I have been diagnosed with a serious medical disorder. Is my diagnosis, alone, sufficient to win my case?

The answer to this question is “No”, unless your diagnosis is for a disease or condition that is so extremely serious that it is included in the Compassionate Allowances (CAL) initiative. (See the “Compassionate Allowances (CAL)” link for a list of medical conditions that are included under CAL.) For all medical disorders other than those covered by CAL, you cannot win your case on the basis of a diagnosis alone. The reason for this is that the rules and regulations used by the Social Security Administration (SSA) are based on the assumption that, at least for most medical conditions, the same disease or condition can affect different people in different ways and with different degrees of severity. Some people with ruptured discs in their back may experience very limited pain and can continue to work in a light duty or sedentary job, while another person who has been diagnosed with the same condition may experience continuous pain that precludes all employment. Even though the diagnosis is the same, the severity of the symptoms can vary greatly. Therefore, in the usual case, you need more information than a simple diagnosis. You need specific medical information about the extent and severity of your disease or medical condition.

The need for specific information about the extent and severity of your medical disorders is shown in steps #3, #4 and #5 of the five (5) step sequential evaluation process that is used by the Social Security Administration (SSA) for deciding disability claims. (See “The Five (5) Step Sequential Evaluation Process” link.)

At step #3 of this process, the SSA determines whether or not your impairment satisfies or “meets” one of the Listing of Impairments (the listings). The listings is a detailed description of several specific impairments, i.e., medical disorders, for each of the major body systems (The SSA uses the general word “impairment” to denote any mental or physical disorder or disease.) For example, there is a “listing” for “disorders of the spine”, for “chronic pulmonary insufficiency”, for “chronic heart failure”, for “hematological disorders”, and etc. Each listing is written to describe a level of impairment that is so severe that it would clearly prevent any person from performing any type of work. If your impairment(s) is as severe as the listing that applies to your impairment, then the SSA will immediately conclude that you are disabled without any further analysis. This is referred to as satisfying or “meeting” a listing. (See the “Five (5) Step Sequential Evaluation Process” link regarding the Listing of Impairments.) The Social Security rules explicitly state that you need more than a simple diagnosis in order to meet a listing. You need medical evidence with information sufficient to satisfy the criteria of that specific listing. The Regulations state the following:

• Can your impairment(s) meet a listing based only on a diagnosis? No. Your impairment(s) cannot meet the criteria of a listing based only on a diagnosis. To meet the requirements of a listing, you must have a medically determinable impairment(s) that satisfies all of the criteria in the listing. C.F.R. section 404.1526 (d) .

If the SSA decides that your condition is not sufficiently severe to meet a listing, then the SSA will proceed to steps #4 and #5 of the evaluation process. At these steps, the SSA must decide whether or not you can perform your past work or any other work in the national economy. The SSA answers these questions by determining your Residual Functional Capacity (RFC). Your RFC is defined as “the most you can still do despite your limitations”. Your RFC is the capabilities that you still have in spite of your impairments. The SSA determines your RFC by considering the severity of all of your impairments and the severity of the symptoms and limitations that are caused by those impairments. In order to be able to show the SSA the full extent of your limitations and disabilities, you need medical evidence that addresses more than just the diagnosis of your impairment. You need medical evidence that shows the severity of your medical disorders, how your medical disorders affect you, how they limit your activities, and how they will cause you problems in a work setting. (See the following links: “The Five (5) Step Sequential Evaluation Process”, “What medical records do I need for my Social Security disability case?” and “The Medical Source Statement”.)

Obviously, your diagnosis is extremely important. But this is just where you get started in trying to prove your case. You need more. You need medical evidence that can satisfy the Five (5) Step Sequential Evaluation Process.

The rules and regulations used by the SSA are very complex. You need the help of a lawyer in the preparation and presentation of your case. If you have any questions or would like to obtain a case evaluation, I would be happy to speak with you. I do not charge for my initial consultation.

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