Public Health Law Map - Beta 5 - Medical and Public Health Law Site

for disability from a multisystem disease such as diabetes. The claimant may not
have eye disease or peripheral neuropathy that qualifies on its own. But, if they
can’t walk without tripping because they can’t feel their feet and they can’t see the
floor, then the two problems together equal the listing for diabetes with peripheral
neuropathy, and the claimant is disabled.
If the claims do not meet or equal one of the listings, then the DDS doctor must
form an opinion about the claimant’s “Residual Functional Capacity.” This is how
most SSA disability claims are decided. DDS determines whether the claimant is
able to do a job in the national economy. Unlike many private insurance systems,
this is not based on whether the person can go back to his or her previous job. The
question is whether the person can do any job.
Taking all the medical problems and allegations into consideration, the DDS doctor
rates impairments on a specific form. The ratings include how much weight can be
lifted, how far and how long can the person walk, how long can they sit, can they
operate foot pedals and hand controls, can they climb, can they crawl, can they
squat, etc. It also requires rating of impairments in use of the hands and arms,
vision, communication (both hearing and speech), and environmental limitations
such as heat, cold, or dust. This list of limitations is then compared to the work the
person has done in the past and any related work the person might do. If they are so
limited that they can’t do any regular job, then they qualify for disability.
This is the area where the personal physician can be of the most help to disabled
patients. Too many doctors write letters that say, “John Doe has spinal stenosis and
is totally and permanently disabled.” The diagnosis is clear but the rest of the
statement will be ignored by DDS. Under the law, it is the Commissioner of the
Social Security Administration who decides whether the person is disabled.
On the other hand, if the treating source opinion (the attending physician’s notes)
gives specific limitations, these must be given careful consideration. The statement
that “John Doe has spinal stenosis and cannot lift more than 10 pounds or walk
more than 100 feet or sit for more than 20 minutes without changing position” will
probably get Mr. Doe his SSA disability benefits promptly.
e) Other Program Requirements
There are some additional components to qualifying for SSA Disability or SSI.
First, there must be objective medical evidence of a severe injury or illness. For
musculoskeletal problems this means an X ray, MRI, or CT scan that shows a
disease or injury. For other types of disease, there must be a positive lab test or an
objective physical finding. This might be a positive ANA or a typical malar rash to
document systemic lupus erythematosus. For diabetic neuropathy, an elevated
blood sugar and an absent reflex would usually be enough. This requirement is
simply intended to weed out the disability claims that are based solely on pain or
disability when there is no underlying disease causing it. A diagnosis alone is not
enough. The diagnosed disease must cause some impairment. The diabetic who has
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