These are the rules SSDI uses to evaluate disabilities. This is
the Listings of Impairments referred to in: What Parkinsonians
Should Know About Social Security Disability Insurance Item#
3665 in the archives. Part 1 covers the basic rules and
Neurological disorders. Part 2 covers Mental disorders.
PART II EVIDENTIARY REQUIREMENTS
Medical Evidence
Under both the title II and title XVI programs, medical evidence
is the cornerstone for the determination of disability.
Each person who files a disability claim is responsible for
providing medical evidence showing that he or she has an
Impairment(s) and how severe the impairment(s) is. However, SSA
will help claimants get medical reports from their own medical
sources when the claimants gives SSA permission to do so. This
medical evidence generally comes from sources who have treated
or evaluated the claimant for his or her impairment(s).
Acceptable Medical Sources
Documentation of the existence of a claimant's impairment must
come from medical professionals defined by SSA's regulation as
"acceptable medical sources." Once the existence of an
impairment is established, all the medical and nonmedical
evidence is considered in assessing impairment severity.
"Acceptable medical sources" generally include licensed
physicians (including licensed osteopaths), licensed or
certified psychologists, and licensed optometrists (for
measurement of visual acuity and visual fields). Social Security
also requests copies of medical evidence from hospitals,
clinics, or other health facilities where a claimant has been
treated. All medical reports received are considered during the
disability determination process.
Medical Evidence From Treating Sources
Currently. many disability claims are decided on the basis of
medical evidence from treating sources. SSA regulations place
special emphasis on evidence from treating sources because they
are likely to be the medical professionals most able to provide
a detailed, longitudinal picture of the claimant's impairments
and may bring a unique perspective to the medical evidence that
cannot be obtained from the medical findings alone or from
reports of individual examinations or brief hospitalizations.
Therefore, timely, accurate, and adequate medical reports from
treating sources accelerate the processing of the claim because
they can greatly reduce or eliminate the need for additional
medical evidence to complete the claim.
Other Evidence
Information from other sources may also help show the extent to
which a person's impairment(s) affects his or her ability to
function. Other sources include public and private social
welfare agencies, non-medical sources such as teachers, day care
providers, social workers and employers, and other practitioners
such as naturopaths, chiropractors, audiologists, and speech and
language pathologists.
Medical Reports
Physicians, psychologists, and other health professionals are
frequently asked by SSA to submit reports about an individual's
impairment. Therefore, it is important to know what evidence SSA
needs. Medical reports should include:
* medical history;
* clinical findings (such as the results of physical or mental status
examinations);
* laboratory findings (such as blood pressure, x-rays);
* diagnosis;
* treatment prescribed with response and prognosis;
* a statement providing an opinion about what the claimant can still do
despite his or her impairment(s), based on the medical source's on
the above factors. This statement should describe, but is not limited to
the individual's ability to perform work-related activities, such as
sitting, standing, walking, lifting, carrying, handling objects,
hearing ,speaking and traveling. In cases involving mental impairments,
it should describe the individual's ability to understand, to carry out
and remember instructions, and to respond appropriately to supervision,
coworkers, and work pressures in a work setting. For a child, the
statement should describe the child's ability to function independently,
appropriately, and effectively in an age-appropriate manner in the
domains and behaviors appropriate for the child's age.
Consultative Examinations
If the evidence provided by the claimant's own medical sources
is inadequate to determine if he or she is disabled, additional
medical information may be sought by recontacting the treating
source for additional information or clarification by arranging
for a CE. The treating source is the preferred source for a CE
if he or she is qualified, equipped, and willing to perform the
examination for the authorized fee. Even if only a supplemental
test is required, the treating source is ordinarily the
preferred source for this service. However, SSA's rules provide
for using an independent source (other than the treating source)
for a diagnostic study if:
* the treating source prefers not to perform these examination;
* the treating source does not have the equipment to provide the
specific data needed;
* there are conflicts or inconsistencies in the file that cannot be
resolved by going back to the treating source;
* the claimant prefers another source and has a good reason for doing so;
* prior experience indicates that the treating source may not be a
productive source.
