My Condition Isn’t Listed, Can I Still Qualify for Disability?

The Social Security Administration offers disability benefits to people who cannot work because of long-term health conditions.  To help make determinations about whether to approve or deny disability claims, the SSA uses a medical catalog called the “Blue Book,” or Listing of Impairments.  But what if you don’t see your injury or illness included?  Our Bensalem, PA disability lawyers go over how to qualify for benefits even if your condition isn’t included in the Listing of Impairments.

Establishing Medical Equivalence

The SSA will not approve a claim unless it rules that an applicant’s disability is so severe that it makes employment impossible.  The SSA decides if a disability is severe by using the Listing of Impairments, which provides detailed medical criteria for many different illnesses.  While some of these criteria are straightforward, many of them are highly complex and use confusing medical jargon, equations, and formulas.  As a result, they are often difficult to meet.

However, you don’t necessarily have to match the criteria in the Listing — you simply have to equal it.  As the SSA states, “To medically equal a listing, the findings of the claimant’s impairment(s) must be at least equal in severity and duration to the criteria of any listed impairment.”  Medical equivalence is addressed by federal regulation § 404.1526.

The duration requirement is 12 months at minimum, unless a condition is expected to end in death.

How to Qualify with a Medical-Vocational Allowance

If you don’t meet a listing, you can still qualify for benefits with a medical-vocational allowance.  Medical-vocational allowances do require that the claimant has a severe disability, but also take other factors into consideration, including age, education, work experience, and residual functional capacity (RFC).

Under § 416.945,  “Your residual functional capacity is the most you can still do despite your limitations.”  The SSA will perform something called an RFC assessment to determine just how much you can and cannot do.  It may test physical functions like sitting, standing, and walking, or mental functions like remembering, understanding, judging, and responding.

The RFC assessment also looks at your past 15 years of employment to determine if the sort of work you have done is classified as unskilled, semi-skilled, or skilled.  It also divides work capabilities into five categories: sedentary, light, medium, heavy, and very heavy. Depending on how these variables interact with each other, a claimant may be found disabled.

For example, if the SSA finds that you have limited education, and no skills or non-transferable skills, you can be considered disabled.  In another example, if you are age 50 to 54, and your RFC assessment finds that you do not have any transferable training or skills and are restricted to performing sedentary work, you will also be found disabled.

How to Qualify Through the Compassionate Allowances Program

Even if you didn’t see your condition in the standard Listing of Impairments, it might be included under the Compassionate Allowances (CAL) program.

CAL offers expedited claim processing to applicants whose “medical conditions are so serious that their conditions obviously meet disability standards.”  However, not only does CAL cover terminal and very advanced illnesses, it also includes many rare diseases which are not found under the regular Listing.  (While the Listing is fairly comprehensive, it tends to focus on somewhat common and well-known conditions.)

For example, if your impairment is chondrosarcoma, and you look in the Listing’s section for malignant neoplastic diseases (i.e. cancer), you won’t find your condition listed. However, you will find it covered under the CAL list.   Many other rare diseases are also covered by CAL.

The SSA periodically holds public outreach hearings, and is continually in the process of expanding the CAL list, to which the SSA adds new conditions on a yearly basis.  It chooses these new conditions to add based on a mixture of feedback from the public, recommendations from advocacy groups, and information from medical experts and their research.

CAL applicants do not have to use any separate or special forms, and should apply using the normal forms and procedures.  CAL claims will be processed more rapidly than standard claims, but the SSA does not inform claimants if their applications have been selected for fast-tracking.  The SSA informs applicants only:

  • If additional evidence is needed.
  • When a decision has been made.

While standard claims can take months or even years to be fully reviewed and processed, expedited CAL claims take as little as a few weeks.  Exactly how fast these applications can be reviewed depends on other factors, like how long it takes for the SSA to procure medical evidence, and whether that evidence needs to be supported by a physical examination.

If you or someone you love has a serious health impairment, call the experienced Doylestown disability lawyers of Young, Marr, Mallis & Associates at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania today to arrange for a free and confidential legal consultation.

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