and Social Security finds you have a severe combination of impairments, your case moves to step three, where SSA decides whether your condition meets the requirements of a listing in the "Blue Book." Social Security's Blue Book contains hundreds of serious medical conditions that, if the stated criteria are met, will automatically qualify a person for benefits.
Having multiple impairments usually doesn't affect whether you meet a listing. However, a few listings, most notably Listing 12.05C for intellectual disability, require you to have a mental or physical impairment in addition to low IQ. Under 12.05C, a person must have an IQ between 60 and 70 and another mental or physical condition that causes significant work-related limitations.
Social Security may also award benefits if a person's condition is medically equivalent to, or "equals," one of the listings in the Blue Book. Suppose an individual has an IQ of 72, as well as crippling anxiety and severe carpal tunnel syndrome. Despite failing to meet the listing because the IQ score is slightly too high, SSA may find that the listing is equaled in severity due to the other serious impairments. (See Nolo's article on disability and low IQ for more information.)
The burden lies on the disability applicant (and his or her lawyer) to prove that he or she medically equals a listing. Meeting this burden often requires an unambiguous opinion from your treating doctor that your combination of impairments equals a listing.
If you're not approved for benefits based on a listing, SSA will assess your Residual Functional Capacity (RFC) in deciding whether you can perform any of your past jobs (step four) or any other occupations in the U.S. (step five). Your RFC is the most work activity you can do, both mentally and physically, despite all your symptoms.
Your RFC addresses your limitations in the following areas:
Your RFC may also include environmental restrictions, such as exposure to extreme temperatures, vibrations, or fumes, that can further limit your abilities to perform certain types of jobs.
SSA will consider all your impairments, separately and in combination, in assigning you an RFC. In considering how your pain and other symptoms limit your work abilities, Social Security should consider how mental conditions like anxiety and depression can make physical problems worse by decreasing one's pain tolerance. (Read about how moderate anxiety and depression factor into physical disability.)
If your various medical limitations make your RFC so restrictive that it prevents all full-time employment, you will meet SSA's definition of disability at step five. Social Security, of course, will try to argue that there are a few categories of jobs that you can do despite what your RFC says. You should consider hiring a disability attorney to argue for you that each additional limitation you have from your less severe medical conditions rules out additional jobs, so that there are actually no jobs left that you can do.
Finally, under SSA's definition of disability, you qualify for benefits only if your impairments have lasted, or can be expected to last, 12 months in a row. If you have multiple related impairments, none of which satisfy the durational requirement on their own, you can combine them to meet the 12-consecutive-month requirement.
Updated December 20, 2023
]]>For instance, if you have a liver transplant (listing 5.09), the SSA won't look to whether or not you can work; you will simply be approved for disability benefits for one year.
The Blue Book describes, for each major body system, the impairments that are considered severe enough to keep an adult from working (in SSA-speak, from doing any gainful activity). In the case of a child under age 18 applying for Supplemental Security Income (SSI), the Blue Book details the impairments that will be approved for disability benefits because they cause severe functional limitations. The criteria for the impairments for adults and children are set out separately in the Blue Book.
Most of the impairments listed in the Blue Book are permanent (or expected to result in death) unless a listing refers to a specific duration. Otherwise, the medical evidence must indicate that the impairment has lasted or is expected to last for the duration of 12 consecutive months.
Receiving a diagnosis of an impairment listed in the Blue Book is not enough to establish that you are disabled. To meet a listing, you need to meet all the requirements set forth by the specific listing. In other words, the medical evidence must show that you have the same symptoms, clinical signs, and laboratory findings as the listed impairment. The SSA lists criteria for each listing to ensure that only the most severe impairments are approved for disability based on medical evidence alone.
If your impairment does not meet all the requirements of a listed impairment, you might still qualify for disability if the medical evidence shows that your impairment is equivalent in severity. Additionally, if you have a combination of impairments, but none of them alone meets a listing, the SSA will consider whether your combined impairments are equal to the severity of a listed impairment. For example, you may have diabetes and back pain that are not that severe by themselves. However, in combination, the SSA might conclude that your diabetes and back pain are equal in severity to a listed impairment.
A determination as to whether a person's impairment can be considered to equal a listing must be based on medical evidence obtained by medically acceptable clinical and laboratory diagnostic techniques. As part of the disability application process, you are responsible for providing medical evidence to the SSA showing that your impairment is severe enough to prevent you from working.
The SSA gnerally gives the medical evidence from your treating doctors the most weight because these doctors are in the best position to provide a detailed longitudinal (long-term) history of your impairment (as long as the doctor's medical evidence isn't inconsistent with other evidence in your file). Therefore, it's in your best interest to obtain regular treatment from your doctor. If, however, you have not received regular treatment, the SSA will order a "consultative examination" to supplement your record.
If the SSA does not find that you have an impairment severe enough to meet or equal a listing, you may still be found disabled at another step in the disability determination process. Although the medical evidence alone may not be enough to establish disability, the SSA will continue its evaluation by assessing your functional capacity for work and by considering your age, education, and work experience.
The Blue Book is organized into two main parts. Part A describes the requirements for evaluating impairments in adults age 18 and over. Part B describes the requirements for evaluating impairments in children under the age of 18. This article describes the major body systems under the listings for adults:
Musculoskeletal System (Listing 1.00) impairments include major dysfunction of a joint, reconstructive surgery of a major weight-bearing joint, spinal disorders, amputation, fracture of the femur, tibia, pelvis, or tarsal bones, fracture of an upper extremity, and soft tissue injury such as burns.
Special Senses and Speech (Listing 2.00) impairments include loss of visual acuity, contraction of the visual field in the better eye, loss of visual efficiency, disturbance of labyrinthine-vestibular function, loss of speech, and loss of hearing.
Respiratory System (Listing 3.00) impairments include chronic pulmonary insufficiency, asthma, cystic fibrosis, pneumoconiosis, bronchiectasis, chronic persistent infections of the lung, sleep-related breathing disorders, and lung transplants.
Cardiovascular System (Listing 4.00) impairments include chronic heart failure, ischemic heart disease, recurrent arrhythmias, symptomatic congenital heart disease, heart transplant, aneurysm of aorta or major branches, chronic venous insufficiency, and peripheral arterial disease.
Digestive System (Listing 5.00) impairments include gastrointestinal hemorrhaging requiring blood transfusion, chronic liver disease, inflammatory bowel disease, short bowel syndrome, weight loss due to any digestive disorder, and liver transplants.
Genitourinary Impairments (Listing 6.00) refer to chronic renal (kidney) disease.
Hematological Disorders (Listing 7.00) include chronic anemia, sickle cell disease, chronic thrombocytopenia (low blood platelet count), hereditary telangiectasia (malformations of various blood vessels), coagulation defects (hemophilia), bone marrow disorders, and aplastic anemias with bone marrow or stem cell transplantation.
Skin Disorders (Listing 8.00) include ichthyosis, bullous disease, chronic infections of the skin or mucous membranes, dermatitis, hydradenitis suppurative (chronic disease of a sweat gland), genetic photosensitivery disorders, and burns.
Endocrine Disorders (Listing 9.00) include pituitary gland disorders, thyroid gland disorders, parathyroid gland disorders, adrenal gland disorders, and diabetes mellitus, and other pancreatic gland disorders.