Consultative Examination Report Content
A complete CE is one which involves all the elements of a
standard examination in the applicable medical specialty. When
the report of a complete consultative examination is involved,
the report should include the following elements:
* the claimant's major or chief complaint(s);
* a detailed description, within the area of specialty of the
examination, of the history of the major complaint(s);
* a description, and disposition, of pertinent "positive"
and "negative" detailed findings based on the history,
examination, and laboratory tests related to the major
complaint(s), and any other abnormalities or lack
thereof reported or found during examination or
laboratory testing;
* the results of laboratory and other tests (e.g., X-ray
s) performed according to the requirements stated in the
Listing of Impairments (see Part III);
* the diagnosis and prognosis for the claimant's impairment(s);
* a statement about what the claimant can still do despite
his or her impairment(s), unless the claim is based on
statutory blindness. This statement should describe the
opinion of the consulting physician or psychologist
about the claimant's ability, despite his or her
impairment(s), to do work-related activities such as
sitting, standing, walking, lifting carrying, handling
objects, hearing, speaking, and traveling; and, in cases of
mental impairment(s), the opinion of the physician or
psychologist about the individual's ability to
understand, to carry out and remember instructions, and to
respond appropriately to supervision, coworkers, and work
pressures in a work setting; and
* the consultative physician or psychologist will
consider, and provide some explanation or comment on, the
claimant's major complaint(s) and any other
abnormalities found during the history and examination or
reported from the laboratory tests. The history,
examination, evaluation or laboratory test results, and the
conclusions will represent the information provided by the
physician or psychologist who signs the report.
Evidence Relating to Symptoms
In developing evidence of the effects of symptoms, such as pain,
shortness of breath, or fatigue, on a claimant's ability to
function, SSA investigates all avenues presented that relate to
the complaints. These include information provided by treating
and other sources regarding:
* the claimant's dally activities;
* the location, duration, frequency, and intensity of the
pain or other symptom;
* precipitating and aggravating factors;
* the type, dosage, effectiveness, and side effects of any medication;
* treatments, other than medications, for the relief of pain or other
symptoms;
* any measures the claimant uses or has used to relieve pain or other
symptoms; and
* other factors concerning the claimant's functional limitations due
to pain or other symptoms.
In assessing the claimant's pain or other symptoms, the
decisionmaker(s) must give full consideration to all of the
above-mentioned factors. It is important that medical sources
address these factors in the reports they provide.
PART III LISTING OF IMPAIRMENTS
The Listing of Impairments describes, for each major body
system, impairments which are considered severe enough to
prevent a person from doing any gainful activity, (or in the
case of children under age 18 applying for SSI, are comparable
in severity to an impairment that would preclude an adult from
engaging in any gainful activity). Most of the listed
impairments are or expected to result in death, or a specific
statement of duration is made. For all others, the evidence must
show that the impairment has lasted or is expected to last for a
continuous period of at least 12 months. The criteria in Listing
of Impairments are applicable to evaluation of claims for
disability benefits or payments under both the Social Security
disability insurance and SSI.
Part A of the Listing of Impairments contains medical criteria
that apply to adults age 18 and over. The medical criteria in
part A may also be applied in evaluating impairments in persons
under age 18 if the disease processes have similar effect on
adults and younger persons.
Part B contains additional medical criteria that apply only to
the evaluation of impairments of persons under age 18. Certain
criteria in part A do not give appropriate consideration to the
particular effects of the disease processes in childhood, i.e.,
when the disease process is generally found only in children or
when the disease process differs in its effect on children and
adults. Additional criteria are included in part B, and the
impairment categories are, to the extent possible, numbered to
maintain a relationship with their counterparts in part A. In
evaluating disability for a person under age 18, part B will be
used first. If the medical criteria in part B do not apply, then
the medical criteria in part A will he used.
The criteria in the Listing of Impairments apply only to one
step of the multi-step sequential evaluation process. At that
step, the presence of an impairment that meets the criteria in
the Listing of Impairments (or that is of equal severity) is
usually sufficient to establish that an individual who is not
working is disabled. However, the absence of a listing-level
impairment does not mean the individual is not disabled. Rather,
It merely requires the adjudicator to move on to the next step
of the process and apply other rules in order to resolve the
issue of disability.
