STEP THREE WINS DISABILITY BENEFITS

WHAT IS STEP THREE OF THE SSA REVIEW PROCESS?

Step three is a crucial step in the SSA review process. That is why it is important for you to understand it. Even though the last thing you need to worry about is one more step in the SSA review process that you have never heard of.

At Cannon Disability Law, we know that going through the Social Security review process is challenging. First, you must file an application for benefits on the SSA’s website. Then, you must fill out all of the forms they send you in the mail. Even though the forms seem like the same forms you already completed. Meanwhile, it takes months for the SSA to make a decision about your case. Finally, when they do make a decision, it is almost always a denial of your benefits.

Is there anything you can do to improve your chances of winning benefits?

Yes. There is. You can understand step three of the five step SSA review process.

Step three of the review process is crucial because it’s where the Social Security Administration (SSA) determines whether your medical condition meets or equals a “listing” in their Blue Book. Meeting a listing can result in automatic approval of SSD benefits. This article will break down step three and explain how to meet or equal a listing. If you understand step three, it will improve your chances of approval.

WHAT IS A LISTING?

At step three, the SSA will ask if your medical condition meets or equals an SSA listing. The Blue Book or SSA listing is a list of medical conditions that qualify you for benefits. There are over a hundred specific medical conditions that qualify for SSDI and SSI benefits. You can learn about the physical conditions that qualify for SSD benefits. Also, you can learn about the mental health conditions that qualify for SSD benefits.

To win benefits from the SSA, your physical or mental condition must meet every element of the listing. This is hard to do. However, the main evidence you need to prove you meet a listing is medical evidence.

If you do not meet a listing, then you can still win benefits if your medical condition equals a listing. Think of it as having two conditions that, when combined, are as severe as meeting the listing.

In order to meet or equal a listing, you must prove your medical condition is severe with objective testing and medical records. The SSA will look for consistent, ongoing medical treatment. They will also look to see what your treating doctor has to say about your symptoms. They will determine how your symptoms impact your ability to work. You cannot go to the doctor one or two times and expect to win benefits. You must build a medical record over time by getting treatment from a supportive doctor.

STEP THREE:  DOES YOUR MEDICAL CONDITION MEET A SSA LISTING?

The SSA maintains a list of mental and physical conditions that qualify for SSD benefits. Each listing specifies the medical elements you must meet to qualify for benefits. Additionally, each listing provides a detailed set of elements that include the following:

• Diagnosis of a Medical Condition: Each listing begins by naming the medical condition that it covers. For example, it could be heart disease, cancer, or mental health disorders like anxiety or schizophrenia.
• Severe Condition: The listing states how severe the condition must be to qualify for benefits. This often includes factors like test results (e.g., MRI, X-rays, blood work) or clear medical evidence that confirms your diagnosis.
• Symptoms or Functional Limitations: Meeting a listing requires medical records that document your symptoms. The records should also show how your symptoms affect your daily life and ability to work. For example, a listing may require evidence of pain, fatigue, or cognitive limitations. For physical conditions, this can include problems with standing, walking, or lifting.

OTHER ELEMENTS YOU NEED TO MEET A LISTING UNDER STEP THREE

• Duration: Your medical condition must be expected to last 12 months or result in death. This means the SSA is looking for chronic medical conditions, not a short illness. Also, the SSA will not consider conditions that will resolve or heal within a matter of months.
• Objective Medical Evidence: The SSA requires medical records, including lab tests, imaging, and physical exam results. For instance, if you have a heart condition, there may be requirements for ECG or stress test results showing your heart disease.
• Treatment History: A listing can include a discussion of treatment plans. For example, a listing may include medications, surgeries, or therapy. The SSA evaluates whether the condition persists despite treatment.
• Residual Functional Capacity (RFC): A listing may include information about how your medical condition limits basic activities like walking, sitting, lifting. A mental listing might include mental tasks. For example, it may require you to prove that your concentration, memory, or ability to get along with other is limited. If the condition does not meet the exact elements of the listing, then the SSA looks at how your illness impacts your ability to work.

