Can I Get Disability Benefits for Obesity?

 

Evaluating Disability Cases Involving Obesity under SSR 19-2p

 

Obesity is a common medical condition characterized by the accumulation of excess body fat.

 

People with obesity have a higher risk for other medical diseases and conditions, including cardiovascular diseases, Type II diabetes, and osteoarthritis. The increased risks that come with obesity make it a significant indicator of poor health.

 

When obesity alone, or combined with other medical impairments, limits your ability to perform daily living activities or full-time employment, you may qualify for Social Security disability benefits for obesity.

 

This article explains how the Social Security Administration (SSA) evaluates obesity in disability claims under Social Security Ruling (SSR) 19-2p, providing advice on developing the evidence and winning your disability hearing before an administrative law judge (ALJ).

 

If you have questions or want to speak with one of Virginia’s best disability lawyers, call us at (804) 251-1620 or (757) 810-5614 or complete the online form.

 

We have helped thousands of adults in Virginia, Maryland, D.C., North Carolina, and West Virginia qualify for disability.

 

And we want to help you and your family.

 

 

Defining Obesity

 

The terms overweight and obesity are labels for weight ranges greater than the weight the medical community considers healthy for a specific height. 

 

Doctors diagnose obesity based on your medical history, physical examinations in the clinic, and body mass index (BMI) scores. 

 

Your body mass index equals your weight in kilograms divided by your height in meters squared (kg/m2). 

 

The CDC defines an adult with a BMI between 25 and 29.9 as overweight. 

 

And an adult with a BMI of 30 or higher is considered obese. 

 

Obesity is further divided into three categories:

 

• Class 1 Obesity: BMI of 30 to 34.9

 

• Class 2 Obesity: BMI of 35 to 39.9

 

• Class 3 Obesity (Extreme or Severe Obesity): BMI of 40 or greater.

 

Can I Be Considered Obese if My BMI is Under 30?

 

Yes.

 

You may still have obesity if you store more fat around your waist than your hips, resulting in a high waist measurement. The data shows that a waist size greater than 40 inches for men and 35 inches for women increases the risk for obesity-related complications.

 

In addition, the CDC states that researchers have shown that BMI may not be the best measurement of obesity for persons with disabilities, such as spinal cord injuries.

 

That is because BMI can underestimate how much body fat a person with less lean muscle mass has.

 

How Common is Obesity in the United States of America?

 

Obesity is a common disease in America, affecting more than 40 percent of the population. 

 

For example, some studies show that more than 30 percent of Virginians are obese. 

 

Many factors contribute to obesity, including:

 

• Automation in the workplace

 

• Diet and nutrition (excessive food energy (caloric) intake)

 

• Genetics (family history)

 

• Lack of physical activity (a sedentary lifestyle)

 

• Other medical conditions (including thyroid problems)

 

Unfortunately, the number of people impacted has grown over the past 60 years. 

 

What Medical Conditions are Associated with Obesity? How Obesity Affects Your Physical and Mental Health.

 

Obesity is associated with several other medical conditions affecting the cardiovascular, endocrine, musculoskeletal, and respiratory systems. 

 

For example, obesity increases your risk of developing the following:

 

• Asthma

 

• Cancers of the breast, colon, endometrium, esophagus, gallbladder, kidney, liver, ovaries, pancreas, and rectum

 

• Cerebrovascular accident (CVA)/Stroke

 

• Chronic pain affecting the knees, ankles, and feet

 

• Depression

 

• Dyslipidemia (abnormal level of fatty substances in your blood)

 

• Gall bladder disease

 

• Heart disease (atherosclerosis, coronary heart disease)

 

• Hypertension (high blood pressure)

 

• Myocardial infarction (heart attack)

 

• Osteoarthritis (degenerative disc disease in the back and spine including spinal stenosis; degenerative joint disease)

 

• Peripheral vascular disease

 

• Sleep apnea

 

• Type II diabetes mellitus

 

In addition, obesity can result in premature death (lower life expectancy). 

 

Does the Social Security Administration Consider Obesity a Medically Determinable Impairment?

 

Yes.

 

The SSA will find that obesity is a medically determinable impairment (MDI) at step two of the five-step sequential evaluation process for determining disability if the objective medical evidence from an acceptable medical source establishes that you are obese.

 

The objective medical evidence includes signs, laboratory findings, or both.

 

Examples of signs and laboratory findings that may establish obesity as a medically determinable impairment include:

 

• Measured height and weight

 

• Measured waist size

 

• Body Mass Index (BMI) measurements

 

The SSA will analyze these measurements over time to determine if the data shows a consistent pattern of obesity.

 

Short-term weight loss (or gain) should not affect the SSA’s assessment.

 

Can Obesity be a Medically Determinable Impairment if My Doctor Did Not Diagnose It Formally?

 

Yes.