Impairments that Affect Multiple Body Systems (Listing 10.00) refer to non-mosaic Down syndrome.
Neurological Impairments (Listing 11.00) include convulsive epilepsy, nonconvulsive epilepsy, central nervous system vascular accident, benign brain tumors, Parkinsonian syndrome, cerebral palsy, spinal cord or nerve root lesions, multiple sclerosis, amyotrophic lateral sclerosis, anterior poliomyelitis, myasthenia gravis (neuromuscular disease characterized by muscle weakness), muscular dystrophy, peripheral neuropathies, subacute combined cord degeneration, degenerative disease not listed elsewhere, cerebral trauma, and syringomyelia (damage to spinal cord due to formation of cyst).
Mental Disorders (Listing 12.00) include organic mental disorders (psychological or behavioral abnormalities associated with dysfunction of the brain), schizophrenic, paranoid and other psychotic disorders, affective disorders, intellectual disorder, anxiety-related disorders, somatoform disorders, personality disorders, substance addiction disorders, autistic disorder, and other pervasive developmental disorders. (Visit our section on disability and mental disorders for more information.)
Malignant Neoplastic Diseases (Listing 13.00) refer to cancers, and include soft tissue tumors of the head and neck, skin, soft tissue sarcoma, lymphoma, leukemia, multiple myeloma, salivary glands, thyroid gland, breast, skeletal system-sacrcoma, maxilla, orbit or temporal fossa, nervous system, lungs, pleura or mediastinum, esophagus or stomach, small intestine, large intestine, pancreas, kidneys, adrenal glands orureters-carcinoma, urinary bladder-carcinoma, cancers of the female genital tract-carcinoma or sarcoma, prostrate gland-carcinoma, testicles, penis, metastatic carcinoma or sarcoma, and malignant neoplastic diseases treated by bone marrow or stem cell transplantation.
Immune System Disorders (Listing 14.00) include systemic lupus erythematosus, systemic vasculitis, systemic sclerosis, polymyositis and dermatomyositis, undifferentiated and mixed connective tissue disease, immune deficiency disorders (excluding HIV infection), human immunodeficiency virus (HIV) infection, inflammatory arthritis, and Sjogren's syndrome.
If you think that you have one of the impairments listed in the Blue Book, read our article on the severity criteria for the particular listing, and then consult your doctor for help in documenting whether your impairment is severe enough to meet or equal one of the listings. For example, if you have not had some of the laboratory tests required by the listing, you should arrange to have them performed. Generally, the SSA requires quite a bit of medical evidence to decide if your impairment is as severe as one listed in the Blue Book. The more medical evidence you can provide to the SSA, the better your chances of being qualified for disability benefits.
]]>However, most people aren’t approved for disability this way. Instead, the majority of applicants will have their claims decided based on whether they qualify for a medical-vocational allowance.
To see if you qualify for disability under a medical-vocational allowance, the SSA has to first figure out your residual functional capacity (RFC). The SSA will then take your RFC and decide 1) whether you can do your past job and 2) whether there is any other work you can do in your area or in the United States. If the answer is no to both of these questions, you will be approved for benefits under a medical-vocational allowance.
Your RFC is the most work you can do on a regular and sustained basis. To decide your RFC, the SSA looks at the medical evidence in your file, any notes or records from your doctors, and the results of any exams you have had by an SSA doctor. The SSA will use this information to prepare a detailed assessment of your ability to do certain work-related activities like sitting, standing, walking, lifting, and carrying. Based on the results of the assessment, you will be assigned an RFC for sedentary, light, medium, or heavy work.
The higher the RFC, the more difficult it is to get approved. This is because the SSA will conclude that the higher your RFC, the greater range and number of jobs are out there that you can do.
The SSA first looks at the tasks required in your old job to see if you have the RFC to still do it. If you have the RFC to do your old job, you will be denied right away. On the other hand, if the SSA decides you don’t have the RFC to do your old job, it will go on to the next step and decide if there is other work you can do.
For example, say your past work was “light,” meaning you had to stand and walk for up to six hours in an eight hour day and lift ten pounds frequently (and 20 pounds occasionally). If you were given an RFC for sedentary work only, then you can’t do your old job, and the SSA will go on to the next step.
On the other hand, if your past work was as a secretary, which is generally a sedentary (sit-down) job, and the SSA concludes you have still have the RFC for a sit-down job, you will be denied unless you can prove that you have other disability-related limitations (such as mental limitations or an inability to attend work regularly because of frequent sickness) that prevent you from doing your past work.
If you can’t do your old job, the SSA has to next decide if there is other work you can do in the national or local economy; if there is, you will be denied benefits. Only if the SSA concludes you can’t do any other job that exists in significant numbers will you be approved.
At this stage, your past work experience becomes especially important, because the SSA will look at it to see if you learned any special skills that could be transferred to a new job.
Here is an example of how an applicant might be denied at this stage.
Generally, if you are 50 or older, it is easier to get approved for Social Security disability (or SSI) benefits. (This may not be true, though, if you have significant job skills, which we discuss below).
If you are over 50, the SSA will use what disability lawyers call the grid rules, or grids, to decide if you can be approved under a medical-vocational allowance. The grids are a series of tables that say when applicants are disabled or not-disabled, based on their RFC, age, education level, skill level of their past work, and whether they learned any skills in their old job that they could use in a new position.
Here is an example of how the SSA might use the grids to decide a claim.
Even though getting approved under a medical-vocational allowance can be challenging, it is possible. In fact, most people are approved for disability benefits this way. It is key that you provide the SSA with as much accurate information about your past jobs as you can; this will help ensure that the SSA classifies your past work correctly. Also, make sure you give the SSA all of your relevant medical information as early in the application process as possible. Most important, ask your doctor to fill out an RFC form for you. Learn more about RFCs here.
Don’t be discouraged if you are initially denied; this happens to most applicants because they don’t understand the process and what information is needed. Make sure you file your appeal on time and that you keep the SSA updated with all your relevant medical information.
]]>To account for the difficulty older claimants may have making vocational adjustments, the SSA has something called the “grid rules” it uses to decide some disability claims. The grid rules are one way you can get approved for disability benefits through a medical-vocational allowance. Social Security generally uses the grid rules (commonly referred to as the “grids") only after it has determined that you can't do the jobs you've done in the recent past.
These grid rules use the following factors to determine whether an applicant is disabled:
Let's take a look at each of these factors and see why, and how, they may affect your claim.
For the purposes of the grids, the SSA divides applicants into the following age groups:
The older the applicant is, the easier it is to get approved using the grids. (For specific grid rules for applicants age 60 and older, see our article on disability for those approaching retirement age.)
The lower your education level, the more likely you are to get approved under the grids. This is because the SSA knows it is harder for people with little education to find jobs they are qualified to do. Here is how the SSA divides education levels:
If you graduated high school and recently completed a post-secondary training program, your education level is a high school graduate or more with training for skilled work. For example, in one case, a 55-year-old woman with a high-school diploma was certified as a nail-technician shortly before she injured her back. The SSA denied her disability benefits because the grids say that anyone with recent training that would provide entry for skilled work is not disabled.
