Social Security Myth #8: Certain Conditions Automatically Entitle You to Disability Benefits

Every Tuesday, Social Security Attorney Taylor Potts will expose some of the more frequent myths surrounding Social Security Benefits. Be sure to “like” our Facebook page and stop back each week as Attorney Potts takes you through The Twilight Zone – Social Security Style. If you have questions about Social Security Disability or VA Disability benefits, contact Attorney Taylor Potts at (304) 845-9750.

Myth #8: Certain Conditions Automatically Entitle You to Disability Benefits

You are about to enter a land beyond what many of us know.  A land that could almost be considered a different dimension.  A dimension of medical records, vocational classifications, administrative law judges, and functional limitations.  Strap yourself in and get ready as we enter the twilight zone of Social Security Disability benefits.


Social Security Disability can be a strange and confusing land, but allow me to be your guide as we (hopefully) shed some of this mystery and bring it back into the realm of reality.  In this series, we will take some of the most common (12 to be exact) misunderstandings, or myths, about Social Security Disability Insurance and Supplemental Security Income and help explain why these myths are not necessarily true and why the myths became so pervasive.


There seems to be a persistent belief that certain conditions automatically qualify you for Social Security Disability benefits.  Oftentimes this type of thinking is associated with severe, long-term conditions such as cancers, Parkinson’s disease, multiple sclerosis (MS), and other incurable, degenerative health problems.  However, as you should have come to expect by now, this is simply not true. 

There is NOT one condition that automatically entitles you to benefits in the eyes of the Social Security Administration.  It IS true, however, that certain conditions are more likely to result in disability benefits.  This is because those conditions are often more severe by their very nature and, therefore, tend to cause more problems in daily functioning.  For the purpose of Social Security Disability benefits, the key question is always the severity of the health problems and limitations you are experiencing from the illness, injury, or disease, and how those problems and limitations affect your ability to function.


The listings are categories of impairments that Social Security can use to determine disability.  They serve two purposes.  First, if the listings criteria are met, Social Security will automatically find that the individual is disabled without any further consideration regarding actual limitations, work availability despite those limitations, age, or any other similar considerations.  It amounts to a check all of the boxes and you win scenario. 

For example, under adult listing 1.04 (Disorders of the Spine) an individual with certain degenerative changes to their spine that can show either 1) nerve root compression, functional loss, and positive reflex/straight leg test results, 2) spinal arachnoiditis with burning or pain-causing position changes every two hours or less, or 3) spinal stenosis resulting in an inability to walk properly, would be found disabled regardless of whether or not they could still perform their past work or certain other types of work based on their actual functioning.

The second purpose that the listings serve is to guide findings of severe impairments.  Social Security does not consider every medical condition, nor do they consider that every medical condition can be disabling, regardless of how severe the condition. 

For example, sleep apnea cannot give rise to a find of disability by itself.  While it can be considered, it can only be considered as it relates to exacerbating other conditions.  The listings determine what conditions can be considered severe and disabling in and of themselves.  If a condition is not a listings criteria, then it generally cannot give rise to a disability by itself.


Once again, this gets complicated. For the most part, disability findings are governed by the listings criteria.  However, sometimes conditions arise that do not and cannot fall within a listings criteria.  In these instances, a court or social security itself may give guidance on assessing non-listings issues.  These non-listings issues are not given listings criteria status, but they can give rise to disability for other reasons and act in a similar fashion as the listings criteria.  These standards for non-listing conditions are often found in the Social Security Rulings (SSR). 


The most often encountered examples of this are migraine and headache issues.  While migraines and headaches can be symptoms that arise from other listing conditions (such as high blood pressure, heart problems, brain injuries, etc.), they can also appear by themselves in what is called a Primary Headache Disorder.  When they are not symptoms of a listing issue, but the alleged disabling condition itself, they can still be considered under SSR 19-4p.  Here, Social Security has given administrative guidance on how an individual with only a Primary Headache Disorder may still be found disabled even if a listing issue is not present.  These types of considerations are very rare, but they do exist and are often initially mishandled by Social Security due to their unique nature.


Your medical issue, whether it is a listing condition or not, may be disabling.  There is more to a claim for Social Security disability benefits aside from simply having a listing condition.  To win your disability claim, it is just as important to be able to show how your conditions affect you, if your conditions are exacerbated by each other or other problems, and how treatment has failed to relief these issues as it is to show you have a condition. 

At Gold, Khourey & Turak, we know the social security system and we know how to win you your benefits.  We have assisted the residents of West Virginia and Ohio in the Ohio Valley with their Social Security Disability claims since 1978.  From St. Clairsville and Steubenville in Ohio to Weirton and New Martinsville in West Virginia, and all cities in between, we are your local law firm of choice near you. 

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We have significant experience in presenting Social Security disability claims in the best way possible to ensure all of your conditions, not just those that are listings, are considered by Social Security examiners and administrative law judges.  If you are making a claim for Social Security Disability Insurance, Supplemental Security Income, VA Benefits, or another Social Security benefit please do not go it alone.  Call us today at (304) 845-9750 for a free consultation. 

If you have been denied social security disability, you only have 60 days to appeal.  It is important to contact our office when you receive the denial so we can begin working on your appeal.