March 2020


Rating SSA’s “4 Questions”
is Art, Not Science

obeseIn a recent newsletter, we described the four key questions being used by Social Security to evaluate the severity of a range of medical problems.

While these questions were initially used in mental impairment claims, SSA spread their use to virtually all neurological conditions and to many other medical impairments.

Briefly the four questions are:

  1. How do symptoms impact the ability to understand, remember or apply information;
  2. How is the ability to interact with others impacted;
  3. What is the impact on concentration persistence or maintain pace; and,
  4. How is the ability to adapt or manage oneself impacted.

If two of these four areas of function are “markedly impaired” SSA will usually find a mentally ill claimant entitled to benefits. For some neurological conditions, only one of these functional abilities needs to be markedly impaired.

Assuming the symptoms of the illness are consistently documented by the treating professionals, the issue is how to rate the severity of the impact.

Truly there is no objective standard and the ultimate decision-making rests with the Social Security Administration. However, SSA provides some guidance with definitions of the terms mild, moderate, marked and extreme.

“No impairment” in a specific functional ability means that the patient can function in this area independently, appropriately, effectively and on a sustained basis.

A “moderate impairment” indicates that that functioning is fair.

“Marked impairment” is characterized by a serious limitation in that area of function. This is the level of functioning that SSA believes significantly impacts the ability to work.

An “extreme limitation” means that there is no ability to function in this area independently, appropriately and effectively on a sustained basis.

Clearly even these definitions are subjective. The decisions are based upon the content of the clinical charts of the treating medical professionals.

One key is that the rating of severity should be based upon the most severe limitations. For example, a worker must be able to concentrate and persist without distraction and maintain a competitive pace. If any one of these three functional capabilities is markedly impaired then that suffices to meet SSA’s threshold. The same is true for the ability to understand and remember, and apply information as well as the ability to both manage and adapt in work settings.

For conditions such as Lupus, an older version of these criteria is still in the Listings and the focus is upon at least one marked limitation in activities of daily living, or in maintaining social functioning or in the ability to complete tasks in a timely manner due to deficiencies in maintaining concentration, persistence or pace.

Medical records which focus on these functional criteria will be stronger support for SSDI and SSI benefits.


In-Service Training at Your Office

If you and your agency want to explore these issues in more detail contact us for an in-service at your location where we can discuss the impact of your work on Social Security applications.



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at your location

If you and your colleagues, or your support group, want to learn more about how different medical impairments are analyzed by Social Security, contact us for one of our free in-service presentations. Consultations are always free.

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