For purposes of the grids, the SSA classifies jobs as unskilled, semi-skilled, and skilled. Those with a history of only unskilled work are more likely to be found disabled under the grids.
The SSA will classify your past jobs based on how you describe them and how the Department of Labor DOL) classifies them. An unskilled job, for example, might be a sorter at a factory. An example of a semi-skilled job is a waitress. An example of a skilled job is a paralegal. To determine a job's skill level, the DOL considers factors such how long it takes to learn a job and whether the job requires specialized education.
If your past work was skilled or semi-skilled, the SSA will consider whether you learned any skills that could be used in another position (called transferable skills). The more transferable skills you have, the more likely it is that the SSA will say there is other work you can do, and the harder it is to win your disability claim.
Note that even though a job may be classified as skilled, the skills learned in that job may be so specific that you can't use them in another position (for example, seamstress work). The SSA won't classify skills like these as transferable.
Your residual functional capacity (RFC) is your remaining ability to do work on a regular and sustained basis (full-time). The SSA will use the objective medical evidence you or your doctor has submitted to do a detailed assessment of your ability to do certain job-related activities like standing, walking, lifting, carrying, and pushing. The SSA will give you an RFC for:
Generally, the higher (heavier) your RFC, the more difficult it will be to get approved under the grids.
To see how the SSA would apply the grids to your case, first find the table that addresses your RFC level, then find the row that describes your age group, educational level, and your past work experience. The final column shows how the SSA will decide your claim based on these factors. Here are two excerpts from the grids.
Education |
Skill Level |
Decision |
Limited or less |
Unskilled or none |
Disabled |
Limited or less |
Skilled or semiskilled, skills not transferable |
Disabled |
Limited or less |
Skilled or semiskilled, skills transferable |
Not disabled |
High school graduate or more-no training for direct entry into skilled work |
Unskilled or none |
Disabled |
High school graduate or more, with training for direct entry into skilled work |
Unskilled or none |
Not disabled |
High school graduate or more, but no training for direct entry into skilled work |
Skilled or semiskilled, skills not transferable |
Disabled |
High school graduate or more, but no training for direct entry into skilled work |
Skilled or semiskilled, skills transferable |
Not disabled |
High school graduate or more, with training for direct entry into skilled work |
Skilled or semiskilled, skills not transferable |
Not disabled |
Skill Level |
Decision |
|
Illiterate |
Unskilled or none |
Disabled |
Limited or less |
Unskilled or none |
Not disabled |
Limited or less |
Skilled or semiskilled, skills not transferable |
Not disabled |
Limited or less |
Skilled or semiskilled, skills transferable |
Not disabled |
High school graduate or more |
Unskilled or none |
Not disabled |
High school graduate or more |
Skilled or semiskilled, skills not transferable |
Not disabled |
High school graduate or more |
Skilled or semiskilled, skills transferable |
Not disabled |
Here are two examples of how the SSA would apply the above sets of grid rules.
If you have an RFC for heavy or very heavy work, the SSA won’t use the grid rules. This is because if you can do heavy or very heavy work, you can also do medium, light, and sedentary jobs, which means that there is a wide range of work you can do.
If you have impairments that aren’t related to your physical capacity, such as mental health issues or trouble using your hands and fingers (non-exertional limitations), you may be able to get approved even though the grid rules say someone in your situation is not disabled. You may also be able to win if you have more than one medical condition. Unfortunately, many applicants in the above situations get denied and need to appeal to win benefits. For more information, see our section on appealing common reasons for disability denial.
]]>According to Social Security Regulation 82-41, a "skill" is defined as knowing a work activity that requires the use of judgment. The regulation notes that a skill gives an employee "a special advantage over unskilled workers in the labor market." Some examples of skills include:
For skills to be "transferable," an individual must be able to apply knowledge or techniques learned in past jobs to other skilled or semiskilled work. (You cannot get transferable skills from an unskilled job, and you cannot transfer skills to an unskilled job.)
A person who has worked as an administrative clerk, a semiskilled position, might have acquired skills such as typing, filing, or operating office equipment that could transfer to other sorts of office jobs. Because those skills could give a job applicant a "special advantage" in the labor market over an unskilled worker, Social Security's rules make it more difficult for those with transferable skills to be found disabled.
According to a rule clarification issued by the Social Security Administration (SSA) in 2014, some common occupations involving skills that could transfer to other light or sedentary (sit-down) jobs include the following:
If your medical situation meets or equals one of the serious conditions found in Social Security's Listing of Impairments (the "Blue Book"), you'll be found disabled automatically. Or, if your condition allows you to perform past relevant work, you will not be found disabled. In these cases, Social Security won't assess whether you have transferable skills.
Transferable skills come into play only in disability cases involving skilled and semiskilled workers age 50 and older. When these workers can't do their past work, they are evaluated under SSA's Medical-Vocational Rules ("the grid rules"). The grid rules can provide the basis for a successful disability claim for certain older individuals who would struggle to re-enter the labor market due to the combination of their age, educational level, work experience, and residual functional capacity (RFC). For example, under the grid rules direct a 55-year-old with a ninth-grade education, unskilled work history, and sedentary RFC would be found disabled even if he or she could theoretically perform some full-time job. The logical underpinning of the grid rules is that older, physically limited workers who possess little education or vocational skills are more or less unemployable in today's labor market.
In many situations, transferable skills can prevent a finding of disability under the grid rules. But Social Security is supposed to take an individual's mental and physical limitations into account when determining a person's skills are truly transferable. A construction worker who experiences cognitive decline due to a traumatic brain injury may no longer be able to read blueprints or operate heavy machinery, even if those skills would ordinarily be classified as transferable. You or your attorney should make sure Social Security's vocational expert (VE) considers how a person's mental and physical impairments could affect the transferability of skills.
If a judge or disability claims examiner finds that you possess transferable skills, he or she must include "findings of fact" in the disability determination stating which skills you've acquired and to which occupations your skills are transferable. These findings generally need to be based on vocational expert testimony. Most claimants with a skilled or semiskilled work history hire a disability attorney who can cross-examine the vocational expert on the important issue of transferability of skills.
Because transferable skills are not the deciding factor in most disability cases, many VEs are not well-versed in Social Security's regulations on this issue. Some VEs erroneously classify traits such as "attention to detail" or "good coordination" as skills. Others might testify, contrary to SSA regulations, that highly specialized skills such as sewing, or regionally specific skills such as logging or fishing, could transfer to other occupations. An experienced disability attorney who understands Social Security's regulations on transferability of skills will be able to pick apart this sort of VE testimony to get you approved under the grids.
]]>The claims examiner uses your medical records and any statements from your doctor to develop your RFC. In addition to the activities you can do, your RFC will state what you cannot do to the limitations caused by your disability. For instance, an RFC might say you can stand for up to two hours and sit for four or more hours, but you can’t operate hazardous machinery.
If you claim on your disability application that you have any kind of physical impairment, and Social Security agrees it’s severe, the agency will develop a physical RFC for you.
If you have a physical disability, your physical RFC will include the “exertional” level of work you can do: sedentary, light, medium, or heavy. Your exertional level is based on how much you can walk or stand and lift, carry, and push or pull objects.
