One way the Social Security Administration (SSA) decides whether you're disabled is to compare your symptoms and limitations against the criteria of a "disability listing." But your medical condition might not fit into the listing exactly. Are you out of luck? No.
When you have a medical condition that doesn't quite meet the criteria of a listing, Social Security might agree that your condition is "medically equivalent" (equal) 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.
When you apply for Social Security disability, if your condition meets the requirements of one of the listed conditions, you'll automatically qualify for benefits. But to meet a listing, your medical condition must be on the list and you must have specific medical evidence that shows your condition matches the requirements of the listed condition in terms of:
For example, if you have ischemic heart disease (coronary artery disease), you'd likely meet the listing requirements if, while receiving treatment:
Fortunately, your condition doesn't have to match a listed impairment exactly for you to receive disability benefits. Social Security can find your condition "medically equivalent" to a listing when you either have a listed condition that doesn't quite meet the requirements or you have a condition that isn't listed. But to equal a listing, you'll need to show that your medical condition is equivalent, in both severity and duration, to the listing for that impairment or a similar impairment. (20 C.F.R. § 404.1526(a).)
For example, if you have frequent seizures, but don't have epilepsy, Social Security would likely find your condition equivalent to the listing for epilepsy if your seizures:
But to prove your condition equals a listing, you'll need medical evidence that backs up your claim.
If you're an adult, Social Security can find that your condition equals a listing in one of three situations:
There's a fourth situation that applies only to children called "functionally equaling the listings" (see below).
Social Security can find that your condition equals a listing when you have a listed impairment, but your condition doesn't meet one or more of the specific criteria in the listing. (20 C.F.R § 404.1526(b)(1).) Perhaps you don't have one or more of the symptoms listed, or you have all the symptoms, but some of them aren't as severe as the listing requires.
If you have other medical findings related to your impairment that are of equal "medical value" as the requirements in the listing, Social Security can find that your condition is medically equivalent to the listing.
You can sometimes equal a listing even when there's no listing for your specific medical condition. (20 C.F.R § 404.1526(b)(2).) If your impairment is very similar to one outlined in the disability listings, Social Security will compare your symptoms and test results with the criteria of the similar listing.
If your medical findings are of equal medical significance to those in the comparable listing, Social Security can find that your impairment equals the listing.
Social Security can determine that you equal a listing when you have multiple impairments, but none of them meet a disability listing individually. (20 C.F.R. § 404.1526(b)(3).) Generally, Social Security must evaluate the combined effect of all your impairments, considering how your impairments interact when reviewing your claim. To equal a listing, the SSA must find that the combined effect of all your impairments is of equal medical significance to those of a listed impairment. (This situation is discussed in detail in our article on multiple disabilities.)
A different theory for meeting the definition of disabled that only applies to children is "functionally equaling the listings." To determine this, Social Security will look at how the child's impairment limits daily activity over six domains of functioning—things like moving and manipulating objects or interacting with others. Learn more about how a child can functionally equal the listings.
You or your disability lawyer will need to explain to Social Security how and why your condition equals a specific listing (called "proposing a theory"). In addition, you'll need to provide supporting medical evidence to back up your theory. Social Security requires medical evidence that does two things:
The best way to provide this evidence is with your doctor's help, especially if your treating doctor believes that your symptoms make you just as limited as someone who meets a particular listing. Social Security should give your doctor's opinion substantial weight, but only if it's backed up by medical evidence and consistent with information from other doctors or sources.
It's 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, such as:
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.
Here are some examples of medical conditions that Social Security found equaled a listing.
Tyler applied for Social Security disability because he regularly suffered from pseudoseizures—seizures that aren't attributed to abnormal brain activity and are usually caused by psychological issues. Tyler tried to equal the disability listing for epileptic seizures by submitting a brief from his lawyer.
Tyler's pseudoseizures occurred weekly and affected his ability to function during the day, which is one way to meet the epilepsy listing. Social Security found that Tyler's pseudoseizures equaled the epilepsy listing in both severity and duration.
Talia suffered from severe vertigo and tried to equal the listing for disturbance of labyrinthine-vestibular function. Even though she didn't have the hearing loss required in the listing, the judge found that the vertigo Talia experienced was so severe that the existence of that impairment alone was enough to equal the listing.
In addition, Talia's treating physician testified at her appeal hearing that not everyone who suffers from labyrinthine-vestibular disturbances has hearing loss. (The ability to present witnesses is one of the reasons most successful disability claims are won at an appeal hearing.)
Below are some examples of impairments that Social Security found didn't equal a listing.