11.01 Category Of Impairments, Neurological
11.02 Epilepsy - major motor seizures (grand mal or
psychomotor), documented by EEG and by detailed description of a
typical seizure pattern, including all associated phenomena;
occurring more frequently than once a month, in spite of at
least 3 months of prescribed treatment. With:
A. Daytime episodes (loss of Consciousness and convulsive
seizures) or
B. Nocturnal episodes manifesting residuals which interfere
significantly with activity during the day.
11.03 Epilepsy - Minor motor seizures (petit mal or
psychomotor), documented by EEG and by detailed description of a
typical seizure pattern including all associated phenomena;
occurring more frequently than once weekly in spite of at least
3 months of prescribed treatment. With alteration of awareness
or loss of consciousness and transient postictal manifestations
of unconventional behavior or significant interference with
activity during the day.
11.04 Central nervous system vascular accident. With one of the
following more than 3 months post-vascular accident:
A. Sensory or motor aphasia resulting in ineffective speech or
communication; or
B. Significant and persistent disorganization of motor function
in two extremities, resulting in sustained disturbance of gross
and dexterous movements, or gait and station (see 11.00C).
11.05 Brain tumors
A. Malignant gliomas (astrocytoma - grades III and IV,
glioblastoma muitiforme), medulloblastoma, ependymoblastoma, or
primary sarcoma; or
B. Astrocytoma (grades I and II), meningioma, pituitary tumors,
oligodendroglioma, ependymoma, clivus chordoma, and benign
tumors, Evaluate under 11.02, 11.03, 11.04A, or B, or 12.02.
11.06 Parkinsonian syndrome. With the following signs:
Significant rigidity, bradykinesia, or tremor in two
extremities, which, singly or in combination, result in
sustained disturbance of gross and dexterous movements, or gait
and station.
11.07 Cerebral palsy. With:
A. IQ of 70 or less; or
B. Abnormal behavior patterns, such as destructiveness or
emotional instability; or
C. Significant interference in communication due to speech,
hearing, or visual defect; or
D. Disorganization of motor function as described in 11.04B.
11.08 Spinal cord or nerve root lesions, due to any cause with
disorganization of motor function as described in 11.04B.
11.09 Multiple sclerosis. With:
A. Disorganization of motor function as described in 11.04B; or
B. Visual or mental impairment as described under the criteria
in 2.02, 2.03, 2.04, or 12.02; or
C. Significant, reproducible fatigue of motor function with
substantial muscle weakness on repetitive activity, demonstrated
on physical examination, resulting from neurological dysfunction
in areas of the central nervous system known to be
pathologically involved by the multiple sclerosis process.
11.10 Amyotrophic lateral sclerosis. With:
A. Significant bulbar signs: or
B. Disorganization of motor function as described in 1l.04B.
11.11 Anterior poliomyelitis. With:
A. Persistent difficulty with swallowing or breathing; or
B. Unintelligible speech; or
C. Disorganization of motor function as described in 11.04B.
11.12 Myasthenia gravis. With:
A. Significant difficulty with speaking, swallowing, or
breathing while on prescribed therapy; or
B. Significant motor weakness of muscles of extremities on
repetitive activity against resistance while on prescribed
therapy.
11.13 Muscular dystrophy with disorganization of motor function
as described in 11.04B.
11.14 Peripheral neuropathies. With disorganization of motor
function as described in 11.04B, in spite of prescribed
treatment.
11.15 Tabes dorsalis. With:
A. Tabetic crises occurring more frequently than once monthly; or
B. Unsteady, broad-based or ataxic gait causing significant
restriction of mobility substantiated by appropriate posterior
column signs.
11.16 Subacute combined cord degeneration (pernicious anemia)
with disorganization of motor function as described in 11.04B or
11.15B, not significantly improved by prescribed treatment.
11.17 Degenerative disease not listed elsewhere, such as
Huntington's chorea, Friedreich's ataxia, and spino-cerebellar
degeneration. With:
A. Disorganization of motor function as described in 11.04B or
11.15B;
B. Chronic brain syndrome. Evaluate under 12.02.
11.18 Cerebral trauma:
Evaluate under the provisions of 11.02,11.03,11.04, and 12.02,
as applicable.
11.19 Syringomyelia. With:
A. Significant bulbar signs; or
B. Disorganization of motor function as described in 11.04B.
John Cottingham "The parkinsn list brings Knowledge, Comfort,
Hope, and Friendship to the parkinsonian world."
[log in to unmask]
