Limitations & Social Security's Disability Criteria

What Functional Limitations Does Social Security Consider?

Physical Limitations		Mental Limitations	Environ- mental Limitations
Sitting	Crawling	Concen- tration	Weather Exposure
Standing	Reaching	Memory	Extreme Heat & Cold
Walking	Handling	Under- standing	Wetness & Humidity
Lifting	Fingering (Fine Mani- pulation)	Maintaining School Pace & Schedule	Noise Level
Climbing	Feeling	Maintaining Work Pace & Schedule	Vibration
Balancing	Talking & Hearing	Responding To Change	Proximity To Moving Parts
Stooping	Tasting & Smelling	Public Interaction	Electric Shock Exposure
Kneeling	Near & Far Acuity	Teacher & Student Interaction	Heights & Explosive Exposure
Crouching	Color & Field Vision	Supervisor & Co-Worker Interaction	Radiation & Chemical Exposure

Adults: What Functional Limitations Are Needed To Prove Disability

Disability Criteria Summary

Your medical condition will produce symptoms. Your symptoms will produce limitations. Your limitations will determine whether you satisfy Social Security's adult disability criteria.

An adult can receive both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) disability benefits. Social Security's Adult Disability Criteria for both types of benefits is the 5-Step Disability Evaluation Process. A summary is as follows:

1. Step 1 - You are not engaging in substantial gainful activity (SGA) and you meet the Durational Requirement (DR),
2. Step 2 - Your medical condition is severe,
3. Step 3 - You satisfy a listing,
4. Step 4 - You cannot perform your past relevant work (PRW), and
5. Step 5 - You cannot perform other work.

You satisfy the disability criteria as follows:

1. You satisfy Steps 1, 2, and 3;
2. You satisfy Steps 1, 2, 4, and 5; or
3. You satisfy one of two very rare special disability profiles.

Limitations And Satisfying Step 2

Step 2 is easily met. If your medical condition and limitations more than minimally affect your work abilities, you meet this Step.

Limitations And Satisfying Step 3 - The Listings

There is a listing for every medical condition. Every listing requires you suffer very specific limitations. We discuss the listing for each medical condition on that condition's specific page. You will need to compare your limitations to the limitations required in the listing.

Limitations And Satisfying Steps 4 & 5

General. There are two ways you can satisfy Steps 4 and 5: 1) you have catastrophic limitations that eliminate all work, or 2) you can have specific non-catastrophic limitations that preclude you from doing your past relevant work (Step 4) and other work (Step 5).

Catastrophic Limitations. If your physical and mental medical conditions and symptoms cause catastrophic limitations, you will have a less-than-sedentary residual functional capacity (RFC). If you have a less-than-sedentary RFC, you cannot perform any work. If you cannot perform any work, you obviously cannot do your past relevant work (satisfying Step 4) or other work (satisfying Step 5), and you are disabled. Alleging disability with catastrophic limitations is very, very common; most claimants make this argument.

There are six catastrophic physical and mental limitations:

1. Lie Down. You must lie down, recline, or elevate your lower extremities at least four to five hours a day plus eight hours when you sleep for a total of about 12-13 hours (Social Security will find you cannot perform even full-time, 8-hour-a-day, sedentary work);
2. Off-Task. You will be off-task from your work duties at least 15-20% of the workday (Social Security generally finds that this rate of disruption will cause any employer to fire you);
3. Absenteeism. You will be absent from work at least two to three days per month (Social Security generally finds that this rate of absenteeism will cause any employer to fire you);
4. Other People. You are unable to successfully interact with other co-workers on even an occasional (1/3 of the time) superficial (very casual) basis (Social Security finds that occasional superficial supervisor interaction is needed for any job);
5. Upper Extremity Use. Your bilateral upper extremity ability to reach, handle, and perform fine manipulation is limited to 10-20% of the workday (Social Security generally finds any job requires upper extremity use at least this much);
6. Vision. You are blind - 20/200 vision or a 10% visual field or worse.

Non-Catastrophic Limitations - Step 4. If you do not have catastrophic limitations, you must show you suffer non-catastrophic limitations that eliminate your past work. In this review, it is difficult to evaluate which non-catastrophic limitations you must suffer to prove you cannot do your past work because there are 10,000+ different jobs in America. Therefore, at Step 4, you will need to do two things. First, show how your limitations prevent you from performing each of your past relevant work jobs - actually performed. This is usually easy to do because if you could do your past work, you would be doing it. Second, look up each of your past relevant work jobs in the Dictionary of Occupational Titles and Selected Characteristics of Occupations (federal sources of all work in this country) and see how others do the jobs nationwide - generally performed. Then show how your limitations prevent you from performing each of your past relevant work jobs as generally performed. Though this is a lot of work, the good news is that most claimants satisfy Step 4.

