We’ve talked a lot about the application and approval process for Social Security disability benefits: what happens when and by whom.
But here’s what you really want to know: How sick do I have to be to get approved for SSI and SSDI?
The short (and harsh) answer is this: you have to be pretty sick.
If you read last week’s episode of the Social Security Secrets, Episode 3: Getting Approved for Social Security — Who Makes the Decision and How?, you know that there are two ways you can get approved for benefits. The first, and one we will talk about here, is if you meet or medically equal a “listing.”
What are the “listings?”
The listings are a list of medical and psychological diagnoses categorized by body system. Each diagnosis contains a list of specific symptoms and/or medical findings (MRIs, blood test results, mental status exam results, etc.) that must be shown by your medical records. These symptoms and findings are usually pretty severe. Some listings are more complex than others.
Meeting a listing
If DDS finds that you meet a listing, they are saying that your symptoms and medical findings match exactly what is required by your condition’s listing.
Some listings, such as the listing for loss of speech, are fairly simple. For this listing, all you need to show is that you cannot produce any speech that can be heard, understood, or sustained.
However, other listings, like the listing that covers back impairments, are more complicated. There are often multiple medical findings that DDS must see in your records, and multiple manifestations that must accompany each medical finding, such as pain, limited range of motion, or weakness.
Let me risk oversimplifying it with this example, using a fake listing:
1. Back impairments.
A. Your back hurts;
B. An x-ray shows you have a broken spine; and,
C. You are unable to bend over because of this broken spine.
If your medical records show A, B, and C, you meet the listing. Your claim for benefits is approved. If you cannot show all three criteria, you do not meet the listing, and DDS will have to continue with its analysis.
Equaling a Listing
If you do not meet a listing, DDS then decides whether you medically equal a listing. DDS will find that you medically equal a listing if your condition is as severe as a condition that would have met the listing, even though your records don’t show all of the medical findings required by your condition’s listing.
Returning to our fake back pain listing, let’s say you have back pain and the x-ray shows a broken spine, but you can bend over. Your records show A and B, but not C. Thus, you do not meet the listing. However, you cannot straighten your back or sit for more than 30 minutes without excruciating pain. This might medically equal the fake back pain listing because not being able to sit for more than 30 minutes without excruciating pain is as severe as not being able to bend over. If it does, you are approved for benefits and the analysis stops. However, if it does not, the analysis continues.
Ultimately, few applicants who are approved meet or medically equal the listings because the listings are so severe. Most who are approved are approved at the last stage of the analysis: whether they can go back to their old job or perform other work. More on this in the next episode.