How Social Security Considers Multiple Impairments When Making Disability Decisions

Many applicants for Social Security disability benefits have several different medical issues that are preventing them from working. The Social Security Administration (SSA) must consider the combined effects of all your impairments, both severe and non-severe, in deciding whether you qualify for benefits. Thus, it is essential when completing your disability application to mention all your medical conditions, including those that are minor compared to your serious problems.

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 $1,470 (in 2023).)

Step Two of SSA's Five-Step Evaluation: Severe and Non-Severe Impairments

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.

Step Three: SSA's Blue Book Listings of Impairments

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.

Steps Four and Five: How Multiple Impairments Can Impact Your Residual Functional Capacity

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:

• Exertional (strength-related) restrictions: Including lifting, carrying, sitting, standing, and walking.
• Non-exertional restrictions: Reaching, handling, bending, and mental limitations such as following instructions, dealing with work stresses, making simple and complex decisions, and interacting with colleagues and the general public.

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.

Multiple Impairments and SSA's Durational Requirement for Disability

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 January 5, 2023}