UNDERSTANDING SSA’S LISTING OF IMPAIRMENTS
WHAT IS SSA’S LISTING OF IMPAIRMENTS?
The Listing of Impairments is a list of medical conditions that the Social Security Administration (SSA) uses to determine whether or not you have a severe medical condition. If the medical condition is severe and you prevents you from working for 12 months or more, then you should be paid SSD benefits. The Listing of Impairments has two sections: one for adults (Part A) and one for children (Part B). Each part is further divided into specific body systems and medical conditions.
In order to win SSDI and SSI benefits, you must have a medical condition that meets all of the elements found in the Listing of Impairments. Sometimes, the listing is also called the “Blue Book.”
The SSA reviews your medical records and compares your symptoms to those in the listing. If you have all of the symptoms and elements on the listing, then you “meet” the listing. Meeting the listing is difficult to do. But, if your medical condition does meet the listing, then you will be paid SSDI and SSI benefits.
It is also possible to “equal” the listing and win benefits. In order for the SSA to find that you have a medical condition that is equal to a listing, your medical symptoms must be equal in severity and duration to a medical condition on SSA’s list. To understand this idea, think of not having all of the symptoms you need to meet a listing, but perhaps you have two severe medical conditions. Those two conditions, when combined, can “equal” the severity of one listing.
WHAT DOES THE LISTING OF IMPAIRMENTS INCLUDE?
The Listing of Impairments includes both physical and mental conditions that prevent you from working. The Listing is divided into 14 major body systems. Within each system, the listing contains a number of conditions that impact specific parts of the body. For example, the Listing includes medical conditions such as asthma, hearing loss, anxiety, and OCD.
It’s important to know that not all medical conditions are listed in the Blue Book. In cases where your medical condition does not meet a specific listing, the SSA will assess whether your condition prevents you from working. They will also consider whether your medical condition will last for at least 12 months or result in death. They will consider medical evidence, work history, education, skills, and other factors. You can learn more about what the SSA considers by reading about the Medical Vocational Guidelines.
Also, even if you do not meet or equal a listing, your can still be paid benefits through the SSA’s residual functional capacity (RFC) assessment. The SSA uses your RFC to determine your ability to perform work activities despite the symptoms of your medical condition.
TWO FORMS OF SOCIAL SECURITY BENEFITS
There are two forms of benefits for which you can file an application: Social Security Disability benefits and Supplemental Security Income benefits. You can file an application online at the Social Security’s website. Below, you can find an explanation as to each type of benefit you can apply for:
SSDI benefits are for those who have worked and can no longer work at any job due to a medical condition. The amount of money you will receive from SSDI benefits every month is based on how much Social Security tax you have paid during your work history. To qualify for SSDI, you must have earned enough “work credits” to qualify. A work credit is an amount of taxable income. You can earn up to 4 work credits per year. The amount of work credits you will need will depend on how old you are when you apply. If you haven’t earned enough work credits for your age at the time you apply, you will only qualify for Supplemental Security Income benefits.
SSI is a needs based benefit and it is for those people with little to no income, such as children and the elderly. Anyone who makes more than a certain amount of money per month cannot receive SSI benefits. The SSA counts the income of those in your house, not just your income and assets. If you have a spouse who earns more than $4000 a month, for example, then that income will prevent you from getting SSI benefits. You cannot qualify for SSI benefits, no matter how severe your medical condition, if you do not meet the income and asset rules for SSI.
HOW DOES THE SSA USE THE LISTING OF IMPAIRMENTS ?
When you apply for SSD benefits, the SSA will review your medical records and compare it to the listing. To meet the listing, your medical condition must be one of those on SSA’s list. Your condition can also equal a listing, but it will still require that you document severe ongoing symptoms. In addition to having a severe medical condition, your condition must also meet the duration rule.
This means your medical condition must last 12 months or longer or result in death. If you condition will results in death, then you must submit a letter from your treating doctor that states you condition will result in death. Your medical conditions may meet the listing, but the SSA might still deny you benefits if you have not yet met the duration rule.
EXAMPLE OF SSA’S 12 MONTH RULE
For a good example of how the duration rule can prevent an award of benefits, read this example. This writer has seen a judge deny benefits to a woman who had cancer, even though her medical record stated she had severe symptoms for two years. During the first two years of her illness, she couldn’t work, but doctors also did not confirm she had cancer. Instead, the doctors said her symptoms were similar to a form of cancer. When the doctors finally stated she had cancer (after two years of treating her symptoms), she was just a few months away from her hearing with the judge.