Your physical RFC level has a huge impact on whether you’ll be granted disability benefits, for several reasons. First, Social Security has a grid of rules, designed to streamline the disability determination process, that dictate when applicants with certain RFC levels should automatically be considered disabled. For example, if you’re over 49 and limited to sedentary work (a desk job or other sit-down job), you’ll automatically be granted disability benefits unless your past work was sedentary or you have job skills or recent job training that would allow you to do sedentary work. As another example, if you’re at least 55 and limited to light work (a job such as a cashier or security guard, where you stand more than sit, but you don’t lift more than 10 to 20 pounds), you’ll automatically be granted disability benefits unless your past work was also light or you have job skills or recent job training that allow you to do light work.
Secondly, if no “grid rules” apply to your situation (say because you’re 45 years old), Social Security will compare the level of your RFC to the level of your past job. If the levels are the same, Social Security will say you can do your old job, unless your RFC also contains non-exertional limitations that prevent you from doing it. If your RFC is for lighter work than your old job was classified as, Social Security will agree that you can’t do your old job, but the agency will then see if there are any jobs at your RFC level that you can do.
Non-exertional limitations are those that don’t involve strength, such as not being able to use your fingers for manipulating objects or not being able to hear well. Non-exertional limitations are important because Social Security will use them in doing a function-by-function analysis of your old job and other potential jobs to determine whether the limitations would interfere with any of the tasks required by these jobs.
Non-exertional limitations include the inability to do any of the following (or having doctor restrictions that prevent you from doing the following):
If you list any type of mental difficulty or emotional illness on your disability application, Social Security is required to investigate the severity of that condition. If the agency finds it to be severe, it must create a mental RFC (or MRFC) for you. A mental RFC details your ability to:
Unlike for physical RFCs, there is no set of grid rules for mental RFCs. But like a physical RFC, Social Security will compare the limitations in your mental RFC to the tasks required in your past job to see if you can do your old job. If not, Social Security will compare the mental limitations in your RFC with the requirements of other jobs in the U.S. to determine whether there are any less mentally demanding jobs you can do. If you can't do any simple, unskilled job, you'll be found disabled. Before deciding that there is a type of job you can learn to do, Social Security must consider both your physical limitations and mental limitations combined.
To make sure your file contains an RFC that is detailed and properly reflects how limited your abilities are, ask your doctor to fill out a form detailing which of the above physical limitations you have. For instance, how long can you walk, how long can you stand, how long can you sit without adjusting positions, how much can you lift, can you stoop or crouch, is your hearing limited, and so on. For mental impairments, ask your doctor to specify whether your ability to do each of the above mental tasks is somewhat limited, seriously limited, or extremely limited. Read Nolo's article on getting your doctor's information into your disability file.
If you hire a disability lawyer, the lawyer will have RFC forms (called medical source statements) to send to your doctors to elicit the appropriate information for your medical condition. If you wish, you can use Nolo's lawyer directory to arrange a consultation with a disability attorney in your area.
]]>First, understand that doctors have mountains of paperwork to complete, such as patients' charts, insurance forms, invoices, and forms from the SSA (Social Security Administration). If you’ve already applied for disability benefits, the SSA’s request for paperwork is probably buried somewhere in that pile, along with a request for information from your lawyer, if you have one.
It is likely your doctor has had many patients who have applied for disability with the SSA. Doctors form habits about how to deal with such claims, and some doctors have attitudes toward the Social Security disability system that can range from friendly to hostile. But you can still take charge and have some control over making sure your doctor addresses your medical concerns regarding your disability.
Plan ahead so that you can get a timely appointment and bring a list of your limitations to your doctor.
If you are thinking about applying for Social Security disability, it is in your best interest to get appointments with your doctors before you apply, so you can discuss your problems and find out if the doctor will help you. If you wait until after you apply for benefits, and then have to wait for an appointment with doctor, Social Security may make a disability decision before you get that appointment.
When you do get an appointment, you need to be prepared, since doctors are busy and are almost always in a hurry. Before you go in, write down the name of each one of your medical problems on a piece of paper. After each disorder, think about specific ways it limits your ability to function normally, using real-life examples. Be sure to include how you are limited in lifting and carrying and how long you can stand and walk. Include any problems you’ve noticed with environmental factors like dust, heat and cold that limit your abilities. If you have a mental disorder, document how well you get along with others, remember things to do, and follow instructions. Note any limiting effects of medications, such as lethargy, sleepiness, or headaches.
Don't assume your doctor will know all the limitations you have and report them to Social Security. Doctors often know less about their patient limitations than the patients themselves. Even small limitations can be important in Social Security's decision on whether you can do certain jobs. For example, suppose you have work experience doing an activity that requires you to flex your thumb repeatedly, but you can’t do it any more. That limitation might keep Social Security from saying you can do your prior work. But if your doctor hasn't included the limitation in his or her report, Social Security won't consider it.
Without your input, your doctor will simply review your medical records, develop an opinion about your limitations, and send it to Social Security without any input by you. You can avoid this by telling your doctor about every limitation you have. And make sure the limitations you list on your disability application are the same as those you report to your doctor. Having your doctor say the same things as you allege to the SSA is more persuasive than your saying it alone.
There are three steps to getting your doctor provide the support you need in your disability claim.
Let the doctor know you'll be applying for Social Security disability, but don't assume your doctor understands the Social Security disability process, which is a complex system. It takes other doctors working for Social Security years to fully understand federal medical policies. It is important to explain to the doctor that you are not requesting an opinion about whether you are disabled. This will be good news to your doctor, who is probably tired of receiving blame from patients about their disability claims sometimes being denied.
You could say something like, “I know you don’t control the government’s disability decisions and I don’t even know if I qualify for disability. However, I need your help in getting accurate information to them so that I can receive a fair evaluation.” You will almost certainly receive a positive response to this statement. And then you can tell the doctor about how your impairments affect you.
Don't tell your doctor verbally about all your limitations and try to get your doctor to write them all down during an appointment. If you do, you will be disappointed. There will not be enough time, you may not remember everything, and the doctor will likely take skimpy or even no notes. Even when doctors listen well, they will not write down the detail you want. Instead, say you have made a list of the problems you have with doing certain things and hand it to the doctor. Ask your doctor to give that information it to Social Security when the agency request information about you. Some doctors may glance at it and try to hand it back. In that case say, “No, Doctor, I made that copy for you.”
After the doctor looks your limitations over, ask the doctor to discuss any limitations he or she disagrees with. Most doctors won't contradict you, but if you exaggerate your limitations so much that they are out of line with what most doctors see in other patients with the same problems, you will get resistance from the doctor. You know the truth about your limitations, with some exceptions. Stick to that and you are most likely to get the help you need.
Another reason a doctor might disagree with your limitations is when you have a certain kind of disorder in which your doctor is a specialist, and your doctor has an opinion on what you should be able to do. For example, say you have had a heart attack in the past. Your cardiologist is going to know how well your heart is pumping. If your limitations are out of line with the doctor's idea of what they should be, the doctor will either want to do further evaluation to find out why you are doing so poorly or may simply not agree with you and think that you are exaggerating your limitations.
