Medical-Vocational Approvals in Social Security Disability Claim Processing

From Disability ESP Newsletter , V09, Issue 4 

By Loretta Crosby, Editor, Claims ESP Disability Newsletter

As I was reviewing the Disability Examiners’ Best Practices worksheet and trying to decide my feature article for this month’s newsletter, one thing kept popping out at me. And that was the Social Security Administration’s (SSA) commandment to its disability examiners to try to allow/approve a claim for disability at the earliest possible date by qualifying a claimant for a “med-voc” allowance instead of trying to qualify him/her using the SSA Book of Listings.

Of course, most claimants who get approved for disability benefits do not really care whether they are approved by “Meeting a Listing” as posted in the SSA’s Listings of Impairments book which examiners refer to on most cases, or whether they get benefits through the provision of a “Med-Voc” allowance, since the money is the same.

Still, it is a fact that most claims that are approved for benefits are based on what the SSA calls a "medical-vocational" allowance, so I thought it would be good to explore this topic.

This article will explain what a “Med-Voc” allowance is as it relates to the disability claims process, and hopefully allow you to put yourself in the picture to determine if your own disability/impairment might lead to a finding of “disabled” when you plug in all the factors that are considered in this type of claim allowance.

What is a Medical-Vocational Claim Decision?

Basically, a medical-vocational disability claim decision is when an examiner uses the SSA Grid Rules to determine whether a claimant should be found disabled or not disabled. For older individuals, 50 or over, it is much easier to get approved for benefits using the Grid Rules.

The gist of the rules is to allow a claim the moment you know that the applicant meets the medical-vocational allowance criteria based on their age, education, previous work skill level and current functional limitations (i.e. can a claimant do sedentary, light, medium or heavy level work given his current medical conditions).

Using the SSA GRID Rules

As an examiner, I often used the GRID rules to allow claims when the claimant was aged 50 or more. Of course all claims allowances / approvals have to have medical records as their foundation to show disability, but once you have established that an older claimant can only do light work – for example -- based on his/her physical impairments, and if the only work that claimant has ever done required a greater exertional level than that, lets say medium level work, then the examiner does not have to try to prove that the claimant meets every medical prerequisite as listed under their particular condition in the SSA Blue Book in order to approve the claim.

In essence, granting a Med-Voc claim approval is an easier way to allow a claim for that older individual.

Because the rules take into consideration physical exertional limitations, which should not change if a claimant is alleging a purely mental disability, the SSA Grid Rules Chart can only be used for claimants whose allegations include a severe physical disability.

An Example of Using the Med-Voc GRID Chart to Reach a Claim Decision

So let’s take a pretend case scenario to try to explain what happens.

You, as claimant, come in with “failed back surgery syndrome” -- yes, there have been so many of them that this condition actually has a name. You claim the pain prevents you from driving your truck long distance as was required in your last job. You have been a long distance truck driver for the past 30 years.  You have a HS GED and you just turned 53 years old.

I, as disability examiner, receive the case and the first thing I do after noting your age, educational level and guessing the skill level of the work you did, try to determine what physical exertional level of work that I must get you “down to” in order to allow your claim using the GRID rules, or the Med-Voc rules.

I look at the work history information you gave to try to determine what exertional level you say you did on your last job. You tell me you did not do any lifting on your job, that all you had to do was drive the 18-wheeler tractor trailer to the destination, fill out some paper work and let someone else unload the cargo for you.

As an experienced claims examiner, I do not believe your exertional level is “Sedentary” which is what you infer when you tell me you did no lifting on your job. So even though you sat down for a lot of the eight hours on the job, I decide I had better look up your job in the Dictionary of Occupational Titles (DOT) for a more accurate work exertional level.

I do this and see that your job is classified as “medium level” work, and is considered “semi-skilled” work. For the purposes of this example, I use this job description as noted  from the DOT listing below.

The DOT has little codes at the bottom of the description that tell me other things about your occupation. This last line:

tells me that the strength of the job was “M” for medium level work (i.e. exerting 25 to 50 pounds of force occasionally, and/or 10 to 20 pounds of force frequently).

The SVP (Specific Vocational Preparation) code of 3 tells me the work is considered semi-skilled work. [For more detailed information on the codes, see our article resource directory at the end of this page.]