Non-Catastrophic Limitations - Step 5. If you do not have catastrophic limitations, you must show you suffer non-catastrophic limitations that eliminate other work. Social Security uses Grid Rules to determine what other work you must show you cannot do to be found disabled at Step 5. The Grid Rules are primarily based on your physical abilities - whether you can perform sedentary, light, and medium exertional level work (you cannot be found disabled if you can perform more than medium exertional level work). Sedentary work is primarily done sitting and handling up to 10 pounds. Light work is primarily done standing and walking and handling up to 20 pounds. Medium work is primarily done standing and walking and handling up to 50 pounds. Therefore, if you have limitations that keep you from standing and walking, you are limited to sedentary work. If you have limitations that keep you from handling over 20 pounds, you are limited to light work. And if you cannot handle over 50 pounds, you are limited to medium work. The Grid Rules are secondarily based on a combination of five other factors: age, education, work skills, proficiency in English, and your mental health limitations. Because of these other factors, which other work you must show you cannot perform is specific to you.

Step 5 Under Age 50 Grid Rule. At Step 5, if you are under age 50 and you suffer non-catastrophic limitations, only one Grid Rule can apply to you:

1. You are 45-49, limited to sedentary work, illiterate or unable to communicate in English, and you have unskilled or no past work experience - Rule 201.17.

Step 5 Over Age 50 Grid Rules. At Step 5, if you are over age 50 and you suffer non-catastrophic limitations, there are 16 ways you can prove you cannot do other work (you are disabled). In Social Security terms, there are sixteen grid rules that "direct a finding of disability." Review the Grid Rules below. If the factors of any specific Grid Rule applies to you, you will be found disabled.

* A word about skills. The Grid Rules only direct a finding of disability if you cannot do semi-skilled or skilled work - that is, you are limited to unskilled work. You can be limited to unskilled work if you 1) do not have work skills at that particular exertional level (e.g. you are a skilled as a welder at the medium exertional level, but you have no skills at the sedentary level); or 2) you suffer cognitive deficits that preclude performing semi-skilled or skilled work tasks.

Factors - Age, Education, Work	Grid Rule
Sedentary Exertion
Age 50-54, H.S. grad. or more not providing entry into skilled work, and no transferrable skills to other work.	201.14
Age 50-54, H.S. grad. or more not providing entry into skilled work, and no past relevant work or only unskilled past work.	201.12
Age 50-54, 7th to 11th-grade education or less, and no transferrable skills to other work.	201.10
Age 50-54, 7th to 11th-grade education or less, and no past relevant work or only unskilled past work.	201.09
Age 55+, H.S. grad. or more not providing entry into skilled work, and no transferrable skills to other work.	201.06
Age 55+, H.S. grad. or more not providing entry into skilled work, and no past relevant work or only unskilled past work.	201.04
Age 55+, 7th to 11th-grade education or less, and no transferrable skills to other work.	201.02
Age 55+, 7th to 11th-grade education or less, and no past relevant work or only unskilled past work.	201.01
Light Exertion
Age 50-54, illiterate or unable to speak English, and no past relevant work or only unskilled past work.	202.09
Age 55+, H.S. grad. not providing entry into skilled work, and no transferrable skills to other work.	202.06
Age 55+, H.S. grad. or more not providing entry into skilled work, and no past relevant work or only unskilled past work.	202.04
Age 55+, 7th to 11th-grade education or less, and no transferrable skills to other work.	202.02
Age 55+, 7th to 11th-grade education or less, and no past relevant work or only unskilled past work	202.01
Medium Exertion
Age 55+, 7th to 11th-grade education, and no past relevant work.	203.10
Age 60+, 7th to 11th-grade education or less, and no past relevant work.	203.02
Age 60+, 6th-grade education or less, and no past relevant work or only unskilled work.	203.01

Satisfying A Special Disability Profile

If you suffer limitations that allow you to satisfy one of Two Special Disability Profiles, the Adult 5-Step Disability Evaluation Process does not apply to you, and you are disabled. Either theory of disability is very rare.

Children: What Functional Limitations Are Needed To Prove Disability

SSI Disability Criteria

A child can receive only SSI disability benefits based on their own disability. Social Security's SSI Child Disability Criteria is 3-Step Disability Evaluation Process. A summary is as follows:

1. Step 1 - Your child is not engaging in substantial gainful activity (SGA) and they meet the Durational Requirement (DR),
2. Step 2 - Your child's medical condition is severe, and
3. Step 3 - Your child satisfies a listing in one of five ways:
• The listing criteria is met exactly - your child meets a listing;
• Your child's medical criteria does not meet the listing criteria exactly, but it is as severe as the listing criteria - your child equals a listing;
• Your child functionally equals a listing by having a marked degree of limitation in two domains of functioning;
• Your child functionally equals a listing by having an extreme degree of limitation in one domain of functioning; or
• Your child functionally equals a listing by satisfying one of five functionally equaling examples.

