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Medical Equivalence

At step three of the sequential evaluation process, the adjudicator must determine whether the claimant's diagnosable medical impairments meet or equal a Listing of Impairments. The Listing of Impairments describes the medical criteria for each body system considered severe enough to prevent an individual from doing any gainful activity. Essentially, the listings are a "short-cut" to getting on disability. Examples of medical diagnoses that meet the Listing of Impairments would include small cell carcinoma of the lungs (Listing 13.14B), amputation of both hands (Listing 1.05A), or an aortic aneurysm with uncontrolled dissection (Listing 4.10). Approximately 25-30% of all disabled beneficiaries meet the level of severity for listings.

Even if a listing is not met, an adjudicator may still deem that a claimant's medical impairment(s) equal a listing. This means that the severity of a claimant's impairment or impairments are of equivalent severity to the criteria described in the Listing of Impairments. While many experienced administrative law judges have stated that medical equivalency is not easy to determine, Social Security Administration has issued a new ruling which offers guidance in finding medical equivalency to the listings. The recent ruling, SSR 17-2p, replaces the language in SSR 96-6p in determining what weight to attach to medical opinions.

To make a finding of equivalence, SSR 17-2p directs the adjudicator to articulate how the record establishes medical equivalency based on a preponderance of the evidence. To assist in evaluating this issue, the adjudicator may request testimony from a medical expert. However, the adjudicator cannot rely on a conclusory statement from the medical expert. Rather, the medical expert must also identify evidence in the medical record to support his or her opinion. SSR 17-2p also points out that the opinion of the medical expert is not binding, and reminds adjudicators at the hearing level that it is their responsibility to determine whether the impairment(s) meet or medically equal a listing.


https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

https://www.ssa.gov/policy/docs/statcomps/di_asr/2011/sect04.html

https://www.ssa.gov/OP_Home/rulings/di/01/SSR2017-02-di-01.html

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In Minnesota, we handle Social Security Disability Insurance (SSDI) claims. Throughout the nation, we handle SSDI applications and appeals for people from Ohio to Kansas, North Dakota to Texas and everywhere in between.

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