At the hearing, this writer argued that her cancer met the listing. The judge stated that her cancer diagnosis had only occurred a few months prior to the hearing, because it took doctors two years to finally state she had cancer. Therefore, he said, she had not had cancer for 12 months, only a few months. Because she did not meet the 12 month rule, he denied the case.
The judge believed that because she had no firm cancer diagnosis during her first two years of symptoms, she could not “meet” the cancer listing. He also refused to consider that she might “equal” a listing, because she did not have “cancer” until the doctors said she did. Therefore, because she only had cancer for a few months, he refused to award benefits.
The judge denied her benefits using the 12 month duration rule. On appeal, we won the case. But, a narrow reading of the rules is a common problem any client will face. Without an attorney, it is very difficult to win benefits.
MAKE THE LISTING OF IMPAIRMENTS WORK FOR YOU
The hard part of winning benefits is that the burden of proof is on you. Therefore, you must prove with medical evidence that you have the symptoms on the list. For example, if you have depression, then you must prove you meet 12.04 from the listing of impairments.
Using medical records, first, you must show you have the symptoms under Part A. Second, you must also show your symptoms are so severe that they also meet the rules under Part B and/or Part C. You can learn more about how the Part B mental rules win benefits. There are times where proving Part C is easier than proving Part B. This is particularly true if you are living in a “highly structured setting.” Learn more about the importance of medical evidence in proving your case for benefits.
For example, if you live in a state mental hospital that also provides treatment, then you live in a highly controlled setting. If leaving that setting would make your mental symptoms worse, then you probably meet the Part C rules.
Another important aspect of winning SSD benefits, is that the benefits also help your family members. For example, if you have a child under the age of 18, then they get benefits too. Likewise, if you win benefits such as SSD, after a 24 month waiting period you can get Medicare benefits. Learn more about Medicare benefits here.
If you receive SSI benefits, you will also receive Medicaid benefits. These benefits are a form of health insurance and they help pay for mental health treatment. The goal is to use your health insurance to seek treatment. Then, hopefully, you will recover and be able to return to work
WHAT WE DO TO HELP YOU WIN SSD BENEFITS
You do not need to try to win SSD benefits by yourself. We can help file your SSD application. Also, we can help you appeal every SSA denial and prove you have an illness on the Listing of Impairments. For example, our attorneys and staff can:
- Send you the paperwork you need to become our client
- Help you file your application for SSD and SSI benefits
- Inform the SSA they should pay your benefits under the Compassionate Allowance Rules
- Request an appeal if you receive a denial from DDS
- Help you confirm your free SSA doctor exam
- Request a Hearing with an Administrative Law Judge (ALJ)
- Prepare you to testify at your ALJ hearing
- Represent you at your hearing and question the expert witnesses.
- Read more about the job expert here
- Learn more about medical expert testimony here
- Request review of an SSA decision with the Appeals Council
- Request review of an Appeals Council denial in Federal Court
If you file your application for benefits online at Social Security’s website, then you have 6 months to complete the application. Try not to take that long to finish it. Once you submit your application online, the SSA sends you an application summary in the mail. You must sign the summary and mail it back. If you need help to file your application, we will help you.
IS IT WORTH THE ATTORNEY FEE TO HIRE AN SSD LAWYER?
It isn’t easy to get Social Security benefits and the application process can be frustrating for most people. But, having an attorney throughout the appeal process can make it easier. It is our belief that when you have a law firm with experience handling your Social Security case, the SSA makes sure that they follow their own procedures.
Additionally, when you have an attorney, 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 attorney with the proper experience raises your chances of winning your SSDI and SSI benefits by 30%. It is also smart to hire an attorney to help you at your hearing. After all, you are the star witness at your hearing. If you hire an attorney with experience, they can prepare you to testify. An attorney will know what type of questions the judge will ask. They will also know the information you need to include in your testimony to convince the judge you should be paid benefits. Learn more about how to prepare for your hearing here.
WHAT WILL IT COST YOU IF YOU DON’T HIRE THE RIGHT LAWYER?
What will it cost you if you don’t hire a lawyer with the legal experience to win your case? If you win your benefits, you will be paid monthly benefits for the rest of your life. For example, if you win benefits at 50 years old, then you will be paid monthly for the next 17 years. You may also win two of years of past due benefits. That means 19 years of payments to the average 50 year old.
