People frequently wonder whether they can get Social Security Disability benefits based on a certain diagnosis. The answer is that disability is based on the severity of the condition, rather than on a particular diagnosis. Almost any medical or psychiatric condition (or combination of conditions) could be the basis for a disability claim, but disability is only awarded when the condition reaches a certain level of severity. Diagnosis is only the starting point in the analysis.
A good example of this is arthritis. A Doctor once told me that everyone over age 50 has arthritis – there is always some wear and tear on the joints. If the symptoms are mild, causing only occasional stiffness or mild pain, it isn’t disabling. A different person with arthritis might be bedridden as a result of severe symptoms. The point at which disability is found is somewhere in between these two extremes.
What is considered when making Social Security Disability decisions
When making disability determinations, the Social Security Administration looks at three sources of information:
1. The medical signs and symptoms. This information is obtained from medical records, reports written by your physician, or physicians examining you for Social Security. There is a list of impairments which are sufficiently severe to qualify as a disability based on the medical information alone.
2. The claimant’s “residual functional capacity” – what he or she can do, during a normal workday, despite their impairments. This can be described in various ways, for example: “can lift or carry no more than 20 pounds occasionally, or 10 pounds regularly”, or “should avoid occupations requiring more than occasional contact with members of the public.” Social Security will consider medical opinions, as well as other evidence, such as testimony from a claimant or other persons, when making this decision.
3. The claimant’s age, education, and previous work history. This is particularly important for persons over the age of 50; as we get older, they make different assumptions about your ability to be retrained for sedentary of light duty work, if your past work was more strenuous.
The Social Security Disability Process
In Pennsylvania, the initial disability decision is made by a state agency. After that decision, a hearing can be requested, which is held before a Social Security Administrative Law Judge. If a claimant is denied at that level, an appeal can be filed, to the Social Security Appeals Council, and then to federal court.