Getting Social Security Benefits by Equaling a Disability Listing
Your symptoms make you just as disabled as someone who meets a Social Security disability listing exactly.
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When you have a medical condition that doesn't quite meet the criteria in one of Social Security's disability listings, Social Security might agree that your condition is medically equivalent to a disability listing. In other words, Social Security might find that your symptoms make you just as disabled as someone who does meet the listing. (The Social Security “blue book" lists impairments that, if met, will qualify you for Social Security disability benefits without the need for additional evidence. For more information, go to our section on how Social Security's disability listings work.)
Ways to Equal a Disability Listing
If your impairments are similar to a listing in the Social Security blue book, but they don't meet all of the requirements in the listing, you may be able to receive benefits if your impairment can "equal" the listing. To equal a listing, you must show that your impairment is equivalent in both severity and duration to a disability listing for a similar impairment. Social Security will allow you to equal a listing in one of three situations:
- You have a listed impairment, but your condition does not meet one or more of the specific criteria in the listing. If you have other medical issues related to the listing that are of equal "medical value" as the requirements in the listing, your condition can equal the listing.
- You have an impairment that does not have a listing, but your impairments are very similar to those outlined in one of the disability listings. If your impairments are medically equal to the impairments found in the similar listing, your condition can be found equal to the listing.
- You have a combination of impairments, but none of them meet a disability listing individually. Social Security will look at listings that are very similar to your impairments, and if the combined effect of your impairments is medically equal to the impairments found in the similar listing, you will be found to equal the listing. (This situation is discussed in detail in our article on multiple disabilities.)
A similar theory for meeting the definition of disabled, which applies to children only, is functionally equalling the listings.
Evidence Required to Show You Equal a Listing
You or your disability lawyer needs to propose a theory to the Social Security Administration as to how and why you equal a specific listing. In addition, you'll need to provide the supporting medical evidence to back up your theory. The best way to provide this evidence is with your doctor's help.
If your treating doctor's opinion is that your symptoms make you just as limited as someone who meets a particular listing, Social Security must give your doctor's opinion substantial weight. In fact, it is difficult to equal a listing without having your treating doctor explain in detail why your condition equals a specific listing and provide medical evidence to back up this assertion. In a written opinion, your doctor should demonstrate how the functional limitations caused by your symptoms equal the functional limitations you would have if you matched a listing exactly.
Examples of Impairments That Have Equaled a Listing
Below are some examples of impairments that did and did not equal a listing.
- An individual with schizoaffective disorder applied for disability benefits with mood swings and some symptoms of psychosis. He was denied. In his appeal brief, his lawyer stated that his client's schizoaffective equals either the disability listing for schizophrenic, paranoid, or other psychotic disorders or the listing for affective disorders. While Social Security found that the individual’s schizoaffective disorder was a severe impairment, the agency found that the effects of the disorder on the applicant's daily function, social functioning, and the ability to timely and attentively complete tasks was not at a "marked" level. (At least one of these abilities must be severely affected to qualify under either of these listings.) The individual was able to cook meals, do housework, drive, and take care of all personal needs. Socially, the individual was able to get along with family and friends and responded well to supervision. And the individual suffered only moderate difficulties completing tasks. Therefore, the applicant's limitations were not at a level necessary to equal the listing. Additionally, the individual did not suffer from episodes of decompensation, an alternate way to meet the requirements of the listing. The judge found that the applicant's schizoaffective disorder did not equal the listing for schizophrenia.
- An individual sought to equal a listing for a musculoskeletal impairment or a listing for a mental impairment based on an array of medical complications stemming from obesity, including liver disease, degenerative disc disease, osteoarthritis, diabetes, pain, fatigue, and depression. Social Security found the obesity did not significantly affect the applicant's daily functioning or ability to work jobs that were less physically demanding. Additionally, the individual failed to note the specific listing that she was trying to equal and thus could not show how her impairment equaled that of a listing. Having a number of impairments is not enough to establish that you equal a listing.
- An individual who suffered regularly from pseudoseizures, which are seizures that are not attributed to any abnormal brain activity and are usually caused by psychological issues, tried to equal the disability listing for epileptic seizures. The pseudoseizures occurred weekly and affected the applicant's ability to function during the day, which is one way to meet the epilepsy listing. Social Security found that the pseudoseizures equaled the epilepsy listing in both severity and duration.