Anton has mood swings and some symptoms of psychosis. He applied for disability benefits for schizoaffective disorder, but Social Security denied his claim. In his appeal brief, Anton's lawyer stated that his client's schizoaffective disorder equaled either the disability listing for schizophrenic, paranoid, or other psychotic disorders or the listing for affective disorders.
But Social Security found that Anton's schizoaffective disorder didn't have a "marked" (severe) effect on his:
At least one of these abilities must be severely affected to qualify under one of these listings, but Social Security found that Anton was able to do things like:
Socially, Anton was able to get along with family and friends and responded well to supervision. And he suffered only moderate difficulties completing tasks. So, Social Security found that Anton's limitations weren't severe enough to equal the listing.
Social Security found Gina's obesity didn't significantly affect her daily functioning or ability to work in jobs that were less physically demanding.
Additionally, Gina failed to submit a written brief noting the specific listing she was trying to equal and thus couldn't show how her impairment equaled that of a listing. Just having multiple impairments isn't enough to establish that you equal a listing.
Jesse had COPD but didn't have the restricted airflow numbers necessary to meet the listing for chronic obstructive pulmonary disease (COPD). Jesse hoped to equal the listing instead, since he also had a heart condition. When his treating doctor was asked if Jesse would meet the listing for COPD, the doctor answered no. When asked if Jesse's COPD combined with a heart condition would equal the listing, the treating physician couldn't determine if it did.
Without any concrete evidence from a doctor stating that Jesse's impairments equal the listing or other unequivocal evidence showing the same, Social Security found that Jesse's condition didn't meet the listing.
Paula had some residual effects from a stroke and tried to equal the listing for central nervous system vascular accident (CVA). The CVA listing requires severe problems with the following:
Under Social Security's rules, a CVA diagnosis without symptoms equal in severity to those in the listing isn't enough to equal a listing.
Paula had mild weakness on her left side and walked with a broad gate, but Social Security found those symptoms weren't severe enough to equal the "disorganization of motor function" requirement of the listing. And the SSA found that Paula's mild difficulty pronouncing words didn't equal the listing's requirement of "ineffective speech or communication."
When you're trying to get Social Security disability benefits, it's up to you to show how your impairments equal a listing. Social Security won't look for listings your condition might equal.
You must include arguments in your written brief to the court (which you submit before your appeal hearing) that explain why and how your impairments are medically equal to a specific listing in severity and duration.
Example: Clara had psoriasis but didn't meet the listing requirements for dermatitis. Before her appeal hearing, Clara failed to provide an argument that pointed to specific medical evidence showing how her psoriasis resulted in severe functional limitations. (The dermatitis listing requires extensive skin limitations that severely limit your abilities.)
The judge concluded that Clara's impairments didn't equal the listing and, without any counterarguments, that conclusion was the final decision.
If you have multiple conditions, Social Security must consider the combined effect of all your impairments. (20 C.F.R. § 404.1523(c).) But you have to explain in your brief how your other impairments have increased the severity of your primary impairment so that it equals the listing. The combination of impairments must lead to a decrease in your overall ability to function at:
Chronic pain and fatigue are common conditions that can increase the severity of other impairments. For example, while your skin problem might not meet the requirements for a skin disorder, severe pain can decrease your ability to function and increase the severity of the skin disorder.
Whatever your multiple impairments are, it's crucial that your doctor provides details about how your combination of impairments meets a listing in severity and duration. And your doctor's statement must point to the medical evidence that backs up that conclusion.
You can try to equal a listing by offering the results of alternative tests to show that you have a required symptom or that your multiple impairments together equal a listing. (Alternative tests differ from those specified in the listing as required proof that you meet the criteria of the listing.)
If Social Security denies that you equal a listing, the agency has to provide adequate reasons why it found your impairment didn't equal a listing. That doesn't mean an ALJ can't discredit alternative tests you submitted after considering them. It just means the judge must provide adequate reasons for rejecting your alternative tests.
For example, the judge doesn't have to consider a diagnostic test that isn't generally accepted by the medical community as equivalent to a test noted in a listing.
Writing a brief explaining how your condition meets the requirements of a disability listing isn't an easy task. First, you must figure out which listing your condition might equal and then write a legal brief setting out proof of each element. It's unlikely you'll be able to convince Social Security that your condition equals a listing without the help of an attorney.
A disability lawyer will be familiar with all of Social Security's disability listings. That allows the lawyer to know which listing your condition is most likely to equal. A lawyer also knows how to work with your doctor to see if there's enough evidence to support this claim and write a convincing brief explaining how your condition equals the listing.
Learn more about the advantages of hiring a disability attorney before your appeal hearing.
Updated October 17, 2023