Limitations And Satisfying Step 2

Step 2 is easy to meet. If your child's medical condition and limitations causes more than minimal effect on their functional limitations, your child meets this Step.

Limitations At Step 3 - The Listings

Meeting Or Equaling A Listing. Social Security has written a listing for every medical impairment. Meeting or equaling a listing means satisfying the language and requirements of a particular listing. Each listing requires that your child has specific medical criteria and specific limitations. We review the listing for each medical impairment on that impairment's individual page. You will need to read the specific listing, and compare your child's limitations to the limitations required in the listing.

Functioning Equally A Listing. Your child can also functionally equal a listing. Although Social Security uses the language, "listing," this criteria is not about satisfying the actual language and requirements of any particular listing. It is instead an evaluation of your child according to six Domains of Functioning:

1. Acquiring And Using Information,
2. Attending And Completing Tasks,
3. Interacting And Relating With Others,
4. Moving About And Manipulating Objects,
5. Caring For Yourself, and
6. Health And Physical Well-Being.

Your child will functionally equal a listing if they have two marked or one extreme degree of limitation in the six Domains of Functioning. Unfortunately, Social Security's official definitions of "marked" and "extreme" are vague, and a reading of both leaves most to wonder what the definitions really mean. Below is my opinion of how Social Security practically defines and evaluates "marked" and "extreme" limitations when deciding child disability cases. Social Security will assess your child's functioning in relation to the functioning of same age children without impairments; that is, your child's ability to perform age-appropriate activities in an age-appropriate manner.

Limitation	Marked Severity	Severe Severity
Your child must recline, lie down, or be bedridden.	About 6 hours per day	More than 6 hours per day
Your child is unable to leave the house.	About 20-25% of the time	More than 25% of the time
Your child cannot attend school and do homework due to medical treatment or symptoms.	About 20-25% of the time	More than 25% of the time
Your child is off-task more than about 25% of the time due to symptoms.	About 20-25% of the time	More than 25% of the time
Your child is unable to sustain pushing, pulling, reaching, grasping, and fingering (fine manipulation).	About 20-25% of the time	More than 25% of the time
Your child is unable to appropriately interact with others (initiating interactions, responding to others, avoidant or withdrawn behavior, anxiety, irritability, or aggression).	About 20-25% of the time	More than 25% of the time
Your child's standardized test scores (which represent their ability to concentrate, learn, and remember) below the mean and their functioning is consistent with the scores (it usually is).	2 deviations below the mean	3 deviations below the mean
*Your child satisfies the sixth domain of functioning with "episodes of illness or exacerbations" (even though Social Security states it only "may" find your child disabled).	Yes	Yes
**Your child satisfies one of five Functionally Equaling Examples.	Yes	Yes

*For the Health And Physical Well-Being Domain of Functioning only, Social Security states is may also consider your child to have a marked or extreme limitation if your child has documented (medical records proving it) episodes of illness or exacerbations that occur on an average of three times a year each lasting two weeks or more, or your child's episodes of illness or exacerbations are equally severe occurring more often but lasting a shorter duration or occurring less often but lasting a longer duration.

**Social Security will find your child has a marked or extreme degree of limitation if they satisfy one of five Functionally Equaling Examples. However, satisfying any of the five examples is very difficult because these examples are actually quite extreme:

1. "Any condition that is disabling at the time of onset, requiring continuing surgical management within 12 months after onset as a life-saving measure or for salvage or restoration of function, and such major function is not restored or is not expected to be restored within 12 months after onset of this condition."
2. Ambulation (walking) is possible only with the help of both arms.
3. Inability to function independently outside the home.
4. Medical supervision 24-hours-a-day.
5. "Major congenital organ dysfunction which could be expected to result in death within the first year of life without surgical correction, and the impairment is expected to be disabling (because of residual impairment following surgery, or the recovery time required, or both) until attainment of 1 year of age."

Assistive Devices

How An Assistive Device Affects Your Disability Case

General. If you suffer a limitation, you may need an assistive device to assist your functioning. The use of an assistive devices can have a significant impact on your Social Security disability SSDI or SSI case. The most common assistive devices include the following:

• Prosthetic device,
• Wheelchair,
• Walker,
• Crutches,
• Cane - four-point,
• Cane - single point,
• Back brace,
• Neck brace,
• Knee brace,
• Arm/hand brace,
• Ankle or foot brace,
• Orthopedic shoes,
• Oxygen tank,
• Hearing aids,
• Glasses/magnifiers,
• Shower chair,
• Shower bar, and
• Ramps.

