FAQ

If the claimant does not have an impairment that is not described in the Listings, First, SSA will find the Listing (or Listings) that is closely analogous to the claimant’s impairment. SSA will then take the medical findings related to the claimant’s impairment and compare them to those in the closely analogous listed impairment. The claimant will equal the Listing if the medical findings related to his impairment are at least of equal medical significance to those in the closely analogous listed impairment.

Under Social Security regulations, an impairment will be found medically equivalent to a Listed impairment “if the medical findings are at least equal in severity and duration to the Listed impairments.” This is done by comparing the claimant’s symptoms, signs, and lab findings with those specific for the Listed impairment; or if the condition is not Listed, with that Listing most similar to the claimant’s impairment.

Dictionary of Occupational Titles: https://occupationalinfo.org/

The SAMHSA SOAR TA Center recommends that you don’t cite the Listing and Grid numbers, e.g.) Ms. Jones meets Listing 12.04, and the alternative Grid rule 203.03. Rather, at the DDS level (initial and reconsideration) we suggest providing a description of how the applicant meets a particular Listing(s) or Grid rule through specific examples from the medical records, applicant quotes, and other collateral sources.

Yes, you should file a SOAR-assisted application because even if you don’t have access to the medical evidence, DDS will request directly from prior treating sources and/or schedule appropriate Consultative Examinations (CE) to obtain diagnoses. Remember, SSA needs a diagnosis to make a disability determination. Remember, to write in the “Remarks Section” on SSA forms, about your efforts to obtain medical information so that DDS will know what they need to do to medically develop the claim.

If you are working on an appeal, you will want to review the file to see DDS’s RFC which was the basis for denial. DDS officially determines the RFC. DDS’ opinions take the form of RFC assessments, physical, mental, or both. Essentially, the DDS physician reviews the claimant’s medical records, including narrative reports or CEs, and prepares a written opinion. Taking the form of an RFC assessment, the opinion is expressed in terms of the physical and mental limitations that the DDS physician believes accurately describe the claimant’s capability. To find the right Grid rule, determine the claimant’s maximum RFC (and find the correct table). You are looking for the table that fits the claimant’s exertional level (sedentary, light, medium), and find the rule that fits the claimant’s other characteristics, e.g.) age, education, skill level. The specific rule will mandate a conclusion of disabled and not disabled. Remember, for a rule to apply it must be consistent with all the claimant’s characteristics. In no grid rule fits, then all evidence and factors must be considered independent of the Grids.

You shouldn’t worry too much about Step 2. DDS uses this step to weed out frivolous claims. At the second step, SSA considers the medical severity of an individual’ impairment(s), e.g.) health problems. An individual must have a medically determinable physical or mental impairment, (or a combination of impairments) that is severe and meet the duration requirement. To be severe, an impairment or impairments must interfere with basic work-related activities. To meet the duration requirement the impairment(s) must be expected to last twelve months or to result in death. If the impairment(s) are not severe or do not meet the duration requirement, the individual is found not disabled. If the impairment(s) are severe and meet the duration requirement, the adjudicator goes to question three.

Since Fibromyalgia is not a listed impairment, SSA offers guidance for how to evaluate. Here is the link- https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html

You can obtain valuable insight into the reason an applicant was previously denied by reviewing the applicant’s electronic folder, or at minimum, obtaining the “Disability Determination Explanation” or denial notice. Most likely, you will have easy access to the denial notice from the applicant or, if you are the authorized representative, SSA should have mailed a copy to you. You can also request reason for denial by contacting your local SSA office. Learn more at Reviewing Denial Notices.

We recommend contacting the DDS examiner assigned to the case to find out where they are in the decision making process. If they have just been assigned the case and are starting to process it, then you have time to write and submit a Medical Summary Report. You could let the DDS examiner know that you have additional evidence to submit. If you do not have an SSA-1696 on file, the claimant will need to be with you when you call. 

When you log-in to the SOAR website, go to your Profile page.  There, you will see a link to access the Certificate of Completion that was e-mailed to you when you passed the course.