Nineteen years is is 228 months. At $1200 a month (which is a lower than average benefit amount), that is $273,600. Additionally, you will win a higher retirement benefit after the age of 67. Let’s say the average higher retirement benefit is $300 a month and you live to be 90 years old. That is another $82,800.
It costs 25% of your back benefit OR $7200 from your back benefit to pay your attorney. You pay whatever is less and only if you win. Let’s pretend you pay the maximum fee of $7200. If you win your case, then your attorney has just won you $356,400, plus early Medicare benefits. You attorney will be paid $7200 and you will be paid $349,200.
All attorneys charge the same amount. So, you can go it alone and not hire an attorney, but chances are you will lose $356,400. Or, you can hire an attorney with no experience and still pay $7200. Finally, you can hire an attorney with over 30 years of experience and still pay $7200 and win $349,200. The choice is yours. But, we hope you can see that the cost of a lawyer with 30 years of experience is “worth it.”
HOW WILL YOU PAY THE ATTORNEY FEE?
We will use our legal skills to help you through the Social Security appeal process. It is our goal to win your case and prove you have an illness on SSA’s listing of impairments. But, it also our goal to make the appeal process easier for you.
We offer a free review of your case. If you call, there is no pressure to become our client. You ask questions, we answer. Even if we don’t accept your case, we will still try to help you.
It also doesn’t cost you any upfront money to hire us. Why? Because we work for free until we win your case. This means you only pay us an attorney fee if we win your case. If we win, then the SSA pays us out of your back benefits. Learn more about past due benefits here. If you do not win, you do not pay an attorney fee.
How much is the attorney fee? The attorney fee is 25% of your back benefit with a cap of $7200. You will pay whatever is the lessor amount. This is best understood through an example. If your back benefit is $10,000, then your attorney fee would be $2500. Which is 25%
However, if your back benefit is $100,000, you would not pay 25% or $25,000 in attorney fees. Instead, you would pay the amount of the fee cap. Therefore, if you win your case, then your fee is capped at $7200.
If we win your case, then you pay whatever is less between 25% of your back benefit and the fee cap. Additionally, you only owe an attorney fee if we win your case. Find out more here about what it will cost.
OUR EXPERT ATTORNEYS & LEGAL STAFF
If you need help winning your SSDI benefits, you have found the right law firm. You can learn more about the attorneys and staff at our law firm on our About Us page.
For example, you may want to know that Dianna Cannon has been helping her clients win Social Security cases for over thirty years. Additionally, Brett Bunkall and Andria Summers have also won thousands of SSDI and SSI cases.
In the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. Our experts can help you file for SSI benefits using the SSA’s website. However, we will still need your help to apply for SSI benefits. Because only you know your personal financial information. SSI benefits require you to have minimal assets and monthly income. You will need to report those items on your application.
Likewise, if you need an appeal, we can help you do that too. There are also many forms that will need to be filled out. Don’t worry. If you have questions about these forms, we will answer them. Likewise, we can help you fill out the forms. You can learn more about SSA’s appeal forms here. Call us today for help winning your SSD benefits.
SEEK THE LEGAL HELP OF OUR EXPERTS
It is not unusual for one person to have two or three types of medical conditions that prevent them from working. However, no matter what condition you have, you must provide the medical evidence proving it. If you have an attorney with experience, they can help you collect medical records and present your case.
Under SSA’s rules, each mental condition has its own listing. To meet a listing, the SSA considers only the elements under that specific listing. If you meet the listing, then you should be paid benefits. Equalling the listing, however, allows the SSA to consider the combination of all of your severe conditions, including physical conditions. But, if you equal the listing, you should also be paid benefits.
Even if you don’t meet or equal a listing, you can still win SSDI and SSI benefits. However, it will be more difficult to prove that you cannot work at any job, unless you hire an attorney. Your attorney can collect the evidence you need to prove to the SSA that you cannot work.
Hire us. We know how to prove to the SSA that you should be paid benefits. Our legal team prepares you for success. During your case, we collect your medical records. All you have to do is get treatment from your doctor. Medical records from your doctor prove you deserve benefits. Medical records prove the case, whether you have a physical or mental condition that prevents you from working.
We know you need benefits to replace your income. Over the past 30 years, we have won over 20,000 SSDI and SSI cases. We want to win your case too. Contact us today for your free review of your case. Let us help you win SSDI and SSI benefits under SSA’s listing of impairments.