My last blog entry discussed the first issue in determining whether a claimant qualifies for Social Security disability; whether they are engaged in substantial gainful activity. Once Social Security determines you are not engaged in substantial gainful activity, the next issue to be analyzed is whether you suffer from a severe medical impairment. A severe medical impairment is a diagnosed medical condition that substantially limits your ability to work and has lasted or can be expected to last at least 12 months or result in death.
First, it is important to understand a severe medical impairment must be diagnosed. Therefore, it is important to analyze what medical evidence exists to establish a severe medical impairment. If there is inadequate medical evidence, Social Security will send you for a consultative examination with an expert hired by Social Security to provide an opinion on your condition. Although sometimes we are able to win cases using consultative examination’s as evidence, generally it is not good for your case if the only medical evidence is a consultative examination. It is also important to realize that your impairment must be a diagnosed medical condition. Unfortunately, people often suffer from mental illness or autoimmune disorders or neurological or other physical conditions for a long time before their doctors are able to determine exactly what illness is causing their symptoms. Without a diagnosed condition, it is extremely difficult to qualify for Social Security disability.
If you have been diagnosed with a physical or mental illness, it is not difficult to meet this requirement of qualifying for disability benefits. However, it must be proven that your condition has lasted or is expected to last at least 12 months or result in death. I have represented many people in Tallahassee and the surrounding areas who have been denied Social Security disability benefits after being involved in very serious accidents. It is hard for them to understand how Social Security could deny their application when they have spent weeks in the hospital and are under restrictions from working based on their doctors orders. Often times, these denials are made by Social Security under the assumption (rightly or wrongly) that it is too early to determine whether the condition will last 12 months. Many clients meet with me in my Tallahassee office shocked because they have been denied despite a cancer diagnosis. These clients are often unable to work while undergoing various treatments, but they are denied because their oncologists believe that after a course of treatment that will last 6 to 9 months, they “should” be able to return to work. Although this is true in some cases, it is very upsetting when good people are denied benefits that they are entitled to because of incorrect opinions or prognoses about their recovery. This is one of the many reasons it is important to consult with an attorney early on so any necessary opinions can be developed and provided to Social Security as early as possible.
As discussed above, there are several issues that Social Security disability applicants can run into regarding the first two steps of the regulatory analysis. However, the great majority of claims are not denied because of issues with substantial gainful activity or lack of a severe medical impairment. In my next blog article, I will discuss the third, fourth, and fifth and final steps involved in determining whether a claimant is disabled.