Step Two of the Social Security Disability Evaluation: Medically Determinable Severe Impairment
To Qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) Benefits, You Must Have At Least One Medically Determinable Impairment that Significantly Affects Your Ability to Work or Complete Activities of Daily Living
The Social Security Administration (SSA) uses a five-step evaluation process to decide whether you are disabled.
Once you prove that you are not engaged in substantial gainful activity (SGA) at step one of this process, the SSA reviews the evidence to decide if you have at least one medically determinable severe impairment. If it rules you do not, the evaluation stops, and you will receive a denial.
This article explains how to prove that one of your medical conditions qualifies as a severe impairment under the Social Security Act. The more medically determinable severe impairments you have, the greater the likelihood that Social Security will find the evidence to support your testimony about pain, depression, and other symptoms.
Read on to learn what Social Security’s regulations and case law from the federal courts say about severe impairments in SSDI and SSI claims.
Then call (804) 251-1620 or (757) 810-5614 to talk to a top-ranked disability attorney.
What is a Medically Determinable Impairment?
Social Security’s Program Operations Manual System (POMS) includes a section entitled DI 25205.005 Evidence of a Medically Determinable Impairment.
According to POMS, a medically determinable impairment (MDI) is a physical or mental condition that results from anatomical, physiological, or psychological abnormalities shown by medically acceptable clinical or laboratory diagnostic techniques. Your written or oral statements of a diagnosis, symptoms, or communication from a medical provider are insufficient to establish an MDI. You must have supportive reports from an acceptable medical source.
Examples of acceptable medical sources include licensed physicians, psychologists, optometrists, podiatrists, speech-language pathologists, and registered nurses.
Is My Medically Determinable Impairment Severe or Not Severe?
After Social Security finds you have a medically determinable impairment, it will determine whether your MDI is severe. This evaluation is necessary for each medically determinable impairment found.
You do not have to meet a high threshold to prove an MDI severe.
An impairment is severe if it significantly limits your physical or mental ability to do “basic work activities.” Examples of basic work activities include physical functions like sitting, standing, walking, lifting, reaching, carrying, or handling, sensory abilities like seeing, hearing, and speaking, and mental functions like understanding and following simple instructions, dealing with changes in routine, or responding appropriately to others in the work environment.
Administrative law judges (ALJs) with Social Security must exercise great care when considering whether your impairments are severe. They should consider an MDI not severe only if it is a slight abnormality which has such a minimal effect on you that it would not be expected to interfere with your ability to work, regardless of age, education, or past work experience.
How Do I Prove My MDI is Severe?
While you must have medically acceptable clinical or laboratory diagnostic evidence to prove you have a medically determinable impairment, you can expand the types of evidence you use to show a severe MDI. The Social Security regulations require ALJs to “consider all of the available evidence …. about the intensity, persistence, and limiting effects of your symptoms ….”
For example, we recommend offering the following additional evidence to prove your medically determinable impairment significantly limits your work abilities:
- Statements from medical providers that treat you, but Social Security does not consider an acceptable medical source.
- The adult function report. Use this paperwork to explain your symptoms (pain, numbness, tingling, headaches, fatigue, shortness of breath, anxiety, weakness) and their frequency and severity.
- Statements from third parties such as family, friends, clergy, or ex-supervisors. Others’ observations on your decreased ability to live an everyday life strengthen your case.
- Pain journal. Although your testimony is insufficient to prove an MDI, once you have established an MDI that could cause your symptoms, you can rely exclusively on subjective evidence to prove your symptoms’ severity, persistence, and limiting effects.
Severe Impairment Examples
The following two examples show how Social Security’s severe impairment step works.
Example 1:
Applicant Bob is a truck driver who tore his rotator cuff while operating a forklift. An MRI revealed tendonitis, and clinical examinations showed positive findings for shoulder instability.
Bob’s treating orthopedic surgeon recommends lifting at most ten pounds.
At the hearing, Bob testifies that he cannot lift more than pounds, has difficulty reaching overhead to get cups out of the cabinet, and takes twice as long to dress and groom due to shoulder pain.
The ALJ should find Bob’s rotator cuff tear and tendonitis severe.
Example 2:
Jane is a nurse for Sentara who suffers a concussion when a mentally ill patient assaults her.
Her neurologist diagnoses post-concussive syndrome with migraines.
At the hearing before an ALJ, Jane testified that she suffers two migraines per week despite taking medication. These migraines last from a few hours to two days, during which she lies down in a dark, quiet room and sleeps.
The ALJ should find Jane’s migraines severe and will award the case if she finds this testimony credible.
Example 3:
Mike suffered a back injury that caused multiple herniated disks while working at an Amazon warehouse.
He ultimately needed a lumbar fusion.
Several months later, Mike’s neurosurgeon declares that Mike has reached maximum medical improvement (MMI) with permanent restrictions of no standing or walking more than two hours in an eight-hour workday and no more than four hours sitting in an eight-hour workday.
At the disability hearing, Mike testified that he spends his day shifting positions and can never get comfortable. He also relies on friends and family members to do lawn work and on Amazon and Grubhub for groceries and shopping.
The ALJ should find Mike’s spinal cord injury severe.
Is an MDI Severe if I Can Do Some Household Chores?
Yes, the SSA may still consider your MDI severe, even if you continue to perform some daily and life activities despite your health.
Federal appellate courts “have bemoaned the tendency of ALJs to overstate claimants’ Residual Functional Capacities and ability to work based on their daily activities.”
Indeed, the United States Court of Appeals for the Fourth Circuit, which includes Virginia and Maryland, has said that “an ALJ errs in extrapolating from daily and life activities that a claimant has increased residual functional capacity, or, in other words, has the ‘ability to do sustained work-related activities on a regular and continuing basis – i.e, 8 hours a day, for 5 days a week, or an equivalent work schedule.” This court has “encountered case after case where an ALJ improperly exaggerated a claimant’s Residual Functional Capacity although the claimant could engage in only limited activities.”
The rationale for finding a physical or mental condition to be a severe impairment is straightforward:
A claimant’s inability to sustain full-time work due to pain and other subjective symptoms is often consistent with her ability to carry out activities of daily living. As one court said, “[t]he critical differences between activities of daily living and activities in a full-time job are that a person has more flexibility in scheduling the former than the latter, can get help from other persons …., and is not held to a minimum standard of perform, as she would be by an employer.” Indeed, “disability claimants should not be penalized for attempting to lead normal lives in the face of their limitations.”
Bottom line: You can show a medically determinable impairment significantly limits you even if you try to perform some chores.
How Many Severe Impairments Do I Need to Qualify for Social Security Disability?
Only one.
Most adults we represent have multiple severe impairments affecting their abilities to work or complete activities of daily living (ADLs).
However, you do not need multiple MDIs to win your disability claim.
Can I Reverse a Social Security Denial Because the ALJ Failed to Find a Specific Medically Determinable Impairment Severe?
Maybe.
Case law supports reversing an unfavorable ALJ decision when that decision omitted all severe MDIs.
An error at this early step in the disability evaluation infects an ALJ’s residual functional capacity assessment at step four, often resulting in incomplete RFCs and vocational testimony not based on substantial evidence.
We have used the case law to obtain federal court remands and benefits awards when the ALJ made a mistake at the severe impairment step.
We Help Adults with Severe Medical Impairments Get Approved for Social Security Disability
We are one of the largest Social Security Disability law firms in the country, representing thousands of disabled adults and children.
Call (804) 251-1620 or (757) 810-5614 for help with your SSDI or SSI case from start to finish.
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