Make sure what you have written is as short and clear as possible without omitting important limitations you might have. Doctors would like to spend as much time with patients as patients want, but that’s not possible. Most will not spend even five minutes reading something you give them during your visit, so try to limit the description of your limitations to a page or two. If you give a doctor a long report, they are not likely to actually read it carefully. More likely, they will skim it quickly and move to examine you, give you some advice, and go on to the next patient.
If your doctor agrees with your limitations, ask your doctor to write a statement to Social Security tying your limitations to the objective medical evidence in your file. For example, “My patient, Mr. John Doe, has severe osteoarthritis affecting all of the joints in both hands, verified on x-ray and clinical examination. He cannot make a tight fist, his grip is weak, and he cannot handle objects smaller than a dime. Stiffness and pain limit him to lifting and carrying no more than 10 lbs.” If your doctor asks for a form to fill out, you can print out a physical or mental RFC assessment form and give it to your doctor. Then follow up with the doctor after a week or two.
]]>Too many disability applicants miss the opportunity to complete this form thoroughly. You should describe specific examples of how you’re limited—physically, mentally, or both—in your daily activities. Also, be sure to mention your difficulties with daily activities to your doctor, so that they become part of your medical record.
The ADL questionnaire asks about any difficulties you experience in a wide variety of daily activities, such as grocery shopping, preparing meals, and social engagement. Here are some suggestions on answering these questions in a way that helps Social Security understand the nature and extent of your limitations.
Mobility refers to any struggles you have with moving around. Walking, getting out of a chair, or bending over are all common mobility problems for people applying for disability benefits.
Disability claims examiners and administrative law judges love numbers, so (when possible) describe your mobility problems using a specific amount such as pounds, minutes, or miles. Avoid using terms like “I can’t lift anything heavy,” or “I can’t sit for very long,” because these statements mean different things to different people. Try to pair a quantity with a consequence, such as “If I walk farther than 20 feet, I get stabbing pain in my knees, and I need to sit down.”
Don’t underestimate the importance of activities that many people take for granted, such as brushing your teeth, getting dressed, and taking a shower. For example, if you have trouble buttoning your shirt or tying your shoes due to carpal tunnel syndrome, that signals to Social Security that you have difficulty with fine motor skills—hand movements that are key for most jobs.
Some claimants, particularly those with severe cognitive impairments such as Alzheimer’s disease, require help with even the most basic personal needs, like using the toilet. Be sure to mention on the ADL form if a caregiver provides help. If you’re completing the form for an applicant with a mental disorder, ask the caregiver for their insight into the applicant’s ADLs.
When describing whether you do maintenance around the house such as cleaning the dishes, sweeping the floor, or mowing the lawn, make sure to discuss why you can’t do these chores. Every household divvies up these responsibilities to some extent, but Social Security is just interested in whether you could do a chore if you had to.
For example, if you don’t prepare meals because your spouse enjoys cooking more, that doesn’t tell the agency whether you have any limitations that would prevent you from working in a kitchen. But if you don’t cook because medication side effects make it hard for you to follow even a simple recipe, Social Security is likely to rule out kitchen work (and potentially all jobs.)
Common chores that Social Security asks about include:
As with mobility issues, when describing any difficulties you have performing these chores, make sure you’re specific and use numbers where possible. Somebody who struggles with using a vacuum cleaner after a rotator cuff repair might write the following on their ADL form:
Limitations from mental disorders aren’t as easy to quantify—few people count how many minutes or hours they can maintain concentration or focus. If you need frequent reminders to pay your bills or let the dishes pile up because you get distracted before you finish, let Social Security know. The agency could find that you’d spend too much time off-task at work for any employers to hire you.
Many people who apply for disability benefits have had to give up favorite hobbies or reduce time spent on recreational activities. You can help Social Security better understand your limitations by telling them what you used to do for fun, and why you can’t do it any longer.
The agency doesn’t expect you to quit everything you enjoy because of a physical illness or mental disorder. But discussing hobbies can be difficult. You don’t want to accidentally give Social Security the impression that you’re more active than you actually are.
When asked about recreation on your ADL form, steer clear of vague terms like “hiking” or “basketball.” Without more detail, the agency doesn’t know if you’re hiking 1 mile or 10 miles, or whether you’re regularly playing basketball or watching it on TV—important distinctions that can mean the difference between an approval or a denial.
Disability applicants, especially those struggling with mental conditions, often report difficulty interacting with others. On your ADL form, it’s important to address how your conditions limit your ability to socialize with other people. For example:
Any change in social activities that you previously were interested in can be insightful. If you had been an active member in a church group but lost interest due to depression or anxiety, for example, Social Security will take that into consideration when determining whether you can work a job involving public contact.
Social contacts aren’t always limited because of mental disorders—advanced lung disease, muscle weakness, or pain can limit your desire and ability to interact socially.
Getting your ADLs form right can be challenging. Many disability applicants overlook limitations that they consider minor or not worth telling Social Security. But these minor limitations—especially when taken together—can have a major impact on your ability to work.
Consider getting an attorney who can walk you through all of your limitations and help you craft a comprehensive list of your ADLs. You can find a representative using our lawyer locator tool here.
For more information, see Nolo’s Guide to Social Security Disability, by David Morton, M.D. (Nolo).
Updated January 31, 2023
]]>A traumatic brain injury (TBI) occurs when a sudden blow to the head causes damage to the brain, often in the form of internal bleeding, bruising, or swelling. The most common triggers of TBIs include traffic accidents, falls, assaults, and sports injuries. Many soldiers returning from Iraq and Afghanistan have suffered TBIs, often due to roadside bombs known as IEDs. (Also see Nolo's article on getting VA disability compensation for TBIs.)
In all, about 1.5 million people a year experience a TBI in the United States, with children, teenagers, and military personnel having more than their share of TBIs.
TBIs can be classified from mild to severe. A "mild" TBI, also called a concussion, occurs when a person suffers confusion or loss of consciousness for less than thirty minutes. Despite being classified as "mild," they're frequently accompanied by serious cognitive impairments such as memory loss, headaches, dizziness, and fatigue. Mild TBIs account for 80% of all brain injuries.
"Severe" brain injuries are those that cause loss of consciousness for more than 30 minutes, along with cognitive impairments such as speech and language abnormalities, poor abstract thinking skills, and loss of motor function. Those who have sustained a TBI often experience related symptoms for months or even years afterward, including sleep disturbances, persistent headaches, poor memory, shortened attention span, and depression.
The presence and severity of a TBI may be diagnosed with MRIs and CAT scans, although many mild TBIs will not appear on neuroimaging. For this reason, neuropsychological testing may be performed to assess the extent of any cognitive deficits.
In late 2016, Social Security added a new disability listing for TBI under neurological disorders (listing 11.18). Previously, Social Security evaluated traumatic brain injury under disability listings for other types of medical conditions: stroke, epilepsy, or organic mental disorders (also known as neurocognitive disorders).
If you suffered a TBI but don't have lasting physical problems, your condition will still be evaluated under another listing: listing 12.02 for neurocognitive disorders. Note that a drop in I.Q. of at least 15 points that results in serious limitations is no longer a method of qualifying for benefits for cerebral trauma under that listing. (For more information, see our article on getting disability for a neurocognitive disorder.)