HOW TO EQUAL A LISTING UNDER STEP THREE

If your condition doesn’t meet a listing, there’s still hope. You may qualify for benefits if your condition “equals” a listing. This happens when your medical condition is as severe as a listing, but doesn’t have every element. However, if your medical illness equals a listing, that means your condition does not match the listing perfectly.

To equal a listing, you need:

1. Comparable Severity: Your condition must be as severe as the medical condition in the listing.
2. Medical Opinion: The medical opinion of your doctor and treating provider can be crucial. They can provide statements that explain how your symptoms and limits are just as severe as those in the listing.
3. Multiple Conditions: Sometimes, a combination of medical conditions equal the severity of one listing. For example, if you have a combination of heart disease and diabetes type 2, then your symptoms may be as severe as someone with an illness that meets a listing.

It is very difficult to prove that you equal a listing. In the past, a judge could decide that the combination of medical conditions was as severe as a listing. That is no longer the case.

HOW THE SSA FINDS THAT YOUR CONDITION EQUALS A LISTING

The SSA states in Social Security Ruling 17-2p that they can find medical equivalence in three ways:

1. If an individual has a medical condition t that is described in the listing, but either:

1. 1. the individual does not exhibit one or more of the findings in the particular listing, or
   2. the individual exhibits all of the findings, but one or more of the findings is not as severe as those in the particular listing, then we will find that his or her condition is equivalent to that listing if there are other findings related to the condition that are at least of equal medical significance to the criteria.

2. If an individual has a medical condition that is not described in the listing, we will compare the findings with those for closest listing. If the findings related to the condition are at least of equal medical significance to those of a listing, we will find that the condition is equivalent to the listing.

3. If an individual has a combination of medical issues, no one of which meets a listing, we will compare the findings with those for a closely related listing. If the findings related to the condition are at least of equal medical significance to those of a listing, then we will find that the combination of conditions is equivalent to that listing.

THE JUDGE MUST CALL A MEDICAL EXPERT TO FIND THAT YOU EQUAL A LISTING

In the past, an SSA judge could award benefits if they found that a combination of medical issues were as severe as a listing. Then, the SSA decided to put a stop to it. They issued a regulation that stated a judge could no longer make a finding of that medical issues equal a listing without the assistance of a medical expert.

Now, for a judge to find that you equal a listing, the judge has to call a medical expert to attend the hearing. The SSA’s internal rules state that a judge must obtain the opinion of a medical expert to find that your physical or mental conditions equal a listing.

This does not mean that the doctor who attends your hearing can examine you. An SSA judge will never ask or permit a medical expert to perform an exam at the hearing. If the judge finds that an exam is necessary because there is not enough evidence about your medical conditions to make a finding, then the judge will request that you attend an exam with a doctor that the SSA’s chooses.

At the hearing, however, the medical expert will review all of your records and can offer an opinion as to whether your medical conditions equal a listing. In complex medical cases, some judges are willing to hire a medical expert. However, in practice, it is rare for a medical expert to appear at the hearing and offer testimony.

YOU NEED MEDICAL EVIDENCE TO MEET OR EQUAL A LISTING 

Once again, you cannot win benefits without medical records. Therefore, if you do not have health insurance, then you need to apply for Medicaid benefits.

However, if you cannot get Medicaid benefits or you cannot afford health insurance, then we have a list of free and low cost health clinics for you. Choose your state and call the free clinic to get medical care:

• CALIFORNIA FREE AND LOW COST CLINICS
• COLORADO FREE AND LOW COST CLINICS
• IDAHO FREE AND LOW COST CLINICS
• NEVADA FREE AND LOW COST HEALTH CLINICS 
• UTAH FREE AND LOW COST HEALTH CLINICS 

When you file for SSD benefits, the SSA will ask your doctor to submit your medical records. As long as your doctor supports your application for SSD benefits, then you should be able to prove you qualify for benefits. However, without medical records you will not have the lab tests, records, imaging, and medical history to prove that you meet or equal a listing. Therefore, medical records are the key to winning SSDI and SSI benefits.

THE SSA CAN SEND YOU TO ONE OF THEIR DOCTORS 

In order to determine if you meet or equal step three, the SSA looks to medical evidence. If you do not have a doctor, it is possible for the SSA to send you one of their doctors. The SSA gives a lot of weight to opinion of their own doctor.

