By Suzanne Villalon-Hinojosa, Attorney
One way to get approved for Social Security disability is by meeting the requirements of one of Social Security's disability listings. But when your condition doesn't exactly meet the criteria in a listing, but it's close, you might be able to convince Social Security that your condition is "medically equivalent" to the listing. If you do, you'll be granted disability benefits.
Social Security's regulation regarding the Listing of Impairments explains that to meet a listing, the disability applicant must satisfy all the criteria of the listing, including any relevant criteria in the introduction of the listing and the durational requirement (one year unless otherwise noted in the listing). But medical equivalence can be found without meeting all of the listing criteria. Medical equivalence is shown when your impairment is equal in severity and duration to the criteria of any listed impairment.
Social Security has specific medical equivalence rules that spell out three ways to "equal" a listing.
If you have a listed impairment but you don't have the requisite medical findings (or you have them all, but one is not severe enough), you can't meet the listing. For instance, you are trying to meet the listing for asthma but you have had only five asthma attacks requiring hospitalization in the last year instead of the required six. But if your doctor or a Social Security medical consultant says your findings are of equal medical significance to the required criteria, you can be approved by equaling the listing. In the asthma example, if all five of your attacks required hospitalization for almost 24 hours, this is probably equivalent to the listing, since hospitalization for over 24 hours counts as two attacks, under the terms of the listing.
If you have an unlisted impairment, you might be able to equal a listing if you have findings closely analogous (similar) to a listed impairment. If your impairments are medically equal to the impairments found in the similar listing, your condition can be found equal to the listing. For instance, if you have chronic lymphocytosis leukemia, which is not a listed impairment, you could try to show your leukemia is just as disabling as chronic myelogenous leukemia, which is a listed impairment. Your medical records would have to show that your leukemia is in the accelerated or blast stage, and your doctor would have to give an opinion that this type of leukemia at this stage is equal in severity to chronic myelogenous leukemia.
If you have a combination of impairments that don’t meet a listing, you could meet a listing if your medical records show evidence that your symptoms and limitations are of at least equal medical significance to the required criteria of a listing. For instance, you may have suffer from Type 2 diabetes, high blood pressure, obesity, severe osteoarthritis in one wrist, and spinal stenosis. You don't meet a disability listing because you can still walk (inability to walk without help is required by the stenosis listing) and you have the use of one hand (difficulties using both hands is required for the joint dysfunction listing). Social Security must consider how your obesity affects your other impairments, and whether the combined effects of your problems are equal in severity to one of the related listed impairments. Note that just having a large number of mild or moderate medical conditions does not mean you can medically equal a listing.
Proving a condition that is unlisted, or that doesn't meet as listing, is disabling through medical equivalence is not easy, but after a few appeals, you might be able to win disability compensation. It usually takes a lawyer's help to be able to pinpoint a relevant listing to equal, propose the theory of equivalence to Social Security, and gather the proper medical evidence to submit. For help, contact a disability lawyer in your area.