 

A formal medical diagnosis of obesity is not necessary for the SSA to find you have obesity as a medically determinable impairment.

 

Indeed, under Code of Federal Regulations Section 404.1521, the Social Security Administration “will not use your statement of symptoms, a diagnosis, or a medical opinion to establish the existence of an impairment(s)”

 

The objective measurements are what matters.

 

Is Obesity Automatically a Medically Determinable Impairment if I Have a BMI of 30 or Above?

 

No.

 

The SSA’s Policy Ruling states, though “there is often a correlation between BMI and excess body fat, this not always the case.”

 

Indeed, a claimant “who has a BMI of 30 or above may not have an MDI of obesity if a large percentage of the person’s weight is from muscle.”

 

The SSA says that “[i]t will usually be evident from the information in the case record whether the person does not have an MDI of obesity, despite a BMI of 30 or above.”

 

But it is not clear how the SSA will determine if a large percentage of your weight comes from muscle when the SSA refuses to purchase tests to measure body composition.

 

Will the SSA Find Obesity is a Medically Determinable Impairment Based on My Self-Reported Height and Weight?

 

Generally, no.

 

Under its Policy Interpretation Ruling, the SSA will not calculate BMI based on your self-reported height and weight.

 

You should, therefore, ask your medical providers to take your height and weight at each appointment.

 

Will the SSA Pay for a Test to Measure Body Fat?

 

No.

 

There are multiple tests to measure your total body fat percentage, such as:

 

• Skinfold calipers

 

• Body circumference measurements

 

• Dual-Energy X-ray Absorptiometry (DXA)

 

• Hydrostatic weighing

 

• Air Displacement Plethysmography

 

• Bioelectrical Impedance Analysis

 

• Electrical Impedance Myography

 

The Social Security Administration, however, will not purchase tests to measure body fat.

 

Therefore, the best option to get the evidence needed to prove obesity is to request a consultative examination to address your other physical impairments.

 

When Does Social Security Consider Obesity a Severe Medical Impairment?

 

Generally, the SSA will consider obesity (and any other medically determinable impairment) as severe if the impairment significantly limits your physical or mental ability to do basic work activities.

 

For example, the question is whether obesity affects your ability to sit, stand, walk, lift, carry, push, pull, kneel, crouch, crawl, and perform other physical tasks. In addition, being severely overweight may limit your work environment, preventing you from doing outside work when hot out. 

 

When making this determination, Social Security must consider all evidence from sources and symptoms (such as fatigue or pain) that may limit your functioning.

 

No specific BMI, weight, or descriptive terms from your doctors will automatically establish that obesity is a severe impairment.

 

For example, using the terms “morbid obesity” or “severe obesity” in your medical records does not necessarily mean the SSA will find obesity a severe medical impairment.

 

Does the Social Security Act (the Blue Book) Include a Listing for Obesity?

 

Not directly. But the Social Security Regulations require the ALJ to consider whether your obesity equals a separate listing due to the functional limitations it causes.

 

At the third step of the sequential evaluation process, the SSA considers whether you have an impairment, or combination of impairments, that meets or equals one of the SSA’s listings in the federal regulations.

 

The SSA’s Listing of Impairments is found in Appendix 1 to Subpart P of Part 404 of the Code of Federal Regulations.

 

If you meet the criteria for a listing for a specific condition, the SSA finds you disabled.

 

If not, the Social Security Administration and the Administrative Law Judge (ALJ) assigned to your case move to step four of the sequential evaluation process.

 

Unfortunately, obesity is not a listed impairment.

 

But obesity may be found medically equivalent to a listed impairment.

 

Social Security Ruling 02-1p, which was rescinded and replaced by Social Security Ruling 19-2p effective May 20, 2019, provided examples:

 

• “[O]besity may increase the severity of coexisting or related impairments to the extent that the combination of impairments meets the requirements of a listing. This is especially true of musculoskeletal, respiratory, and cardiovascular impairments. It may also be true for other coexisting or related impairments, including mental disorders.”

 

• When evaluating impairments under mental disorder listings, severe obesity satisfies the criteria in Listing 12.05C for a physical impairment imposing an additional and significant work-related limitation of function.

 

• By itself, obesity is medically equivalent to a listed impairment if it results in an inability to ambulate effectively, as defined in sections 1.00B2b or 101.00B2b of the listings. In addition, obesity may substitute for the major dysfunction of a joint due to any cause (and its associated criteria), with the involvement of one major peripheral weight-bearing joint in listings 1.02A or 101.02A, ad we will then make a finding of medical equivalence.

 

• The SSA may find that a combination of pulmonary or cardiovascular impairment and obesity are of equal medical significant to one of the respiratory or cardiovascular listings. The rationale for this is that additional body mass increases the workload of the cardiovascular and respiratory systems because it makes it harder for the chest and lungs to expand and provide oxygen.

