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Social Security Issues Policy Interpretation Ruling Regarding Rulings on Medical Equivalence Evidence in a Disability Hearing

If you are seeking Social Security Disability in Massachusetts, it helps to understand the process and requirements. In any determination for Social Security Disability, a decision-maker must review and make findings based on the medical evidence presented by the applicant. The Social Security Administration (SSA) recently released a new ruling (SSR 17-2p) on the evidence that is needed by a consultant or adjudicator to find medical equivalence. This Ruling provides insights for consultants, adjudicators, attorneys, and applicants on what must be presented for a successful ruling.

An SSI claim goes through the five-step Sequential Evaluation Process. If disability is determined at any step, the process is considered complete. During the third step of the evaluation, a medical assessment is conducted that looks at whether or not the applicant’s impairment(s) lines up with the ones on the formal Listing of Impairments. Paper workGenerally, the applicant must meet all of the requirements of one of the listings in order to qualify for SSI, but the decision-maker may still find an individual is disabled if her or his impairment medically equals a listed impairment.

The SSA considers an impairment to be medically equivalent if it is equal in severity and duration to the criteria of the listed impairment. Medical equivalence can be found in three ways. The first possible scenario is when an applicant has an impairment that is described but does not exhibit a specific finding in the listing, or meets all of the findings of the listing but not the severity. The second is when the impairment is not described in the listing but provides findings that are similar to one or more of the listed impairments. The findings must be equal to the medical significance of a listed impairment. The third is when an applicant has a combination of impairments, and none of them meets a listing. The SSA allows the decision-maker to compare the findings as a collective to see if it is analogous to listed impairments. Similar to the second scenario, the findings must be equal to the medical significance of a listed impairment.

During the process, several entities may contribute to the medical findings. Initially, Medical and Psychological Consultants determine whether or not the impairment meets or equals a listing. If a hearing is requested, an ALJ, possibly with the help of a medical expert, then makes findings based on the evidence. If the determination is appealed, the Appeals Council (AC) assesses whether or not the evidence supports the prior findings. Both the ALJ and the AC must rely upon all of the evidence previously provided, but neither is bound to make the same determination if the evidence does not support a finding of medical equivalence. At all levels, the findings must be thoroughly noted and accompanied by a rationale to provide other parties with an understanding.

The Listing of Impairments found in the Code of Federal Regulations, Appendix 1 to Subpart P of Part 404, is extremely comprehensive, but it may not cover your exact disability. The SSI review process can become extremely frustrating if your condition does not easily meet the medical criteria set within this list. While the SSA allows for unique circumstances to be considered, strong advocacy can help a consultant or adjudicator see the medical equivalence. A thorough and thoughtful presentation of evidence can make a difference in whether or not SSI is awarded.

The Massachusetts Social Security Disability attorneys at Karsner & Meehan can help you with your claim. Our attorneys have a knowledge and understanding of the review process that can lead you or your loved one to a successful result. Call our office today for a free, confidential consultation at 508.822.6600.

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