- An individual tried to equal the listing for chronic obstructive pulmonary disease (COPD) since he didn't have the restricted airflow numbers necessary to meet the listing. When the applicant's treating physician was asked if the individuals would meet the listing for COPD, the physician answered no. When asked if the individual’s COPD, combined with a heart condition, would equal the listing, the treating physician could not determine if it did. Without any concrete evidence from a physician stating that the individual’s impairments equal the listing or other unequivocal evidence showing the same, the individual cannot be found to meet the listing.
- An individual with deep vein thrombosis (a blood clot in his leg) tried to equal the listing for chronic venous insufficiency (CVI), but the lack of a particular medical finding was enough to prove that his symptoms were not equal in severity and duration to the CVI listing. For some listings, the specific criteria (in the cases of CVI, brawny edema, non-healing wounds, ulcers, or cellulitis) are required because they are indications of the severity of the impairment. Without meeting those key criteria, the judge found it impossible for the individual to have severe enough impairments to be disabled to the point necessary for Social Security disability benefits.
- An individual with severe vertigo tried to equal the listing for Disturbance of Labyrinthine-Vestibular Function. Even though the applicant didn't have the hearing loss required in the listing, the judge found that the vertigo the individual experienced was so severe that the existence of that impairment alone was enough to equal the listing. In addition, the applicant's treating physician testified that not everyone who suffers from labyrinthine-vestibular disturbances has hearing loss.
- An individual who had some residual effects from a stroke tried to equal the listing for central nervous system vascular accident (CVA). The CVA listing requires severe problems walking, using your hands, or communicating. Social Security found that a diagnosis was not enough without symptoms that were equal in severity to those in the listing. Social Security found that the applicant's mild weakness on the left side and walking with a broad gate were not enough to equal the "disorganization of motor function" requirement of the listing, or alternatively, the applicant's mild difficulty with pronouncing words did not equal the listing's requirement of "ineffective speech or communication."
Your Burden to Prove That You Equal a Listing
As the individual who is trying to get disability benefits, it is up to you to show how your impairments equal a listing. Social Security will not look for listings for your condition to equal. You must include arguments in your brief to the court that you submit before your appeal hearing that explains why and how your impairments are medically equal to a listing in severity and duration.
For example, an individual who had psoriasis that did not meet the listing requirement for dermatitis failed to provide an argument that pointed to specific medical evidence as to how the psoriasis resulted in severe functional limitations. (The dermatitis listing requires extensive skin limitations that severely limit your abilities.) The court came to the conclusion that the applicant's impairments did not equal the listing and, without any counterarguments, that conclusion was the final decision.
If you have multiple impairments that may equal a listing, you must also include in your brief how your other impairments have increased the severity of the impairment to the point that you equal the listing. The combination of impairments must lead to a decrease in your overall ability to function at home, work, and in the community and thus increase the severity of your primary impairment. Chronic pain and fatigue are common conditions that can increase the severity of other impairments; for example, while your skin problem may not meet the requirements for a skin disorder, severe pain can decrease your ability to function and increase the severity of the skin disorder. It is important that your doctor provide detailed reasons as to how your combination of impairments allows you to meet a listing in severity and duration.
Offering Alternative Test Results
You can try to equal a listing by offering the results of alternative tests (tests that differ from those set out in the listing to prove that an individual meets an impairment) to show that you have a required symptom or when there are multiple impairments that together equal a listing. If Social Security denies that you equal a listing, the agency must provide adequate reasons as to why it found your impairment does not equal a listing. This does not mean that an ALJ cannot consider and then discredit alternative tests that were used (for example, a diagnostic test that is not generally accepted by the medical community might not be considered equivalent to a test noted in a listing), just that the ALJ must provide adequate reasons for rejecting your alternative tests.
Getting Help Proving That You Equal a Listing
It is rare for a disability applicant without a lawyer to be able to prove that his or her medical condition equals a disability listing. It can be difficult to figure out which listing you might equal and to write a legal brief setting out proof of each element. A disability attorney, who is familiar with all of Social Security's disability listings, can formulate a theory as to which listing your condition might equal, work with your doctor to see if there is evidence to support this theory, and write a convincing brief setting out his or her theory. To find a local lawyer who can help you, visit our disability lawyer page.