 

How Do You Prove that Obesity Results in Functional Limitations? 

 

Because the SSA does not have a specific obesity listing, I recommend focusing on providing testimony and developing evidence showing how obesity limits your residual functional capacity (RFC). 

 

Your RFC is the most you can do in a work setting regularly and continuously (eight hours a day, five days a week) despite your medical impairments. 

 

The more limitations included in your RFC, the greater the likelihood of success with your Social Security disability claim. 

 

For example, you should present evidence (both testimony and a disability letter from your doctor) about how obesity affects your ability to do the following:

 

• Sit

 

• Stand

 

• Walk (for example, the inability to walk without using an assistive device or to walk a block at a reasonable pace)

 

• Lift

 

• Carry

 

• Push

 

• Pull

 

• Climb

 

• Balance

 

• Stoop

 

• Kneel

 

• Crouch

 

• Crawl

 

• Manipulate objects (for example, fatty tissue may prevent you from typing, using a phone, or operating small hand tools)

 

In addition, consider offering evidence on how obesity does the following (if applicable): 

 

• Increases the stress on weight-bearing joints such as the hips, knees, ankles, and feet

 

• Necessitates using an assistive device for balance and mobility (cane, walker, crutches, wheelchair, etc.)

 

• Decreases your ability to tolerate humidity or heat

 

• Prevents you from avoiding hazards, such as forklifts or debris found in warehouses and elsewhere

 

• Causes fatigue that forces you to nap during the day

 

• Decreases cognitive performance

 

Do Special Rules Apply if I Have Type II Diabetes and Obesity?

 

Obesity is the leading risk factor for developing Type II diabetes. Indeed, the increase in the number of Americans with diabetes has corresponded with the rise in obesity rates.

 

Social Security Regulation 14-2p acknowledges this relationship between obesity and diabetes. It states that a person with diabetes mellitus and obesity –

 

[M]ay have more severe complications than the effects of each of the impairments considered separately. For example, in adults, neurovascular complications of DM may result in an amputation of a lower extremity. The neurovascular impairment, along with obesity, may make successful rehabilitation with prosthesis more difficult. Although neurovascular complications are rare in children, obesity increases the likelihood of developing these complications.

 

So although the SSA does not have a special rule for persons with diabetes and obesity, it does recognize the relationship between the two conditions.

 

If the ALJ denies your case and inadequately addresses how obesity can increase the severity of limitations from diabetes, bring it to the Appeals Council or federal court’s attention. This failure may help you obtain a remand or reversal of the denial.

 

Will Social Security Find that I Have Failed to Follow Prescribe Treatment for Obesity if I Do Not Exercise as Much as I Should or Choose Not to Have Weight Loss (Bariatric) Surgery? 

 

No.

 

Often the goal of medical treatment for obesity is to lose weight by any amount to improve your health and quality of life.

 

Treatment may include behavioral changes (a better diet and exercise), medication, or surgery.

 

Your physician may recommend surgery as a last resort when you have a BMI of 40 or higher.

 

Surgery for obesity alters the stomach, intestines, or both to reduce how much food you can eat at once or the amount of time food is available for digestion.

 

Social Security regulations require a person to follow the treatment prescribed unless they have reasonable justification for not doing so.

 

In my experience, however, the SSA rarely denies benefits for obesity due to failure to follow prescribed treatment. Indeed, a past regulation stated the SSA would not find that a person failed to follow prescribed treatment if they refused to have surgery for obesity (due to the risks and potential side effects).

 

Will I Lose My Disability Benefits if I Lose Weight?

 

Not necessarily.

 

The SSA recognizes that your weight may fluctuate over time.

 

Typically minor weight loss (less than 10 percent of initial body weight) is too insignificant for Social Security to find you have had medical improvement in obesity.

 

Instead, there is an increased likelihood the SSA will consider that obesity has medically improved if you have lost at least ten percent of your body weight for at least 12 months.

 

But losing more than ten percent of your body weight and keeping the weight off does not necessarily mean losing your SSDI or SSI benefits.

 

The SSA must still pull your case for review.

 

Then it must find you no longer meet the disability definition considering your RFC with the other medical impairments, age (the older you are, the more likely you remain disabled under the Grid Rules), education, and work experience.

 

Get Help Winning Disability Benefits for Obesity

 

Obtaining an allowance for Social Security disability insurance (SSDI) benefits or Supplemental Security Income (SSI) due to obesity requires the development of specific testimony at your hearing before an ALJ and medical reports showing how obesity affects your other impairments.

 

Showing up with a certain BMI is not enough to win your disability case. But having evidence that your weight causes functional limitations is a sign you may win your SSD hearing.

 

If obesity is a significant reason you cannot work, we can help.

 

Call us at 804-251-1620 or 757-810-5614 or complete our online contact form for a consultation.

 

We want to help you start on the path to financial security when health takes away your livelihood.