Very often, the effects of obesity are often quite severe and interfere with a person’s ability to work and perform activities of daily living. The question then becomes is how does obesity play into a claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. The Social Security Administration (SSA) has regulations and rule interpretations regarding the evaluation of obesity. Typically, a person suffering from obesity that is applying for Social Security Disability Insurance (SSDI) or SSI benefits has numerous severe impairments.
However, there are situations where a person’s obesity alone can be so significant that it is the main impairment upon which a disability claim is based. In the past, there was a social security disability listing (9.09) that specifically dealt with obesity. In 1999 the obesity listing was deleted in its entirety from the lists of impairments in 20 CFR Subpart P, Appendix 1. The SSA made changes so that obesity is still addressed within the listings, but they are more addressed by the potential effects obesity causes rather than obesity itself. For example, listings in the areas of musculoskeletal respiratory and cardiovascular body systems. The preambles of listings 1.00, 3.00, and 4.00 make it clear that the SSA still considers obesity to be a medically severe condition and remind adjudicators to consider the effects of obesity when evaluating disability in that the combined effects of obesity with other impairments can be greater than the effects of each of the impairments considered separately.
As with any condition, the SSA first determines whether an impairment is a medically determinable impairment (MDI). The SSA generally relies on the judgment of the physician in determining the diagnosis of the impairment and look to body weight or BMI. There is no specific level of weight or BMI that equates with a severe or non-severe impairment rather the SSA supposedly performs an individualized assessment of the impact of obesity on an individual’s functioning when deciding whether the impairment is severe.
If the obesity is considered to be a severe MDI, then one follows through to the sequential evaluation to determine if the claimant’s obesity meets or equals a listing. As noted by SSR 02-1p, because there is no listing for obesity, the SSA will find that an individual with obesity “meets” the requirements of a listing if he or she has another impairment that meets the requirements of a listing or if in combination with obesity meets the requirements. The SSA may also find that obesity by itself is medically equivalent to a listed impairment. For example, if it resulted in an inability to ambulate effectively as defined in Section 1 of the listings.
Following the sequential evaluation process, if someone does not meet a listing, the SSA determines the level of functioning of the individual for purposes of determining the residual functional capacity (RFC) and its effect on ability to do work. Obesity must be considered in assessing the residual functional capacity (RFC). Although there is a statement in SSR 96-8p, that “body habitus” is not a factor to be considered in assessing RFC, it must be remembered that body habitus is not a medically determinable impairment, but obesity can be. It is very difficult to win a case at Steps 4 or 5 of the sequential evaluation process for obesity alone, but often it can be the needed extra limitation to reduce the RFC below the needed levels. This is true because obesity can affect the RFC in terms of sitting, standing, walking, lifting, carrying, climbing, etc.
If you need more information about a Social Security Disability/SSI, personal injury, EEOICPA, long or short-term disability, Railroad Retirement Board disability, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611 or through our website.