Social Security Disability, Veterans Benefits

In its ongoing efforts to revise and refine the guidance given to Judges and Adjudicators on how to determine total disability, the Social Security Administration has again revised its analysis of obesity and its impact on the ability to sustain work activity.

Historically, Social Security clearly felt that severe obesity was a critical issue and could preclude full time work. Prior to October 1999, there was a Listing for obesity in the Listings of Impairments However, in that year, SSA deleted that Listing and made it much more challenging for people suffering from severe obesity to obtain benefits.

Recognizing the problem, SSA issued a Ruling in 2002 focusing on obesity and the analysis for Social Security disability benefits. Recently, however, SSA rescinded the 2002 Ruling and issued SSR 19-02p which now is the guideline for the evaluation of obesity related problems.

In SSR 19-02p, SSA acknowledges that obesity can be a medically determinable impairment which can cause severe functional limitations. The Ruling does not define obesity, but notes that for some people, it means a BMI of 30 or more. For other people, the Ruling notes that BMI may be more normal, but the accumulation of fat around the waist may be defined as obesity.
SSA will consider obesity to be a medically determinable impairment if there are objective findings in the medical charts to support the diagnosis. A physician’s statement of obesity is not sufficient. SSA wants the medical chart to include height, weight, waist sizes and BMI over time.

The Ruling notes that obesity may cause symptoms such as fatigue, and may worsen other medical problems such as diabetes, heart disease, respiratory problems, arthritis, mental impairments and cancer. It may impact exertional activities such as sitting, standing, walking, lifting, and non-exertional activities such as balancing, stooping, kneeling and crouching. It could also increase stress on weight bearing joints and limit range of motion. Extreme fatty tissue in the hands could impact fingering and manipulation of objects.
All of this is based upon the content of the medical charts. Patients must have their weight, height, waist size and BMI regularly documented and must be consistently recorded signs at every medical visit.

Unfortunately, there was some analysis in the 2002 Ruling that has been deleted. That Ruling explained that the inability to follow a diet or lose weight is not necessarily a failure to follow medical treatment. Explicit language on this issue was helpful.

In the 2002 Ruling, SSA described how to analyze the failure to follow prescribed treatment for obesity. That Ruling specified that this is only an issue if there is actually a prescription issued for treatment with the expectation of improvement which would resolve disability. Most weight loss goals in treatment are much more modest. This important caveat is eliminated in 19-02p.