Disability applicants frequently have multiple health issues that prevent them from working full time that, when considered on their own, are not serious enough to win a disability claim. When a claimant (applicant) has multiple impairments, however, the Social Security Administration (SSA) is required to consider the combined effect of all of the claimant’s impairments on his or her ability to do work-related activities.
To win your claim for disability, you must prove to the SSA that you suffer from a severe impairment that prevents you from doing substantial work. Some disability claimants have illnesses that qualify them for automatic approval because they are "listed" impairments; most do not. (To learn how you can combine impairments to meet or equal a listing, read our article on combining multiple disabilities to meet a listing.)
If your illness does not meet or equal the requirements of one of Social Security's impairment listings, you must then prove that your medical condition prevents you from doing your past work and any other work in the country. This article will discuss combining medical conditions to show that you can't work (and are eligible for a medical-vocational allowance).
The SSA defines a “severe” impairment as one that significantly limits a person’s ability to perform at least one work-related activity such as:
A “not severe” impairment is one that has no more than a minimal impact on a person’s ability to do work-related activities.
If the SSA has determined that you have multiple severe impairments, the agency will prepare an RFC (residual functional capacity assessment) to see how those impairments impact your ability to do work-related activities. The SSA will consider only limitations that stem from your impairments and that are documented in your medical record. This is why it's important to provide the SSA with as much medical evidence as you can. For more information, see our section on RFCs.
For example, in one case, a 55-year-old claimant with a high school education suffered from carpal tunnel syndrome in her left hand. Her past work was as a sorter. The SSA classified her past job as unskilled, light work (based on how long it took to learn her job and because she was required to stand throughout the day). Although she had surgery, her grip strength and ability to finger and feel with the affected hand was greatly diminished. The SSA determined that this non-exertional impairment was severe, but did not meet (or equal) a listing.
The claimant also had a right hip replacement that permanently affected her ability to walk more than a block without pain or to stand more than 20 minutes at a time. Additionally, the claimant had to use a cane in her right hand to help her walk. The SSA also determined that this was a severe impairment, but that it did not meet a listing.
Despite this, the SSA found that in light of the combination of her severe impairments, she had only the residual functional capacity to do a sedentary job. This job restriction, when considered along with her age, education, and past work experience, meant that under the SSA’s grid rules, the claimant was disabled. (Read our article on how a restriction to light or sedentary work can help you win a medical-vocational allowance.)
In order to qualify for disability, your illness must last, or be expected to last, 12 consecutive months; otherwise you will be denied. If you have two related impairments that when combined, are severe, the SSA will consider them together to decide if you meet 12-month durational requirement. Conversely, if one of the impairments is expected to improve, or in fact does improve in twelve months, and the remaining impairment is not severe by itself, the SSA will find that you don’t meet the durational requirements.
If the SSA determines that you have both severe and not severe impairments, the agency will next consider how these impairments, when combined, affect your ability to work. Again, the SSA will use an RFC that considers all of your symptoms to make this assessment.
For example, another 55-year old claimant, a commercial fisherman, filed for disability based on COPD (chronic obstructive pulmonary disease), a bulging disk, and rheumatoid arthritis in his hands and wrists. The SSA determined that the COPD was a severe impairment, but that it did not meet or equal a listing. And based on the documented medical evidence, the SSA determined that the arthritis and bulging disk were not severe impairments.
However, when the SSA prepared the claimant’s RFC, it found that the combined effects of the arthritis and bulging disk significant impacted the claimant's ability to lift and carry, and therefore were severe. Additionally, the COPD limited his ability to stand and walk to no more than a few hours a day. In light of these restrictions, the SSA determined that the claimant could perform only sedentary work. At the disability hearing, the VE (vocational expert) testified that the claimant could no longer do his prior job as fisherman, and although his past work was semi-skilled, there were no transferable skills that he could use in another job. Accordingly, under the SSA’s grid rules, he was found disabled under a medical-vocational allowance.
Many disability applicants apply for disability because of a physical impairment and in addition have moderate depression or anxiety. The SSA has to consider how these non-severe mental health issues affect your ability to work. For more information, see our article on disability and moderate depression and anxiety.
The mere existence of an impairment is not enough for the SSA to decide it is severe, and your claim will be denied if the SSA decides that your impairment, or combination of impairments, is not severe.
To prove you have a severe impairment, you must provide objective medical evidence that shows that the impairment significantly impacts your ability to do work-related activities. Even if the SSA decides that all of your impairments are not severe on their own, it must still consider them as a whole to see how they affect your ability to work. To do this, the SSA will again prepare an RFC using your medical records.
For example, a claimant suffered from chronic fatigue syndrome, fibromyalgia, anemia, and mild depression. The SSA decided that in light of the objective medical evidence, the impairments were, individually, not severe. This is because the claimant was using a combination of medication, physical therapy, and psychotherapy to manage the symptoms. However, the SSA further found that the claimant experienced the following documented symptoms stemming from her impairments:
The SSA concluded the combination of these symptoms had more than a minimal impact on her ability to perform work-related activities and were, therefore, severe.
Just because the SSA determines that your impairment, or combination of impairments, is severe does not necessarily mean you will win your claim. The finding that you have a severe impairment is only the second step in a five-step process. After finding your combination of impairments is severe, the SSA must decide whether it meets or equals a listing or causes limitations too great for you to work your past job or do other work. For more information, see our section on on how medical disability is decided.
The most important thing you can do is let the SSA know about all of your impairments when you first apply for disability. Remember your case is decided almost exclusively on your existing medical records. Make sure to describe your symptoms in detail, the treatment you receive, and how the symptoms affect your day-to-day life. Also, be sure to provide the SSA with your complete medical history, including the names of your treating doctors, any facilities where you have been hospitalized or treated, a complete list of medications, copies of any diagnostic tests, and a description of what treatments you have tried and whether they were effective.
While you are not required to hire an attorney to appeal a disability denial, winning your claim based on a combination of impairments can be difficult. If you decide to have a consultation with a lawyer before going to your hearing, you can use our website to locate a disability attorney in your area.