Obesity is a term used to describe people whose weight is higher than what is considered healthy. Obesity is established based on a person's body mass index (BMI), which is determined by measuring a person's height and weight. A BMI of 30 or more is considered obese.
The only true medically objective symptom of obesity is a BMI of 30 or more. However, obesity is linked to an increased risk for many related illnesses, such as high blood pressure, heart attack, stroke, Type 2 diabetes, high cholesterol, sleep apnea, cancer, infertility, gallbladder disease, and depression. Because of the diseases associated with obesity, people are frequently prescribed multiple medications to manage the co-existing illnesses.
The primary treatment for obesity is weight loss. Obesity-related diseases are often mitigated when a person reduces his or her BMI.
The Social Security Administration (SSA) evaluates medical conditions with a step-by-step process.
In order to decide a claim for SSDI or SSI disability benefits, the SSA will first determine whether you are working at the substantial gainful activity (SGA) level. In 2016, this amount is $1,130; therefore, if you are earning $1,130 or more a month the SSA will assume you aren't disabled and will automatically deny your claim.
If you are earning less than the SGA amount, the SSA will then determine whether or not your obesity is a "severe" impairment. According to the SSA, a "severe" condition is one that causes more than a minimal interference with your ability to perform work-related activities.
At the next step, the SSA will look at your medical condition to see whether you have a qualifying illness that is outlined in its Listing of Impairments. Unfortunately, obesity is no longer a qualifying condition as set forth in the impairment listings. But because obesity often causes many additional health problems, in some cases the diseases caused by your obesity will satisfy the criteria of an SSA impairment listing.
Even though the SSA no longer includes obesity as a qualifying condition, the agency does acknowledge the unique health issues that obese people face. To this end, the SSA has advised disability claims examiners and administrative law judges (ALJs) to consider whether the obesity causes such extreme limitations that it could "equal" another listing. For example, if the obese individual is incapable of walking effectively without assistance, the individual's condition may "equal" the impairment listing for major dysfunction of a joint.
In addition, the SSA will consider the "combined effect" of obesity with any other related illnesses a person has. This means that you may suffer greater pain or other symptoms from your obesity-related illnesses than if you were not obese. For example, an individual who is both obese and has arthritis will likely have increased symptoms and decreased mobility due to the arthritis than an arthritis sufferer who is not obese. Similarly, an obese person with coronary artery disease will not be capable of as much exertion, and will become more easily fatigued, as a person of normal weight with coronary artery disease.
If you are headed into an appeal hearing with an ALJ judge, it may be helpful to read the SSA's policy statement on obesity. This document can be found at http://www.ssa.gov/OP_Home/rulings/di/01/SSR2002-01-di-01.html.
If you don't have an obesity-related condition that meets an impairment listing, it can be more difficult, but not impossible, to win your claim. You can still argue that your obesity limits your functioning so much that you can't work, if your doctor agrees with this assessment. The SSA will decide if you are able to do your past work, or any other work, despite the limitations of your obesity. The SSA will take into account your age, education, past work experience, and how your obesity affects your ability to do work-related activities (your functional capacity--see below). If the SSA determines that there is no work you can be expected to do in light of these factors, it will approve your claim. It is often easier for older, less educated people to win a claim for disability based on limited functional capacity caused by obesity.
To help prove there is no other work you can do, it is important to obtain a physical Residual Functional Capacity (RFC) assessment from the physician(s) who treats you for your obesity and related illnesses. The more supportive an RFC you are able to provide the SSA, the more likely you are to win a claim for disability. For example, if your doctor's RFC assessment states that you are limited to doing sedentary work, but you don't have the skill sets for office work (and you are to old to be expected to learn new skills), you may be deemed disabled.
An RFC is an assessment by the SSA, or a detailed report by your doctor, that states what limitations you have because of your obesity and any related illnesses. For example, if you have limitations in how long you can sit, stand or walk your doctor should state them in the RFC. The RFC should also explain your limitations on pushing, pulling, lifting, carrying and climbing.
Obese individuals often suffer from difficulty walking. If you have been prescribed a cane or walker to assist you, it is extraordinarily helpful to provide this information to the SSA. If you need a cane to walk, you can't carry anything or use your hands while standing. However, you must provide a copy of your prescription or a statement for your doctor confirming that the walking device was prescribed; the SSA will not consider the use of an assistive device as part of your RFC otherwise.
Obese individuals also often suffer from significant fatigue. Fatigue is an important factor in establishing whether a disability claimant can engage in full-time work. Therefore, it is important that your doctor address fatigue in your RFC and whether you need to rest or take unscheduled breaks during the day. The SSA recognizes the significant effect fatigue has on the ability to maintain work-related activities, especially as a result of sleep apnea (a disease highly associated with obesity).
Many obese people suffer from mental health issues like depression and anxiety. If you are under a doctor's care for any mental health issues, it is important to report this to the SSA. You should also request that your mental health provider prepare a psychological RFC that addresses any work-related mental limitations caused by your depression or anxiety. For example, a mental RFC should include statements about your ability to concentrate, work on your own, get along with others, follow directions, or be reliable.
When your physician prepares your physical RFC, it is important that he or she only make statements based on objective medical evidence. This means that the SSA will not consider your doctor's statements as to your limitations without evidence such as laboratory results, sleep studies, medication lists, heart studies, x-rays, CT scans, MRIs, and your doctor's notes from appointments to confirm the RFC.
Although the SSA will consider opinions from most licensed physicians, the SSA gives greater authority to RFCs that are prepared by specialist trained in treating your particular illness. Therefore, it can be helpful to seek treatment (and an RFC) from a psychiatrist or therapist instead of your family doctor for treatment of your obesity-related anxiety and depression.