What does it mean to be "Disabled under [the SSA] rule?

Government entities create their own realities, governed by the rules that each has put into place.  When I first studied the IRS rules on reporting income, I was surprised to read that the IRS expects people to report and pay tax on income generated through illegal activities, such as selling drugs or stolen property.  In my mind, the word for emphasis in the previous sentence should be “illegal”, but in the collective mind of the IRS and “according to their rules”, the word for emphasis is “income”.  According to the IRS, “earned income” includes all compensation that a person receives from work that s/he performs, regardless of the legality of that work.

The Social Security Administration, likewise, determines the reality of “disability”.  According to the SSA, an adult, defined as anyone 18 years old or older, is “disabled under [their] rules, they first ask if the applicant is performing “Substantial Gainful Activity”, defined as earning $1,690/month or more before tax and in the absence of special conditions (2026).  The focus on the capacity to earn income in Step One sets the tone for the entire 5-step sequential evaluation of eligibility.  The applicant’s impairment or combination of impairments will be analyzed always in the context of the effect on the applicant’s capacity to work.  Therefore, in the second step, the SSA then asks if the applicant’s impairments are “severe”.  An impairment is “severe” if it significantly limits the person’s capacity to perform basic employment-related functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling; seeing, hearing, and speaking;  understanding, carrying out, and remembering simple instructions; using plain judgment; responding appropriately to supervision, co-workers and usual work situations; and dealing with changes in a routine-work setting.

The SSA will determine that an impairment is “severe” if it “meets or equals” one of the so-called “Adult Listing of Impairments” entries.  The Adult Listing is a catalogue of many disabling conditions grouped under categories.  Many conditions or diagnoses have the required symptoms or indicators organized in lettered subgroups, with instructions that an applicant’s presentation must include certain elements from each subgroup.  For example, to qualify as “disabled under [their] rules” by a Traumatic Brain Injury (TBI), the applicant’s impairments must be:

…characterized by A or B:

A. Disorganization of motor function in two extremities (see 11.00D1), resulting in an extreme limitation (see 11.00D2) in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities, persisting for at least 3 consecutive months after the injury.

OR

B. Marked limitation in physical functioning, and in one of the following areas of mental functioning, persisting for at least 3 consecutive months after the injury:

1.        Understanding, remembering, or applying information; or

2.        Interacting with others; or

3.        Concentrating, persisting, or maintaining pace; or

4.        Adapting or managing oneself.

To qualify as “disabled” due to Autism Spectrum Disorder, the applicant’s impairment must be:

…satisfied by A and B:

A.       Medical documentation of both of the following:

1.        Qualitative deficits in verbal communication, nonverbal communication, and social interaction; and

2.        Significantly restricted, repetitive patterns of behavior, interests, or activities.

AND

B.       Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:

1.        Understand, remember, or apply information.

2.        Interact with others.

3.        Concentrate, persist, or maintain pace.

4.        Adapt or manage oneself.

The four “areas of mental functioning” in both paragraphs “B” correspond to a certain of the activities that the SSA has determined are essential to the capacity to work.  Within some categories, one subgroup of symptoms or presentation may be common to all impairments catalogued under that category.  TBI falls under the category of Neurological Disorders.  Autism falls under the category of Mental Disorders.  Most impairments catalogued under either of those two categories carry the requirement that the applicant demonstrates significant limitations in those four areas of “mental functioning” that appear in the above two paragraphs “B”. 

Analogously, many of the impairments catalogued under Musculoskeletal Disorders require that the applicant demonstrates one or more of the following:

1. A documented medical need for a walker, bilateral canes, or bilateral crutches or a wheeled and seated mobility device involving the use of both hands; or

2. An inability to use one upper extremity to independently initiate, sustain, and complete work-related activities involving fine and gross movements, and a documented medical need for a one-handed, hand-held assistive device (see 1.00C6d) that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand; or

3. An inability to use both upper extremities to the extent that neither can be used to independently initiate, sustain, and complete work-related activities involving fine and gross movements.

The limitations described in paragraphs 1-3 above correspond to certain of the physical activities that the SSA has determined are essential to work. 

Subgroups of symptoms, which overlap throughout all or most of the impairments within a category, can be useful for two situations.  The first is a situation of comorbidity in which an applicant has more than one diagnosis and the presenting symptoms may be attributable to any or all.  For example, if an applicant is diagnosed with autism, intellectual disability, and depression, it is not necessary to attribute a “marked” limitation in understanding, remembering, or applying information to any particular diagnosis, since the SSA considers this limitation as a characteristic of all three.  An applicant with severe arthritis might have required reconstructive surgery of a major weight-bearing joint and the fact that the applicant must use a mobility aid may be attributable to either or both of those causes.

Commonality of criteria across categories of impairments can also provide a useful guide when the applicant’s diagnosis is not specifically “listed”.  For example, Fragile X syndrome is not a specific Adult Listing.  However, people with Fragile X typically experience limitations with at least some of the 4 mental functions listed under Autism, Intellectual Disability and other Mental Disorders.  An applicant having documentation of those limitations can then consider whether her/his other documented characteristics most closely “equal” the other diagnoses catalogued under Mental Disorders.  Fibromyalgia is not specifically “listed”, but the pain and fatigue caused by the condition may generate functional limitations that “equal” those described under the category of Musculoskeletal Disorders. 

As a person with a disability, you live your own reality.  The key to working with Social Security is to express how your reality impacts your capacity to work using the language and criteria that the SSA has established as the “rules”.