What does Social Security consider a “medically determinable impairment?”

December 7, 2021 in

If you have a serious medical condition that is interfering with your ability to maintain regular work activity, you may be eligible for Social Security Disability Insurance benefits. Social Security Disability Insurance is a federally administered program that pays benefits to those who have worked and paid taxes on their income, and who are unable to engage in substantial gainful activity due to a medical condition that lasts or is expected to last for at least twelve months. Social Security refers to medical conditions as “medically determinable impairments,” and the impairment must be severe.

What exactly is a “severe” impairment, and how do you prove to Social Security that your impairment is in fact severe and prevents you from being able to work? Social Security defines a “severe” impairment as one that affects an individual’s ability to perform basic work-related activities. Social Security follows a two-step process for evaluating an individual’s symptoms. First, Social Security determines whether the person has a “medically determinable impairment” that could reasonably be expected to produce the individual’s alleged symptoms. Second, Social Security will evaluate the intensity and persistence of the individual’s symptoms and determine the extent to which the individual’s symptoms limit his or her ability to perform work-related activities.

When following this two-step process, Social Security relies very heavily on what they refer to as objective medical evidence – the individual’s medical records. Therefore, one of the most important things you need to do to get your Social Security Disability claim approved is to seek treatment from medical providers. You may first start by going to your primary care provider, or PCP. The PCP will refer you to any specialists who are needed to treat your condition. Your PCP may be able to treat some of your conditions themselves, but for certain impairments, it is best to seek care from a specialist. One example is major depressive disorder – although PCPs can prescribe antidepressants, severe depression is best treated by a psychiatrist, who will have the expertise to prescribe a wider variety of medications, as well as greater insight into a wider variety of psychiatric conditions. For the purposes of your disability case, objective medical evidence includes diagnostic testing results as well as clinical observations which your medical provider has made and documented in your medical records. One form of diagnostic testing which is very heavily relied upon is diagnostic imaging. This includes X-rays, CT scans, and MRIs. These are especially critical if your condition is related to musculoskeletal pain. For example, if you are experiencing back pain, you will need to have some type of imaging done to diagnose the cause of your pain, such as an MRI showing spinal stenosis. Another example is reduced strength in your hands. If you have a medical condition that makes it difficult for you to use your hands or manipulate small objects, you will need to have documentation in your medical records of reduced grip strength, reduced sensation (which can be determined through nerve conduction studies), or some other type of objective test performed by your provider. If there are insufficient medical records in your file with limited diagnostic testing or objective medical findings, Social Security will schedule you for a consultative examination. During this examination, you will be examined by a medical doctor who will test your functionality in several areas, such as the ability to bend or squat, the ability to manipulate fine objects, and the ability to perform different types of walking tests. If your disabling conditions are mental health-related, you will be examined by a psychologist who will test various aspects of your mental functioning. The state examiner will report his or her findings to Social Security.

The next step of the process is for Social Security to evaluate the intensity, persistence, and limiting effect of the Claimant’s symptoms to determine the extent to which they should limit the claimant’s work-related activities. Social Security will review the symptoms that you describe to them when completing your application and determine whether the symptoms which you are describing are consistent with the objective evidence noted in the medical records. If Social Security finds you’re your descriptions concerning the intensity, persistence, and limiting effects of the symptoms are not consistent with the medical evidence and other evidence in your record, your case will be denied. Therefore, it is extremely important to maintain regular visits with your medical providers and ensure you are giving your providers information about the symptoms that you are experiencing so that they may be documented in your record. In addition to your doctors’ treatment notes, LaBovick Law Group will send questionnaires for your medical providers to complete. The questionnaires ask your providers to give their opinions on your ability to perform the specific activities that Social Security looks at when evaluating your case. For example, your doctor will estimate on the questionnaire how long he believes you can sit for at one time or in an 8-hour workday, or how long you can stand for at one time or in an 8-hour workday.

Social Security will also review any third-party statements that are submitted on your behalf regarding your functionality. For example, you may choose to have family members who live with you or who help you with household or personal care tasks complete questionnaires regarding your ability to complete certain activities, as well as provide other comments regarding your condition. However, Social Security will not find these statements as persuasive as medical records and comments provided by your medical doctors. Therefore, they can help your case if they are consistent with the information reported in the medical records but will not win your case alone – hence why it is so important to maintain regular contact with your medical providers.

Understanding Social Security’s rules regarding medically determinable impairments can be very challenging. It is best to receive guidance from an attorney who is familiar with Social Security’s regulations and can skillfully use the facts from your medical records to win your case. Give LaBovick Law Group a call at (561) 625-8307 for a free case evaluation.