In its listing, Social Security considers TBI to be brain damage caused by a closed head injury, penetration by an object into the brain tissue, or a skull fracture. To qualify for benefits under the listing, your medical records must document that you either:
OR
What does "marked" mean? It can be considered as seriously limiting—worse than moderate, less than extreme. In practice, a mild TBI usually does not qualify a person for benefits based on the listings, but many people who have suffered mild TBIs are approved for disability under a medical-vocational allowance.
If you don't meet the TBI listing, Social Security will measure your residual functional capacity (RFC) to determine whether you can do your current job despite your physical and mental limitations. Your RFC is a description of your maximum work-related capabilities and your limitations.
If your current (or most recent) job is too mentally or physically taxing given your limitations, Social Security will use your age, education, work history, and RFC to determine whether other, less mentally or physically demanding jobs exist that you can perform. If Social Security agrees that your RFC doesn't allow for any gainful employment, you'll receive a "medical-vocational allowance."
It is crucial that you provide documentation of all your medical treatment and functional limitations arising from your TBI so that Social Security can accurately assess your condition. This may include:
If you suffer from impairments other than a TBI, such as depression, PTSD, or anxiety, be sure to submit documentation for those conditions as well. Social Security will consider the total effect of all your impairments on your ability to work. The more evidence you can provide about your limitations, the better your chances of getting approved.
]]>Because of these reasons, the Social Security Administration (SSA) often has to rely largely on the claimant’s statements to make its disability decision rather than on objective medical evidence like x-rays or MRIs. This means that the SSA’s decision often simply depends on whether it believes the claimant is telling the truth and not exaggerating.
When the SSA evaluates a back claim, the agency will look at:
You must be able to prove to the SSA that the symptoms of your back problem are caused by a “medically determinable impairment.” This means that you have to provide the SSA with evidence that shows you have some sort of back abnormality. For example:
A functional limitation is something you can’t do because of your back problem. The extent of your functional limitations and how they impact your ability to work are the most important aspect of your claim. The more functional limitations you have, the less likely you can work full time.
Your functional limitations are used to determine your residual functional capacity (RFC). Your RFC is the most you can do on a regular and sustained basis (full-time). For example, an RFC might say you can walk up to six hours per day, lift up to 20 pounds occasionally, and carry up to 10 pounds frequently.
To make your RFC assessment, the SSA will use the medical evidence in your file to prepare an RFC form. Here are some examples of functional limitations that are assessed on an RFC form:
Even though the SSA doctors will prepare an RFC assessment for you, it is vital to your claim that your treating doctor fill out an RFC form for you as well. Make sure that the doctor who prepares your RFC form is a back specialist.
Certain functional limitations are more likely to result in an approval for disability benefits than others. Remember, however, that these limitations must be documented in your medical records. Here are some examples of limitations related to back problems that may help you get approved for benefits:
Your credibility can make or break your case, especially if your medical records alone can’t demonstrate that your problem is disabling. To assess your credibility, the SSA may assess and compare the following factors:
In addition to these, the SSA will also consider:
An important factor in determining whether your statements are credible is the consistency of your statements throughout your record and to the SSA. For example, if a person tells the SSA that he cannot walk more than a block without resting, yet the record indicates the claimant routinely does yard work, the claimant’s credibility will be damaged. Another example is if the claimant tells the SSA that she cannot sit for more than a few minutes at a time without pain, yet the SSA interviewer observes no discomfort in the claimant during an hour-long interview process.
The efforts you have taken to alleviate your symptoms are an important factor in determining your credibility. This means that SSA will be more inclined to believe a person’s statement about his or her pain if the records indicate a long-term effort at finding successful treatment. For example, did the claimant try multiple medications and dosages? Did the claimant seek alternative treatments such as acupuncture? Did the claimant go through long-term physical therapy?
Some back conditions are more likely to get approved than others. This is often because they can be documented more easily on “medically acceptable imaging” or with some other objective means like sensory or reflex tests. The following are back conditions that are fairly easy to prove and that will satisfy the SSA's official disability listing for back problems, meaning they'll automatically qualify for benefits.
Arachnoiditis. This is an extremely painful condition caused by inflammation of the membrane that surrounds and protects the spinal cord. Symptoms often differ among sufferers but include pain, weakness, painful electrical sensations in the legs, and the loss of bowel and bladder function.
Spinal stenosis. This is caused by the narrowing of the spinal column that then puts pressure on the spinal cord and can cause pain, numbness, and weakness. Severe spinal stenosis in the cervical spine (upper) can even lead to bowel and bladder incontinence.
Nerve root compression. This can be caused when a bulging or herniated disc, spinal fracture, or arthritis puts direct pressure on a nerve. Severe nerve root compression can lead to pain, weakness, numbness, and eventually muscle wasting.
Whether you have one of the above conditions or plain old degenerative disc disease, the more evidence you can provide about your limitations, the better your chances for getting approved. If you've had spinal surgery, see Nolo's article on disability benefits after spinal fusion.
]]>Can disability applicants with mental disorders who abuse medication, drugs, or alcohol still get disability benefits? It depends. Let's look at how Social Security treats applicants with drug or alcohol addictions.
For disability applicants with physical impairments, any limitations caused by substance abuse or addiction (for instance, fatigue, anxiety, depression, or difficulty concentrating) can't form the basis of a disability claim. Specifically, a person can't receive disability benefits if drug addiction or alcoholism (what Social Security calls "DAA") is a "material factor" in their disability. To decide whether drug or alcohol is a material factor, Social Security looks at whether a person's impairments or disabling limitations would be reversed of the applicant stopped using.
For example, if a person abuses alcohol and experiences severe abdominal pain from inflammation of the liver,Social Security won't consider this limitation as potentially disabling -- as long as it goes away when the person stops drinking. Likewise, stimulant drugs like methamphetamines can cause increased blood pressure, but this effect is reversible if the person stops taking methamphetamines, and so is not considered limiting. (However, if a person has a dependency on prescription stimulants, like Adderall, Social Security will consider whether any reversible effects of the drugs are limiting, as long as the medication is taken a prescribed. See Nolo's article on how prescription drugs affect disability for more information.)
But even if some of an applicant's disabling limitations would be reversed if the drug or alcohol use stopped, this doesn't mean the applicant can't get disability benefits. It just means that Social Security will consider only the following to determine if they are severe enough to qualify for disability benefits:
There are a few additional points to consider when the applicant claims a mental limitation or disability on his or her application.
Inability to abstain. Abusing medication is a common problem in clinical medicine. Patients with schizophrenia may, for example, abuse a number of substances in an attempt to control symptoms. These patients, because of their mental disorder, may not be able to abstain from using multiple drugs. For that reason, Social Security should never consider drug use by individuals with medically severe mental disorders like schizophrenia as a material factor unless:
Because of these issues, Social Security should be particularly hesitant to find drug or alcohol use a material factor in psychotic disorders, major depression, autism, bipolar disorder, organic brain disease (that's more than mild), and those with markedly low IQ.
In-person examinations. To make a DAA determination, a medical consultant working for Disability Determination Services will look at medical evidence regarding applicants' inability to sustain from substance abuse and whether their mental limitations would improve without substance abuse.
