Using "Staged" Conditions as an Argument for Disability Benefits

Arguing that your condition has progressed to a "late-stage", or later stage, can help win disability benefits at an appeal hearing.

By Suzanne Villalon-Hinojosa, Attorney

Certain impairments listed by Social Security as disabling are staged by treating sources. Staging is a progression and shows a worsening condition. Whenever you hear the terms "late-stage", or "stage IV", you’re hearing the concept of staging.

In many Social Security disability cases, progression of an impairment towards later stage can be used at the hearing to convince the Administrative Law Judge (ALJ) to grant a disability award. Here's a quick overview on how it may work.

Staging as an Argument for Disability Benefits

While the concept of staging is not considered in their Social Security listing, it can be used to argue that a later stage equals the severity of listing criteria, and that the claimant should therefore be awarded benefits.

For example, kidney function level is measured by the calculation of the Glomerular Filtration Rate (GFR) based on the creatinine levels in the blood and the individual’s age, race and gender.[i] Stages 3 and 4 can result in significant functional impairment due to anemia, bone disease and other associated symptoms.   But the listing only provides a listing level impairment when the claimant is on dialysis (Stage 5).

One could argue that the claimant equals the kidney listing even before they need dialysis if the GFR is at an earlier stage.   If the claimant also suffers from other diseases, such as diabetes, they may equal in combination, see section below.

Here is another example: gout is one of the inflammatory arthritic conditions considered in the autoimmune system disorders. See the condition listed as crystal deposition disorders at 14.00D6c(iv).   We were able to show that our client equaled 14.09 when diagnostic studies revealed tophus deposits, associated with the most serious stage of gout.

Which Conditions Are "Staged"?

There are many conditions, listed or not, which are in fact staged by health care professionals.   These include, but are not limited to:

Current Social Security Listing Do Not Consider Staging

Unfortunately, the current listings do not include any kind of staging analysis. In fact, in 1991 the cardiac listings included criteria for chronic heart failure which equate to functional restrictions consistent with NYHA[ii] class III or IV.”[iii] But that criteria was removed in 2006 and replaced with “extreme limitation” language. [iv] Nevertheless, one could argue that a later stage equals a listing because it represents a condition that is of equal medical significance to the required criteria.

These arguments can be very effective at the hearing level, and an experienced attorney should be able to help strengthen a claimant’s case when disability severity is at issue.

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