An assistive device is relevant to your Social Security disability case in two ways. First, Social Security will generally find that the use of an assistive device (whether used in the workplace, school, or home) means your condition is more severe than if you do not need an assistive device. Second, Social Security will examine your use of the assistive device (to be used in the workplace for adults or in general for children) and determine whether it helps or limits your functioning. Assistive devices may help your functioning, limit your functioning, or most commonly, simultaneously do both. For example, if you use a wrist brace, it may alleviate some of your pain, but it may also limit some of your flexibility. Also for example, if you use a cane, it will help you stand and walk, but it will also limit the use of your hand (the one that holds the cane).

Children. If you are a child, you must show your assistive device causes you to meet or equal a listing - this is difficult. You can also show your assistive device affects you in one of the six domains of functioning - this is easier. The need for an assistive device will directly apply to four domains:

1. Attending and completing tasks,
2. Moving about and manipulating objects,
3. Caring for yourself, and
4. Health and physical well-being.

Adult. If you are an adult under age 50, you must show you cannot perform any work of any kind anywhere in America to meet Social Security's disability criteria. The easiest jobs in America are unskilled sedentary (sit-down) jobs. Hence, generally the use of an assistive device is helpful in your disability case only if it prevents you from sitting, using your hands, or using your vision - the primary three physical requirements of sedentary work.

If you are over 50, the disability evaluation process is more complicated, but generally, you must show you cannot do your past relevant work or other work. As discussed above, work is done at the sedentary, light, medium, heavy, or very heavy exertional level. If Social Security determines either your past relevant work (Step 4) or your other work (Step 5) is at the sedentary exertional level, you will need to prove to Social Security that your assistive device affects your ability to sit, use your upper extremities, or see. If Social Security determines either your past relevant work or other work is at a light, medium, heavy, or very heavy exertional level (all require you to stand or walk most of the day and handle heavy weight), you will to need to prove to Social Security that your assistive device affects your ability to be on your feet or handle weight.

Let's look at two over-age-50 examples. You are 53, your past relevant work is as an electrician, and you need a cane as a result of your medical condition. In this example, Social Security will commonly find you can no longer perform your past relevant work because the job requires you to regularly be on your feet, and the use of your cane hinders your ability to successfully work on your feet throughout the day (Step 4). Social Security will also find that you do not have transferable skills to other work because the skill set of an electrician is very narrow (Step 5). Therefore, Social Security will find you disabled. Let's take another example. You are 52, your past relevant work is as a hospital nurse, and you need a cane as a result of your medical condition. In this example, Social Security will commonly find you can no longer perform your past relevant work as a hospital nurse, but you can use, or transfer, your nursing skills to the job of an advice nurse which is a sedentary job wherein you do not need to be on your feet, and hence the use of the cane, by itself, will not prevent you from performing this job; you will be denied benefits.

Listings. Assistive devices are directly related to the following listings:

1. Musculoskeletal Listings - Adult 1.00 & Child 101.00 [orthopedic conditions such as foot, ankle, knee, hip, back, neck), amputation, bone fractures, and soft tissue conditions (e.g. skin conditions, and burns)];
2. Neurological Disorders - Adult 11.00 & Child 111.00; and
3. Immune System Disorder - Adult 14.00 & Child 114.00.

Prescription Vs. Getting An Assistive Device On Your Own

A Prescription Is Best. It is a super big deal to Social Security whether your doctor determines you need an assistive device or whether you get it yourself. The issue is this: is the device medically necessary? If your doctor determines you need an assistive device, it is an indication to Social Security that your doctor feels the device is medically necessary. If you get an assistive device on your own, it is unclear to Social Security if it is medically necessary. In other words, Social Security, as nearly always, finds your doctor more credible than you about medical issues - including your own abilities, limitations, symptoms, and need for an assistive device.

Written Evidence. If your doctor believes that an assistive device is necessary, it must be in writing. Written evidence from your doctor of your need for an assistive device usually takes four forms: 1) your doctor notes the need for a device in your medical records, 2) your doctor refers you to an office or group in your healthcare system to obtain the device, 3) your doctor writes an actual prescription, of 4) your doctor writes you a note or letter that you need the device. If your doctor noted your need for a device in your medical records, Social Security will read it when it reviews your medical records. If the doctor wrote a prescription, made a referral, or wrote you a note, those may nor may not be in your medical records - probably not.

If your prescription is not in your medical records, or your doctor feels you need a device, but hasn't written it down anywhere, you will need to get your doctor to write a Doctor Statement that you need the device. The statement can be very simple. It should contain at least three statements: 1) the doctor is your treating provider, 2) the reason why you need an assistive device, and 3) the date you began needing the device.