Obesity

The National Institutes of Health tells us that obesity is simply having too much body fat. The condition of being obese is different from being overweight, which, according to the National Institutes of Health, means weighing too much. (The apparent difference between obesity and overweight is that being overweight can be from any source such as muscle, bone, water or fat. On the other hand, obesity is solely from too much fat.)

Up until October 25, 1999, the Social Security Administration recognized the disease of obesity as a severe medical impairment that could qualify under the Listings of Impairments, listing 9.09. The condition for qualification was in 2 parts. The first part was having a weight which equaled or exceed the weight specified in the table (there was a table for men and a table for women). The table cross-referenced height and weight. The second part was having at least one of the following in addition to the weight: 1.) a history of pain and limitation of motion in any weight bearing joint or the lumbar spine with associated imaging studies; 2.) hypertension at or above a specified value; 3.) history of congestive heart failure; 4.) chronic venous insufficiency with pain on weight bearing and persistent edema; or 5.) respiratory disease at a specified level contained within a prescribed table.

Effective October 25, 1999 the Commissioner of Social Security deleted listing 9.09 “because our experience adjudicating cases under this listing indicated that the criteria in the listing were not appropriate indicators of listing-level severity. In our experience, the criteria in listing 9.09 did not represent a degree of functional limitation that would prevent an individual from engaging in any gainful activity.” (See POMS DI 24570.001 Evaluation of Obesity.) By September 12, 2002, the Commissioner of Social Security published its final Social Security Ruling (SSR-02-1p) which was designed to provide guidance on how the Social Security Administration evaluates obesity within the context of disability claims.

SSR-02-1p suggests that the diagnosis of “obesity” is one that is at first, left up to the medical professionals. It also provides that SSA can diagnosis obesity even if a physician has not made that diagnosis. Underpinning any diagnosis of obesity is a compliance with the Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults established and published by the National Institutes of Health. Once obesity is established, the 5-step sequential evaluation process is employed to determine disability. So, the obesity must be severe. The emphasis here is on the functional effect obesity as opposed to a name (i.e. “severe”, “morbid”, or “extreme”). Once severity is established, a determination must be made regarding whether the severe obesity equals a listing. Since there is no longer a listing for obesity by itself, the only way for obesity to qualify as a listing level impairment is for it to equal, in combination with another severe impairment, a listing. While all the severe impairments which make up listings can, in theory, join with obesity to equal a listing, three are three categories of severe impairments which are most commonly considered by the Social Security Administration.

The three categories are musculoskeletal, respiratory, and cardiovascular impairments. A fourth category is mental disorders. The point recognized by the Social Security Administration is that due to the pervasive effects of obesity, medically, the obesity itself may be substituted for, in the case of the musculoskeletal category, major dysfunction of a joint. In the categories of respiratory and cardiovascular impairments, obesity may cause additional workload on the body with respect to breathing and, in turn, causing the heart to work harder to pump oxygen through the body.

Even if there is no finding of equivalence, an analysis under Step-4 and Step-5 must be made. The Social Security Administration recognizes that obesity may adversely affect an individual’s ability to sit, stand, walk, lift, carry, push and pull. In addition, it may have a deleterious effect on fine finger manipulation; an ability to tolerate extremes of heat and humidity. It is well known that sleep apnea may be caused by obesity. Sleep apnea, in turn, makes a person sleep during the day thus compromising mental clarity. The Social Security Administration also knows that obesity may affect social functioning.

Even though listing 9.09 has been deleted, SSR 02-1p offers hope that the disease of obesity may still severe as a basis for disability.