SSA Provides New Guidance On Obesity As A Disabling Impairment With Social Security Ruling 19-2p
The SSA issued Social Security Ruling 19-2p this year, rescinding and replacing SSR 02-1p, that was previously used to evaluate obesity as a disabling impairment. SSR 19-2p states that “obesity,” when established by objective medical evidence (signs, laboratory findings, or both) from an acceptable medical source (AMS), is a medically determinable impairment (MDI). People with obesity have a higher risk for other impairments, and the effects of obesity combined with other impairments can be greater than the effects of each of the impairments considered separately. Obesity, by itself, is not a listed impairment; however, the functional limitations caused by the MDI of obesity, either alone or in combination with another impairments, may medically equal a listing. Obesity in combination with another impairments may or may not increase the severity or functional limitations of the other impairment(s). The SSA will evaluate each case based on the information in the case record.
The new ruling states that obesity is a complex disorder characterized by an excessive amount of body fat, and is generally the result of many factors including environment, family history and genetics, metabolism, and behavior. Health care practitioners diagnose obesity based on a person’s medical history, physical examinations, and body mass index (BMI). For adults, BMI is a person’s weight in kilograms divided by the square of his or her height in meters (kg/m ). People with obesity weigh more than what is considered the healthy weight for their height. In the medical community, obesity is defined as a BMI of 30.0 or higher. No specific weight or BMI establishes obesity as a severe impairment within the disability program.
Health care practitioners may take a waist measurement to help diagnose obesity. If a person’s BMI is within the normal range, he or she may still have obesity if his or her waist measurement is high. People who store more fat around their waist rather than their hips may have a greater risk of obesity-related complications. The risk increases for a waist size greater than 35 inches for women and greater than 40 inches for men.
The new ruling states that obesity is often associated with musculoskeletal, respiratory, cardiovascular, and endocrine disorders. Obesity also increases the risk of developing impairments including:
- Type II diabetes mellitus;
- Diseases of the heart and blood vessels (for example, high blood pressure, atherosclerosis, heart attacks, and stroke);
- Respiratory impairments (for example, sleep apnea, asthma, and obesity hypoventilation syndrome);
- Mental impairments (for example, depression); and
- Cancers of the esophagus, pancreas, colon, rectum, kidney, endometrium, ovaries, gallbladder, breast, or liver.
The fact that obesity increases the risk for developing other impairments does not mean that people with obesity necessarily have any of these impairments. It means that they are at greater than average risk for developing other impairments.
When the SSA evaluates the severity of obesity, they consider all evidence from all sources. They consider all symptoms, such as fatigue or pain that could limit functioning. They consider any functional limitations in the person’s ability to do basic work activities resulting from obesity and from any other physical or mental impairments. If the person’s obesity, alone or in combination with another impairments, significantly limits her physical or mental ability to do basic work activities, they will find that the impairment is severe. They will find the impairment is “not severe” if it does not significantly limit the person’s physical or mental ability to do basic work activities.
No specific weight or BMI establishes obesity as a “severe” or “not severe” impairment. Similarly, a medical source’s descriptive terms for levels of obesity, such as “severe,” “extreme,” or “morbid,” do not establish whether obesity is a severe impairment for disability program purposes. The SSA will do an individualized assessment of the effect of obesity on a person’s functioning when deciding whether the impairment is severe.
Obesity is not a listed impairment; however, the functional limitations caused by the MDI of obesity, alone or in combination with another impairments may medically equal a listing. For example, obesity may increase the severity of a coexisting or related impairments to the extent that the combination of impairments medically equals a listing.
The SSA will consider whether a person may have limitations in any of the exertional functions, which are sitting, standing, walking, lifting, carrying, pushing, and pulling. A person may have limitations in the nonexertional functions of climbing, balancing, stooping, kneeling, crouching, and crawling. Obesity increases stress on weight-bearing joints and may contribute to limitation of the range of motion of the skeletal spine and extremities. Obesity may also affect a person’s ability to manipulate objects, if there is adipose (fatty) tissue in the hands and fingers, or the ability to tolerate extreme heat, humidity, or hazards.
The SSA will assess the RFC to show the effect obesity has upon the person’s ability to perform routine movement and necessary physical activity within the work environment. In cases involving obesity, fatigue may affect the person’s physical and mental ability to sustain work activity. This may be particularly true in cases involving obesity and sleep apnea. The combined effects of obesity with another impairment(s) may be greater than the effects of each of the impairments considered separately. For example, someone who has obesity and arthritis affecting a weight-bearing joint may have more pain and functional limitations than the person would have due to the arthritis alone. The SSA will consider all work-related physical and mental limitations, whether due to a person’s obesity, other impairments, or combination of impairments.
The new SSR on obesity is applicable on May 20, 2019. If your struggle with obesity, remember that it is part of your physical make-up and if it restricts your ability to function, the ALJ must consider whether obesity impacts your ability to work, along with other disabling impairments. If you have questions about this issue, call us at Cannon Disability Law.