Written by:
Linda Cosme – Vice President of Disability Policy & Strategy, Citizens Disability
Disability Advice Tips for Medical Equivalence
When applying for Social Security Disability benefits, proving that your condition meets the Listing of Impairments set by the Social Security Administration (SSA) can be challenging. However, even if your condition does not exactly match a listed impairment, you may still qualify for benefits through medical equivalence. Medical equivalence allows claimants to receive disability benefits if their condition is equal in severity and impact to a listed impairment.
Understanding Medical Equivalence in SSDI Claims
The Social Security Administration (SSA) has strict medical criteria for approving disability claims, outlined in the Listing of Impairments. However, many individuals have conditions that don’t exactly match a listed impairment but still severely impact their ability to work. In these cases, medical equivalence becomes a crucial pathway to securing benefits. Medical equivalence allows a claim to be approved if the combined severity of a person’s symptoms and limitations is equal in impact to a listed condition.
Because SSA evaluates medical equivalence differently at various stages of the disability application process, it is important to present a well-supported case from the beginning.
Disability Advice fiercely advocates for medical equivalence at the initial and reconsideration level because Disability Examiners (DEs) have greater access to State Agency Medical or Psychological Consultants than Administrative Law Judges (ALJs) at the hearing level.
How Medical Equivalence Is Evaluated at Different Levels
Social Security Ruling (SSR) 17-2p, effective March 27, 2017, applies to all pending claims. SSR 17-2p states that, while at the initial and reconsideration levels medical equivalence is determined by medical and/or psychological consultants, at the hearing level it is ALJs “and some attorney advisors” who determine medical equivalence. To assist in the medical evaluation, adjudicators “may” request and consider medical expert evidence.
SSR 17-2p prohibits a disability examiner or an adjudicator from finding that a claimant’s impairments are medically equivalent to a listed impairment unless a medical consultant, psychological consultant, medical expert, or Appeals Council medical support staff opines that the claimant’s impairments(s) medically equal the listing. Under the Ruling, an ALJ or the Appeals Council are not required to obtain an opinion from a medical expert about medical equivalence if the ALJ or the Appeals Council believes that the evidence does not reasonably support a medical equivalence finding. An ALJ may not rely on a medical expert’s conclusory opinion that a claimant’s impairment(s) medically equal the listing, but “must ask the ME to identify medical evidence in the record that supports the ME’s” opinion that a listing is medically equaled.
Establishing Medical Equivalence
When determining medical equivalence, SSA considers whether a claimant’s condition is as severe as a listed impairment, even if it does not match exactly. This can be established in three primary ways:
- Listed impairment: If an individual has an impairment that is listed but he/she does not exhibit one or more of the findings specified in the listing, or he/she exhibits all of the findings but one or more is not as severe as specified in the listing, SSA can find the impairment to be medically equivalent to that listing if the individual has other findings that are at least of equal medical significance to the required criteria.
- Unlisted impairment: If an individual has an impairment that is not described in the Listing of Impairments, SSA can compare the individual’s findings with those for closely related listed impairments. If the findings are at least of equal medical significance to those of a listed impairment, SSA can find the individual’s impairment to be medically equivalent to that listed impairment.
- Combined impairments: If an individual has a combination of impairments, SSA can compare the individual’s findings with those for listed impairments. If the findings are at least of equal medical significance to those of a listed impairment, SSA can find the individual’s combination of impairments to be medically equivalent to the listed impairment.
Each of these pathways requires comprehensive medical documentation that clearly illustrates the severity and functional impact of the claimant’s condition.
Building a Strong Case for Medical Equivalence
Because medical equivalence decisions rely on professional judgment, claimants must present a well-supported case backed by detailed medical records, physician statements, and functional assessments. SSA looks for evidence that symptoms severely limit daily activities, mobility, and cognitive function, even if the medical condition does not meet the exact criteria of a listing.
Key steps to strengthening a medical equivalence claim include:
- Providing Extensive Medical Documentation – Claimants should submit test results, imaging, specialist reports, and detailed physician statements that highlight how their symptoms limit their ability to work.
- Demonstrating Functional Limitations – SSA evaluates how a condition impacts everyday life, including the ability to walk, lift, concentrate, and perform job-related tasks.
- Seeking Expert Opinions – A medical professional’s statement linking the claimant’s symptoms to SSA’s criteria can be crucial.
Without a strong case, SSA may deny a claim due to insufficient evidence. Since Disability Examiners rely heavily on medical and psychological consultants at the initial stages, claimants who advocate for medical equivalence early may improve their chances of approval without needing a lengthy appeals process. If your condition significantly impacts your ability to work, ensuring a well-documented claim can make all the difference.
Disability Advice Can Help You Prove Medical Equivalence
Establishing medical equivalence requires strong medical evidence and a clear understanding of SSA’s evaluation process. Disability Advice can guide you through this process by helping you gather comprehensive medical documentation, present your case effectively, and appeal a denial if necessary. If your condition does not meet a listed impairment but severely impacts your ability to work, contact Disability Advice today to discuss your options.
- Free case evaluation
- Assist with denied claims
- Ensure you have all documents
- Make the process easy for you
Written by:
Linda Cosme – Vice President of Disability Policy & Strategy, Citizens Disability
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“Professionalism at its best. From intake to getting my claim started, they are the ones you need. 100% recommend to everyone.”
Pablo P.
“Having never gone through this process before, it was very easy and straightforward. VERY professional and polite.”
Alan A.
“I had a great experience with my representative. She was very friendly and she made the process very easy. I’m glad I had the pleasure to work with her in filing my claim. She provided great customer service.”
Dana C.
“I was very nervous about reaching out for help with disability benefits. This experience was so much easier than what I thought it would be. They were understanding and supportive, and answered all of my questions. I would highly recommend them.”
Alice P.
“One of the best customer service experiences I have ever had. Patient and kind and couldn’t of made my experience better. Thank you for all the help.”
Jama M.
“The person I spoke with was very knowledgeable and very thorough with answering all of my questions and making sure all my information was correct. He was very patient, kind, and was very helpful. I wasn’t sure if I would qualify, and he checked and took all of my information. The process was made very easy, thank you so much for your help.”
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