So using this additional DOT information, I then consult the GRID rules and look under your appropriate age category as well as the exertional level I need to get you down to. In this case it is light work, which is one step down from medium level work.

If you are 50 or over, the examiner will always try to get you down at least one exertional level because it will be much easier to get a “disabled” finding on your claim if you can not do the exertional requirements of your past job(s).

This means I will be checking your medical records as they come in and hoping that they will show you can no longer do your past work exertional level. Because if you are 50 or over, even if you are found to be able to do the next exertional level, i.e. you go from being able to do medium level work to now only being able to do light level work because of your disability, then I have a good chance at being able to allow your claim based on what the GRID rules dictate.

In this example, I like Grid Rule 202.06 as a starting point because I know if your medical records indicate you are no longer capable of medium level exertion on your job, this rule found under the “Light Level” rules may allow me to approve your claim.

It may sound complicated, but in effect, because you are at least 50 years of age, I am simply looking at your past work exertional requirement of “Medium” and looking at the next level down, “Light”, to see which rule I will use to allow your claim in the event that your medical records show that you can now only do light work.

Reading the GRID Chart

In the chart below, extracted from the GRID rules, the first column indicates the Rule # that must be cited by the claims examiner if your claim is allowed; the second column indicates your age status; the third column indicates your educational level; the fourth column indicates your SVP work skill level; and the fifth and final column tells me whether or not you should be determined “disabled” or “not disabled.”

Table No. 2—Residual Functional Capacity: Maximum Sustained Work Capability Limited to Light Work as a Result of Severe Medically Determinable Impairment(s)

By using the GRID chart, I do not have to go to the SSA Blue Book of Listings which requires me to show x,y and z in your medical records file in order to allow your claim. It can be very difficult to approve your claim if you are missing one of the prerequisites listed in that book.

So instead I use the GRID rules which tells me plainly that a person of Advance Age (50-54—column 2), who can only do light work (see the heading for this GRID rule which will indicate we are looking at “Light” level work), with a 12th grade education (Column 3) should be approved for benefits, or found “Disabled”. As previously noted, I used the DOT listings to determine the work skill level which was indicated as semi-skilled.

After this initial review of your claim, with no medical records yet in file, I now know that if I receive any medical records on you, that I only have to substantiate that you can no longer do your past medium level work in order to approve your claim. I then make a note of this somewhere in your file and just wait for the medical records to come in. I am hoping that the x-rays or range of motion studies that come in will suggest that you can only do "light" level work.

If the medical records show you can still do medium level work, and your claim does not meet the requirements listed in the SSA Blue Book, then your claim will be denied because even if you can not do your past work, there are hundreds of thousands of medium level jobs a semi-skilled worker will still be able to do in the national economy.

If, however, your medical records confirm that you can only do light level work as a result of your impairment, and I determine you have no transferrable skills from you past work, then I can site the GRID rule, 202.06, to allow your claim.

Find Yourself on the GRID Chart to Get a Clue of Your Potential Claim Outcome

Referring to the GRID rules chart can help you see in advance what category of applicants will be determined to be disabled based on their age, education, current work exertional level and past work skill level.

And generally, if you are over 50 or 55, the examiner just needs to prove you can no longer do any of your old jobs before granting benefits, i.e. if you used to do light work and can now only do sedentary level work, the GRIDS may dictate a finding of “Disabled”. Still, skill level and educational level are factors that must be considered as well as any transferrable skills you may have that might be used in "other" work.

But you should be able to get a good idea as to how your claim will play out by referring to the GRID charts if you are alleging a physical disability as the majority of these type claims are determined using these charts.

What you might conclude if you study the GRID charts is that if you are a younger individual with more than a high school education, it will be very difficult for you to get disability benefits if the examiner has to use the GRID rules to decide your claim in the event that your medical condition does not otherwise “meet” or mimic one of the listings found in the SSA Blue Book.

Questions about this article? Please visit our new Claims ESP disability forum to ask them. 

Resource Box:

Grid Rules – See the rules SSA / DDS uses to determine if you are disabled or not.

DOT Definitions – This is a site I found which gives some DOT explanations. I do not think it is the official DOT site, but I could be wrong.

Claims ESP Forum – Get your questions answered here from yours truly or others involved in the disability arena.

SSA Listings of Impairments – Your claim will either be decided using these rules or the Grid Rules.

Get help with your claim – Free Claim Evaluation in Selected States.

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