If your treating doctor has a different opinion to that of the SSA doctor, then the judge will take that into account. But it is likely that the SSA will give more weight to the medical opinion of their own doctors. Learn about the SSA doctor exam.

Hiring a lawyer to help you get all of your medical records is a wise choice. The SSA stops getting the medical records in your case after they deny your case for the second time. This means that a year may go by without any collection of your records. Then, your case will be set for a hearing. Learn how to obtain your medical evidence for free.

If you do not have an attorney helping you, then there will be no one getting your medical records during the time you are waiting for a hearing date. However, you must have medical records in order to prove a mental condition or physical condition before a judge.

Additionally, all of those medical records must be in to the judge more than one week prior to your hearing. If you submit medical records later, then the judge does not have to consider them. This is known as the 5 day rule. Learn about the 5 day rule for sending in medical evidence.

WHY STEP THREE IS IMPORTANT FOR YOUR SSD CLAIM

Step three of the disability review process is one of the fastest ways to secure benefits. If the SSA determines that your condition meets or equals a listing, you skip the remaining steps of the evaluation process. Meeting step three means that the review process stops and the SSA pays your benefits.

Here are a few tips to help improve your chances of winning benefits by meeting a listing:

1. Consult Your Doctor: Your doctor should be familiar with the SSA’s Blue Book criteria. Make sure they provide detailed medical records and an opinion that supports your claim.
2. Keep Records: Collect and organize all medical records, including test results, progress notes, and treatment records. These will be critical in proving your condition meets or equals a listing.
3. Work With an Attorney: Navigating the SSA’s complex system can be overwhelming. Our SSD attorneys can help you understand which listing may apply to your case. We can also guide you in gathering the necessary evidence.

In addition to medical testing, it is wise to have a medical opinion from a doctor. Your doctor can review the listing and tell the SSA whether you meet a listing under step three. However, most of the time, no matter what your doctors states, the SSA will claim it is an opinion they do not need to follow. A number of years ago, the SSA published regulations stating that the issue of disability is one that only they can decide.

IS IT WORTH THE ATTORNEY FEE TO HIRE AN SSD LAWYER?

It isn’t easy to get Social Security benefits.  The application process can be frustrating for most people. But, having an attorney during the five step SSA review process can relieve stress. In our experience, when you have a law firm handling your SSD case, the SSA follows their own procedures.

Additionally, when you have an attorney with legal experience, they will have access to Social Security’s decisions throughout the process. They can also submit medical evidence that may be missing from your case.

There is evidence that hiring an expert SSD attorney triples your chances of winning SSD benefits. It is also smart to hire an attorney to represent you at your hearing. After all, you are the star witness at your hearing. If you hire an attorney with experience, then they can prepare you to testify at your hearing. Find out how to prepare for your hearing.

HIRE OUR LAW FIRM TO PROVE YOU MEET STEP THREE

Step three of the disability review process can make or break your case. If your medical condition meets or equals a listing, then it is possible to win your benefits earlier in the review process. Understanding how to meet step three helps you know what medical evidence to submit. Also, knowing how to present within the SSA rules is key to winning monthly SSD payments.

Hire Cannon Disability Law to give you legal advice and walk you through the application process. In the past 30 years, we have won millions of dollars in future and past due SSD benefits.

If you need SSD benefits, then hire an attorney with the legal experience to win. If you don’t win, then you don’t pay an attorney fee. Hiring our law firm triples your chances of winning SSD benefits. For help, contact us.

If you want to learn more about our lawyers and staff, then read About Us. For example, you can learn about Andria Summers. She has spent 23 years working at our law firm. She can help you with your Medicare advantage plan.

Additionally, Dianna Cannon has been helping clients win benefits for over thirty years. Ms. Cannon has years of Federal Court experience. She has also taught law school and written a book on SSDI benefits. Brett Bunkall also has years of legal experience helping people win their SSI and SSDI benefits. We are Social Security law experts.

You can trust us to help you win benefits. We are here to help you every step of the way. If you need assistance with your disability claim, contact us for a free review of your case. We can tell you if your medical condition meets or equals step three.