A very often asked question.

Basically, SSA uses the Listing of Impairments to decide, for want of a better term, are the cut and dry cases that, assuming the non medical requirements are met, will automatically qualify a patient for either SSI or social security disability insurance3 benefits. Briefly, SSI disability is a fixed monthly benefit paid to a severely disabled individual who has not worked long enough to be eligible under the Social Security Act and has few, if any, resources. In other words, to be eligible for SSI disability you have to be both severely disabled and quite poor. On the other hand, to be eligible for Social Security disability benefits, you have to be severely disabled and have worked long enough and paid enough into the system to be covered as an insured worker. Both programs however, share the same definition of disability. The patient must be suffering from a disease or condition, or combination of conditions, anticipated to result in death, or, to last longer than 12 months, and which prevents the patient from engaging in substantial gainful work activity. As indicated, certain conditions are considered so severe that they automatically 1ualify a patient. This is where the term Listings come into play.

The Listing of Impairments is a summary of medical criteria, divided into 14 different anatomical categories, each dealing with a specific body system, that, if met, satisfies the issue of disability for purposes of social security without further consideration of age, education or work history. For example, someone suffering with Rheumatoid Arthritis will meet the requirements of disability if there is a history of persistent joint pain, swelling, and tenderness involving multiple joints with signs of joint inflammation on current physical examination despite prescribed therapy for at least 3 months, resulting in significant restriction of function of the affected joints, and this activity is anticipated to continue at least 12 months. In addition, corroboration of diagnosis at some point in time by either, positive RA factor, elevated sedimentation rate, finding of antinuclear antibodies, or histologic changes noted in biopsy of synovial membrane will satisfy the listing. Age, education or work history would have no affect on the decision and benefits would be paid.

As mentioned, there are similar criteria for most commonly recognized diseases or conditions. It is also possible that medical equivalence can b found if the condition or disease is not specifically covered by the Impairment Listing. The anatomical divisions include musculoskeletal, special senses, and speech, respiratory, cardiovascular, digestive, genito-urinary, hemic and lymphatic, endocrine, neurological, mental disorders, neoplastic diseases, immune system, and multiple body systems. Within each of these categories specified laboratory, clinical, imaging, and other test data are needed to be met.

Over the coming year, we will focus in future publications on one or more of these areas and provide specific examples of claims that were deemed to have met the Listings.

Again, please remember, if a patient does not necessarily meet the Listings, he may nevertheless qualify for benefits if his disease, condition or combination of diseases and conditions, preclude him or her from engaging in substantial work taking into account age, education and work experience.

If the Listings are not met, the issue then focuses on functioning.