Obesity and Social Security Disability
By Pitt Dickey

This column will examine how the Social Security Administration (SSA) evaluates obesity in Disability Insurance Benefits claims. Until 1999, the SSA could approve the payment of disability benefits to a claimant if the person met certain weight standards in an Obesity listing used by the SSA. However in 1999 the SSA deleted the Obesity Listing and de-emphasized the effect of being overweight in the disability insurance system.

In September 2002 the SSA issued a new policy on obesity which it now follows to consider the effect of being overweight in a person's disability claim. The remainder of this column will look at this new ruling on obesity and disability benefits. The SSA defines obesity as "a complex, chronic disease characterized by excessive accumulation of body fat. Obesity is generally the result of a combination of factors - genetic, environmental and behavioral." The SSA uses a scale called the Body Mass Index (BMI) which was developed by the National Institute of Health to classify obesity in adults. The BMI is the ratio of a person's weight in kilograms to the square of his height in meters. This is awkward to visualize without an example using pounds and inches of height. I'll give an example in English as to what this means to the average person.

For example Joe is 5' 10" tall and weighs 245 pounds. Joe is 70" tall. The conversion for 1 inch equals 2.54 cm. The conversion for 1 pound equals .4536 kg. To see what Joe's BMI is 70" x 2.54 cm equals 177.8 centimeters. 177.8 centimeters equals 1.778 meters. To convert Joe's weight, 245 pounds x .4536 kg equals 111.13 kilograms. To compute Joe's BMI we need to figure the square of his height, 1.778 x 1.778 equals 3.16. The ratio is Joe's weight 111 kg divided by the square of his height 3.16. 111 divided by 3.16 equals a BMI of 35.12. If you are curious you can figure out your BMI using the above example.

The SSA has three levels of obesity. Level I is for people with a BMI of 30-34.9; Level II is for people with a BMI of 35.0 -39.9, Level III is for people with a BMI of above 40. Joe's BMI of 35 puts him at Level II. People at the Level III of BMI are described as having "extreme" obesity with the greatest risk of developing obesity related health problems.

The SSA notes that treatment for obesity "is often not successful." The SSA recognizes that obesity is a risk factor that increases a person's chance to have a variety of impairments. The SSA notes that obesity can lead to "chronic diseases of the cardiovascular, respiratory, and musculoskeletal systems. Obesity increases the risk of developing impairments such as Type II diabetes; gall bladder disease; hypertension; heart disease; peripheral vascular disease; dyslipidemia (excess fatty materials in the blood); stroke; osteoarthritis; and sleep apnea." Obesity is also associated with endometrial, breast, prostate and colon cancers and can contribute to depression. The SSA also recognizes that obesity effects can "be subtle, such as the loss of mental clarity and slowed reactions that may result from obesity related sleep apnea."

The SSA generally accepts the opinion of the claimant's treating physician to establish a diagnosis of obesity. Obesity is considered by the SSA over a period of time. Temporary weight losses are not considered a cure for obesity. Even though obesity no longer has its own Listing to determine disability, the SSA can find that a person equals another listing as a result of health related problems due to obesity. Obesity is determined to be a "severe impairment" when either alone or in combination with another "medically determinable impairment, it significantly limits an individual's physical or mental ability to do basic work activities." The SSA does not have a specific weight or BMI rating that equals a "severe impairment". The issue is whether the person's obesity is so severe that it limits his abilities to do basic work activities.

As there is no specific Listing for obesity, the SSA can find a person "meets" the requirements of a Listing if he has another impairment that alone meets the requirement of a Listing. The example used by the SSA cites a case where "obesity may increase the severity of a co-existing or related impairment to the extent that the combination of impairments meets the requirements of a Listing." The SSA finds this combination to be "especially true" when the obesity is combined with "musculoskeletal, respiratory, and cardiovascular impairments." For example, there is an Orthopaedic Listing under which a claimant can be found disabled if he is "unable to ambulate effectively", this is typically as a result of some sort of bone injury or illness such as arthritis, but obesity can be of such a degree that it can "substitute for the major dysfunction of a weight bearing joint." Such a finding could allow the SSA to pay the disability claim of the person with arthritis and obesity.

If a person has a variety of health problems, none of which meet the level of severity that is required by the SSA for disability, the SSA can consider the impact of the person's obesity with the other problems and find that he meets the Listing. The example used by the SSA is "obesity affects the cardiovascular and respiratory systems because of the increased workload the additional body mass places on these systems. Obesity makes it harder for the lungs to expand. This means that the respiratory system must work harder to provide needed oxygen. This in turn makes the heart work harder to pump blood to carry oxygen to the body."

The SSA recognizes that obesity can cause limitation of physical function. An obese person may have limitations "in any of the exertional functions such as sitting, standing, walking, lifting, carrying, pushing and pulling. It may also affect ability to do postural functions such as climbing, balance, stooping and crouching."

The SSA is in fact very understanding of the limitations and health problems that obesity can cause despite the fact that the SSA deleted the specific Listing for obesity.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 555 Executive Place, Fayetteville, N.C. He can be reached at 485-8020 or by email at pitt@smithdickey.com.