Proving Medically Determinable Impairment
The Social Security Administration (SSA) has set guidelines that establish eligibility for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Importantly, you must be disabled due to a “medically determinable impairment” in order to qualify for disability benefits. That means you must have a condition that can be proven with verifiable medical evidence.
It can be difficult to prove that an impairment is severe enough that you qualify for Social Security benefits. The experienced Clayton Social Security disability representatives at Adams & Associates Disability, Inc. can help you understand the application process and gather information necessary to proving your claim.
Defining An “Impairment”
In order to understand what a medically determinable impairment is, you must first know what qualifies as an “impairment.” An impairment is a physical or mental condition that results from abnormalities of an anatomical, physiological, or psychological nature. That condition must cause functional limitations of daily activities that prevent you from working.
The SSA maintains a listing of impairments and medically determinable requirements for both Adults and Children. If you can show that you have an impairment through the methods described on that listing, then you may qualify for benefits if your impairment is so severe that it prevents you from working, or, for children, causes marked or severe functional limitations.
Medically determinable impairments on the Adult Listings (Part A) include the following:
- Musculoskeletal System – major dysfunction of joints, reconstructive surgery or surgical arthrodesis, disorders of the spine, amputation, fracture of certain bones, soft tissue injuries
- Special Sense and Speech – loss of visual efficiency, disturbance of labyrinthine-vestibular function, loss of speech, hearing loss with or without cochlear implant
- Respiratory System – chronic pulmonary insufficiency, asthma, cystic fibrosis, pneumoconiosis, bronchiectasis, lung infections, pulmonary vascular hypertension, sleep-related breathing disorders, lung transplant
- Cardiovascular System – chronic heart failure, ischemic heart disease, recurrent arrhythmias, congenital heart disease, heart transplant, aneurysm of aorta or major branches, chronic venous insufficiency, peripheral arterial disease
- Digestive System – gastrointestinal hemorrhaging requiring blood transfusion, chronic liver disease, inflammatory bowel disease (IBD), short bowel syndrome (SBS), weight loss due to any digestive disorder, liver transplant
- Genitourinary Disorders – chronic kidney disease, nephrotic syndrome, complications of chronic kidney disease
- Hematological Disorders – hemolytic anemias (sickle cell disease, thalassemia, etc.), disorders of thrombosis and hemostasis, bone marrow failure, hematological disorders treated by bone marrow or stem cell transplantation, repeated complications of hematological disorders
- Skin Disorders – ichthyosis, bullous disease, chronic infections of the skin or mucous membranes, dermatitis, hidradenitis suppurativa, genetic photosensitivity disorders, burns
- Endocrine Disorders – disorders of the pituitary, thyroid, parathyroid, and adrenal glands, diabetes mellitus, pancreatic disorders
- Congenital Disorders – non-mosaic down syndrome, mosaic down syndrome, any other catastrophic congenital disorders
- Neurological – convulsive or nonconvulsive epilepsy, central nervous system vascular accident, brain tumors, Parkinson’s disease, cerebral palsy, spinal cord or nerve root lesions, multiple sclerosis, amyotrophic lateral sclerosis, anterior poliomyelitis, myasthenia gravis, muscular dystrophy, peripheral neuropathies, subacute combined cord degeneration, other degenerative diseases, cerebral trauma, syringomyelia
- Mental Disorders – organic mental disorders, schizophrenia and other paranoid and psychotic disorders, affective disorders, intellectual disability, anxiety-related disorders, somatoform disorders, personality disorders, substance addiction disorders, autistic disorder
- Cancer – any type of cancer, including sarcomas, lymphomas, leukemias, melanomas, and carcinomas, even if the primary site is unknown
- Immune System Disorders – lupus, vasculitis, sclerosis, HIV/AIDS, connective tissue disease, inflammatory arthritis, Sjogren’s syndrome
Childhood Listings (Part B) include many of the above, but also include a category for infant issues like low birth weight and failure to thrive.
If you have a condition that is not listed on the Adult or Child Listings, your condition may still qualify as a medically determinable impairment. If your doctor told you that you have a condition that prevents you from working, you may still apply for benefits and use the listing that most closely matches your condition to describe your limitations.
How To Prove You Have An Impairment
You must do more than report to the SSA that you have a condition that is as severe as one described in the Child or Adult Listings. You must prove that it is medically determinable. That means you must provide evidence of your impairment through reliable medical opinions and verifiable medical tests.
Reliable medical opinions must from medically licensed service providers. Most doctors, psychologists, and psychiatrists have the appropriate medical licenses to provide opinions to the SSA. However, massage therapists, chiropractors, acupuncturists, yoga instructors, physical trainers, and sports medicine caregiver do not usually have the training and education to obtain a medical license. Thus, their records and notes hold little weight with the SSA. The best source of information about your impairment is a licensed physician with a specialist certification, such as a podiatrist or optometrist.
Opinions and records provided by licensed physicians must contain verifiable medical evidence from tests and evaluations. A description of your symptoms as told by you is not enough. Acceptable tests include clinical and laboratory tests, such as MRIs, CAT scans, blood screens, and biopsies. Evaluations, such as mental exams performed by licensed psychologists or psychiatrists, are also acceptable.
In addition to providing the appropriate type of medical evidence from an acceptable provider, you must also include medical evidence from the onset of your disability through the current date. The SSA will want to see medical documentation of all treatments and prescriptions over time to show that you are unable to work on a sustained basis. You must show that your condition is ongoing and severe.
A Social Security Disability Representative Can Help
The SSA will deny your claim for benefits if you do not prove that you have a medically determinable impairment that is severe enough to prevent you from working and is expected to last at least one year or result in death. You can improve your chances of approval by providing the necessary medical documentation from an acceptable licensed provider to show that your impairment is disabling.
A knowledgeable Clayton Social Security disability representative can help you gather the appropriate information and submit it to the SSA. Contact Adams & Associates Disability, Inc. today at (888) 551-1190.