When information on these questions isn't available from the disability applicant's treating psychiatrist, Social Security will send an applicant to an independent mental consultative examination. Unlike with physical impairments, DDS medical consultants cannot rely on their expertise alone to provide an opinion that a mental disorder will improve with the cessation of drug use – the DDS medical consultant must look at evidence from either:
Further, evidence that a treating psychiatrist has given advice to a patient with schizophrenia or another serious mental disorder that he or she should not abuse legal or illegal drugs and that the advice has been disobeyed is not in itself sufficient for Social Security to consider the drug use a material DAA factor (and to ignore the applicant's mental limitations caused by the drug or alcohol use on account of their being reversible if the applicant stopped the substance abuse.) If there is any question, the benefit of the doubt should go to the applicant. For example, in most cases involving schizophrenia, it is too difficult to make predictions about what the person’s mental condition would be when not taking drugs.
In mental disorders of lesser severity, such as personality disorders, it is much more likely that Social Security will consider the drug use a material DAA issue and that any substance abuse-related mental limitations will be considered reversible if the applicant stopped using drugs or alcohol.
Reversibility of limitations. How does Social Security decide whether an applicant's mental impairments or limitations would still exist if the applicant stopped using drugs or alcohol? As in physical disorders, for those with mental, psychological, or emotional disorders, the informed judgment of a medical doctor (psychiatrist) is needed to evaluate whether drug use is a material factor in mental disability claims. (Read more in our article on who makes DAA determinations.)
Even if the opinion of the applicant's treating doctor is that there will be significant improvement if the applicant stopped using drugs or alcohol, Social Security won't find that DAA is a material factor unless the evidence of record supports that conclusion. Unsupported opinions (guessing or bias) from the applicant's psychiatrist or primary care doctor is no more acceptable from these treating sources than it would be from Social Security consultants or employees.
Also, Social Security should take particular care in accepting opinions from treating psychologists (rather than psychiatrists) that there would or would not be improvement in a mental disorder if the drug or alcohol use stopped. Although such opinions carry some weight, substance abuse issues involve drugs with many possible physical toxicities—including to the brain—of varying reversibility. Denials for drug or alcohol use based on a treating psychologist’s or other non-physician’s opinion would be questionable on the part of Social Security, just as they would be for a Disability Determination Services consulting psychologist or one performing an independent consultative mental status examination.
Periods of abstinence and ability to abstain. If the applicant has abstained from abusing drugs or alcohol for some amount of time, Social Security will look to whether the applicant's mental limitations improved during that time period. But again, even if periods of abstinence show clear and significant sustained mental improvement in the past, that is not a compelling argument that a claimant with drug or alcohol addiction and an additional severe mental disorder, such as a schizophrenia, has the judgment or ability to modify their abusing behavior. This is true even if the applicant's doctor submits an opinion to the contrary.
]]>Skill levels come into play both when Social Security looks at whether there are other jobs you can learn to do and when Social Security assesses whether you fall into any of its "grid rules." The grid rules are a set of charts arranged by RFC that Social Security uses to decide if a person is disabled, based on his or her age, education, and skills. If you have "transferable skills" – knowledge learned at one job that you could use at another job – you can't qualify for disability using the grid rules. (For further explanation, see Nolo's article on the disability grid rules.)
Many times disability applicants think their past jobs are unskilled and that they have no jobs skills. Then they are surprised to be denied for disability benefits because Social Security categorized their job as semi-skilled (and because Social Security says they have job skills they can transfer to a new job). For instance, a shipping and receiving clerk might think he or she is doing unskilled work because the job mainly involves loading and unloading boxes, but Social Security considers this to be is a semi-skilled job, and could find that someone who had worked as a shipping and receiving clerk would have clerical job skills that he or she could use at another type of job.
Social Security categorizes jobs into skilled work, semi-skilled work, and unskilled work. It relies on the Dictionary of Occupational Titles to classify jobs into these categories. Let's look at what each category of work entails and which category some common jobs fall into.
Unskilled work involves simple tasks and doesn't usually require one to exercise judgment. It typically requires only a month or less to learn. Many, but not all, unskilled jobs require physical strength or coordination.
Here are some examples of unskilled jobs:
If you have a history of only unskilled work, Social Security can't say there are semi-skilled or skilled jobs you can do; you can do only unskilled work, and only if your limitations allow it.
Also, unskilled jobs don’t produce transferable skills, so if your only jobs have been unskilled and you are 50 years or older, you have a chance of fitting into a grid rule that says you're disabled. (On the other hand, if you have transferable job skills and you can do at least sit-down work, you won't be found disabled.)
Semi-skilled work requires paying attention to detail or protecting against risks but it doesn’t include complex job duties. Semi-skilled work doesn't require you to have advanced training or education and typically takes between three and six months to fully learn a semi-skilled job.
Some semi-skilled jobs require monitoring, quality checking, or doing repetitive tasks. Here are some examples of semi-skilled jobs:
If your past work history includes any semi-skilled work, Social Security may say there are many unskilled or semi-skilled jobs you can do, if your limitations allow it. And it's less likely that you'll fit into a disabled grid rule, because Social Security is more likely to find you have some transferable job skills.
Skilled work requires workers to use their judgment to make decisions and may require them to measure, calculate, read, or estimate. Skilled work often has specific qualifications such as educational degrees or professional training and usually requires intellectual reasoning and problem-solving skills. It typically takes six months to a year or more to learn a skilled job.
Here are some examples of skilled jobs:
It's difficult for a disability applicant with a history of skilled work to be found disabled – unless the applicant can't do even sedentary work – because there are many different types of skilled, semi-skilled, unskilled sedentary jobs that a person with skills may be able to do. And it's much less likely for a skilled worker to fit into a grid rule, because someone with transferable job skills won't be found disabled under the grid rules.
Some types of jobs straddle two categories. For instance, the job of cashier can fall into either the unskilled category or the semi-skilled category. The DOT classifies grocery checkers as semi-skilled workers and puts other types of cashiers, such as parking lot, dining room, self-service gasoline, and change-booth cashiers, into the semi-skilled category.
The best way to see how Social Security will classify your job is to search the Dictionary of Occupational Titles for the occupation that best matches your job (both in terms of title and duties). You need to look at the SVP number assigned to the job: SVPs of 1 and 2 mean the job is unskilled, SVPs of 3 and 4 mean the job is semi-skilled, and SVPs of 5 and above mean the job is considered skilled.
Sometimes Social Security mistakenly thinks a disability applicant's past job included job skills when it actually didn't. This usually happens because the agency has gotten the details of the applicant's job wrong. (The agency will assume you did a job as it is generally performed; if you didn't, you may not have gained the job skills Social Security thinks you did. For more information about this, see Nolo's articles on when Social Security makes mistakes about your job history and proving you don't have transferable job skills.
]]>At the initial application stage, the disability examiner assigned to your case will request your recent medical records, usually those from the past two to three years. If your file contains insufficient medical evidence, in many cases Disability Determination Services (DDS) will arrange for you to attend a consultative examination (CE) with a doctor paid by Social Security.
