Social Security Disability Lawyers: Riverside, Orange & San Bernardino Counties
Disability Benefits for Obesity
The Social Security Administration (SSA) does not consider "obesity," including morbid obesity, as a disabling condition per se. [Referenced, infra.]
What is Obesity?
The National Institutes of Health (NIH) established medical criteria for the diagnosis of obesity in its Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (NIH Publication No. 98-4083, September 1998).
These guidelines classify overweight and obesity in adults according to Body Mass Index (BMI). BMI is the ratio of an individual's weight in kilograms to the square of his or her height in meters (kg/m2).
For adults, both men and women, the Clinical Guidelines describe a BMI of 25-29.9 as "overweight" and a BMI of 30.0 or above as "obesity." Level I obesity includes BMIs of 30.0-34.9. Level II includes BMIs of 35.0-39.9. Level III, termed extreme or morbid obesity, includes BMIs greater than or equal to 40.
Approximately 35% of adults in the United States are considered "obese" (i.e., BMI >30.0).
The Clinical Guidelines do not provide criteria for diagnosing obesity in children. However, a BMI greater than or equal to the 95th percentile for a child's age is generally considered sufficient to establish the diagnosis of obesity.
Removing Obesity From the Social Security Listing of Impairments
On August 25, 1999, the SSA removed Listing 9.09, Obesity from the Listing of Impairments in 20 CFR, subpart P, appendix 1 (the listings)., at 64 FR 46122 (1999).
However, even though the SSA deleted obesity from its Listing of Impairments, in evaluating long-term disability claims, the SSA still takes into consideration the potential impact that obesity has in causing or contributing to impairments, especially in the musculoskeletal, respiratory, and cardiovascular systems.
The SSA recognizes that obesity increases the risk of developing type II (adult onset) diabetes mellitus, gall bladder disease (gall stones), hypertension, heart disease (heart attack), stroke, peripheral vascular disease, fatty liver ("NASH"), degenerative osteoarthritis in weight-bearing joints and in the spine, and sleep apnea.
Obesity has been associated with several cancers, including uterine (endometrial), breast, prostate, and colon cancers.
Treatment of Obesity
Obesity is a life-long medical condition. Diet and exercise ("life-style changes") are often prescribed, but an initial successful weight loss is unfortunately usually followed by relapse. The recidivism rate is >90% in most studies.
Medications for weight loss include orlistat (Xenical), lorcaserin (Belviq), phentermine, topiramate (Qsymia), buproprion, naltrexone (Contrave), and liraglutide (Saxenda). They can have side effects, and it is debatable as to how well they work in the long-term. On average, in double-blinded, placebo-controlled clinical trials, medications may help you lose up to 3-9% of body weight.
Bariatric surgery (e.g., gastric by-pass, gastric sleeve) can achieve excellent results, but there are substantial risks and benefits that must of carefully considered.
Vagal nerve blockade involves implanting a device under the skin of the abdomen that stimulates the vagus nerve and sends signals to the brain to let it know when the stomach feels empty or full.
Disability Benefits for Obesity
Just having obesity by itself, even morbid obesity, does not automatically entitle you to long-term disability under the Social Security Act (SSDI) or an employer-based disability plans(ERISA).
However, if you have other medical conditions that are related to your obesity (e.g., heart disease) or limitations as to how long you can sit or stand; if you require a cane or walker; if you have chronic fatigue or need to rest or take unscheduled breaks; or, if you suffer from depression, then these are factors of disability that, if they are properly documented by your doctor in your medical records, may entitle you to an award of disability benefits.
Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.