With few exceptions, the physicians who perform the "independent" disability exams for Social Security rarely write reports favorable to claimants. Oftentimes the consulting doctor specializes in an area of medicine completely unrelated to your alleged impairment, and performs a perfunctory exam that lasts fifteen minutes or less.
Perhaps this explains why disability attorneys are constantly reminding their clients of the importance of obtaining consistent medical treatment. Under Social Security's "treating physician rule," the opinion of your treating doctors generally outweighs those of a medical consultant from Social Security. Moreover, disability examiners often assume that a lack of consistent treatment indicates a non-severe medical situation. In fact, many disability claimants, even those with life-threatening conditions, are unable to obtain treatment for financial and other reasons.
Before discounting your alleged impairments based on your failure to obtain medical treatment, disability examiners and Social Security judges must consider your explanations for the lack of treatment. In particular, Social Security regulations require examiners and judges to consider that you may not be able to afford health care or have access to any free or low-cost services. Similarly, if you're failing to take prescribed medication or follow other prescribed treatment, SSA must consider whether this is due to financial constraints.
The burden is on you to prove that you cannot afford to see a doctor or obtain medical treatment and that there are no low-cost alternatives available. In practice, your explanation will be much more persuasive if you can show that you've done the following:
With the advent of the Affordable Care Act ("Obamacare"), you should also consider applying for subsidized health insurance on the new exchanges (learn more here). Beginning in 2014, insurers are not allowed to deny coverage or charge more to those with pre-existing conditions.
According to the Supreme Court, disability proceedings are investigative in nature, not adversarial. Thus, an Administrative Law Judge has a duty to develop (gather) the evidence and examine the facts in your case. If the medical evidence is ambiguous or insufficient, the ALJ may choose to ask questions of a medical expert, re-contact your treating doctor, or schedule you for a consultative exam.
While SSA regulations state that your treating doctor is the best person to do a consultative exam (CE), unfortunately most practicing physicians won't accept the fees paid by Social Security for the performance of those exams. Thus, if a disability examiner or ALJ does decide that you need a CE, you're likely to see a physician consulting for the SSA.
Don't rely on Social Security to set up a CE on its own initiative. If your recent treatment history is spotty, you should submit a written request for a CE to the hearing office handling you're case. Feel free to state whether you'd prefer to see a particular type of specialist, but understand that SSA may not be able to accommodate your request.
Occasionally, a disability attorney might pay for you to be examined by a doctor who will submit a report for Social Security. Due to the expense involved, however, most attorneys only elect this option in cases where their clients' problems are obvious but undocumented. In other words, disability attorneys will risk their own (or their firm's) money only when a medical exam could realistically turn a losing case into a winning one. In most circumstances, the client is required to reimburse the attorney for the costs of the exam if he or she is approved, and sometimes, even if denied.
In addition to arranging for an exam or requesting one from the SSA, an attorney will be better able to explain gaps in your medical treatment history to the SSA, obtain statements from relatives or employers familiar with your condition, and elicit well-supported opinions about your functional limitations from doctors who have seen you only once or twice.
Attorneys are also frequently able to point you in the direction of an affordable health care provider in your area, and some may be willing to assist you with a Medicaid application. Given the length of time between an application for disability benefits and a hearing (often a year or more), obtaining Medicaid benefits early in the disability process may allow you to establish regular treatment well before your hearing.
]]>The Social Security Administration (SSA) defines obesity as a chronic disease marked by an excess of body fat and usually caused by a combination of genetic, behavioral, and environmental factors. Obesity increases the risk for heart disease, diabetes, respiratory problems, and a host of other medical issues. Over one-third of Americans suffer from some form of obesity.
Obesity is divided into three levels calculated using a height-to-weight ratio known as Body Mass Index (BMI). Those with Level I obesity have a BMI of 30 to 34.9. Level II obesity includes BMIs of 35 to 39.9. A BMI of 40 or more indicates Level III obesity, also called morbid obesity. Doctors diagnose obesity using the BMI scale or by measuring a person's waist size or weight.
When applying for disability benefits to mention all your medical conditions, including obesity. Even if your doctor has not formally diagnosed you with obesity, you should include it on your disability application if you believe your weight is interfering with your ability to work.
Until 1999, obesity was one of the impairments listed in Social Security's "blue book," meaning that a person would automatically qualify for disability benefits if he or she met the requirements of the obesity listing. While Social Security will still consider an individual's obesity and the extent to which it limits day-to-day functioning, in practice, the removal of the obesity listing has made it more difficult for obese individuals to get approved for disability benefits.
While a person can no longer "meet" a disability listing for obesity, it is still possible (though rare) to "equal" a listing. In this situation, a person's obesity must be equal in severity to one of the listed impairments. For example, if a person is unable to walk due to obesity, this may medically equal listing 1.03, which is met when reconstructive surgery on a weight-bearing joint prevents a person from walking for at least twelve months.
Obesity may also help satisfy the requirements of a listing that calls for an impairment in addition to the primary medical condition. For example, to meet the listing for intellectual disability, an applicant must have a low IQ plus an impairment that imposes "an additional and significant work-related limitation."
At steps four and five of Social Security's five-step sequential evaluation, the SSA determines whether your age, education, work experience, and Residual Functional Capacity (RFC) allow you to perform your past work or any other jobs that exist in the U.S. Your RFC is a description of the physical and mental capabilities you have in spite of your impairments. If no jobs are available for a person with your vocational history and RFC, you'll be found disabled at step five via a Medical-Vocational Allowance.
An obese individual might have exertional limitations like difficulty standing, walking, or sitting for certain periods of time. Obese people are sometimes restricted in their ability to lift or carry heavy objects, climb stairs or ladders, or stoop, balance, bend, crouch or crawl. It's important for you to document all your physical limitations to the extent possible by providing the SSA with your treatment notes and doctors' opinions. Social Security will only include exertional limitations in a person's RFC when there is a solid medical basis for doing so.
It is rare that obesity is the sole basis for a disability claim, as there are often other underlying health issues present. Social Security's regulations recognize that obesity can exacerbate a number of musculoskeletal, respiratory, and cardiovascular conditions, and that many of those conditions also contribute to obesity. Similarly, mental health disorders such as depression and anxiety can be made more acute by obesity, and vice versa. As a result, Social Security will consider the combination of all your impairments in assessing your RFC.
Occasionally an Administrative Law Judge will deny a person's disability claim because the individual has been "prescribed" a healthy diet and exercise by a doctor but has failed to follow the doctor's orders. This reasoning is faulty and makes a great basis for appeal to the Appeals Council. The SSA's rules are clear on this issue: A treating doctor's recommendation that an individual should follow a diet or exercise regimen does not count as prescribed treatment, and failure to do so isn't grounds for denial of benefits.
If you've been approved for disability benefits based partly on obesity and you lose weight, the SSA may find that you've experienced "medical improvement" and are no longer disabled. While minor weight fluctuations (less than 10% of body weight) won't affect your case, sustained weight loss of more than 10% of body weight that lasts at least twelve months could be considered medical improvement. But if you have impairments other than obesity, Social Security will assess whether those conditions have improved as well before deciding that your disability has ended.
Whether you're applying for disability benefits at the initial level, or you've already been approved and are undergoing a Continuing Disability Review, your chances of success will increase if you hire an experienced disability attorney.
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