The Social Security Administration (SSA) has issued a new Ruling about evaluating disability cases involving primary headache disorder.

Primary headache disorders are a collection of chronic headache illnesses characterized by repeated exacerbations of overactivity or dysfunction of pain-sensitive structures in the head. Examples include migranes, tension headaches and trigeminal autonomic cephalalgias.  They are typically severe enough to require prescribed medication and sometime warrant emergency department visits.  Physicians diagnose primary headache disorder only after excluding alternative medical and psychiatric causes of the symptoms, and after review of the full medical and headache history and conducting a physical and neurological examination.  The International Diagnosis of Headache Disorders -3 criteria are used to as diagnostic criteria and are included in the Ruling.

A diagnosis or statement of symptoms is insufficient to establish primary headache disorder as a medically determinable impairment.  To establish primary headache disorder as a medically determinable impairment, there must be consideration of the following findings by an acceptable medical source:

— A primary headache disorder diagnosis which must document review of medical history, a physical examination, and excluding alternative medical or psychiatric causes.

— An observation of a typical headache event by the acceptable medical source.  In the absence of such direct observation, Social Security can consider a third party observation of a typical headache event.

— Remarkable or unremarkable findings on laboratory tests. Social Security will not purchase tests related to headaches or allegations of headaches.

— Response to treatment.  Evidence documenting ongoing headaches that persist despite treatment may constitute medical signs to help establish a medically determinable impairment.

Although primary headache disorder is not a listed impairment, it can, alone or in combination with other impairments, medically equal a listing.  Epilepsy (listing 11.02) if the most closely analogous listed impairment to primary headache disorder.

If primary headache disorder does not medically equal a listed impairment, Social Security assesses residual functional capacity.   For example, symptoms such as photophobia may cause difficulty sustaining attention and concentration.  (SSR 19-04p, August 26, 2019.)

The Social Security Administration (SSA) has issued a ruling explaining how cases pending at the Appeals Council will be adjudicated when the claimant has raised a timely challenge to the appointment of an administrative law judge under the Appointments Clause of the United States Constitution.

In Lucia v. Securities and Exchange Commission, 138 S.Ct. 2044 (2018), the United States Supreme Court held that the Appointments Clause of the United States Constitution requires that administrative law judges be appointed to their positions by either the President, a court of law of the department head.  On July 16, 2018, the Acting Commissioner of Social Security ratified the appointment of Social Security administrative law judges and administrative appeal judges and approved those appointments on her own.

The Appeals Council will grant a claimant’s request for review in cases where the claimant timely requests Appeals Council review of an administrative law judge decision or dismissal issued before July 16, 2018 and raises, either at the Appeals Counsel level or previously at the administrative law judge level, a challenge under the Appointments Clause to the authority of the Administrative Law Judge who issued the decision or dismissal in the case.

When the Appeals Counsel grants review in this situation, the Appeals Council will conduct a new and independent review of the claims file and either remand the case to an administrative law judge other than the judge who issued the decision under review, or issue its own new decision about the claim covering the period before the date of the administrative law judge’s decision.  In its review, the Appeals Counsel will not presume that the prior decision was correct.

In cases where the administrative law judge dismissed a request for hearing, the Appeals Council will vacate the dismissal order.  It will then either decide whether the hearing request should be dismissed or remand the case to another administrative law judge to determine that issue.

In these cases, the claimant may ask to file briefs with the Appeals Council.

When the Appeals Council grants review, it will mail a notice to all parties stating the reasons for the review and the issues to be addressed.  The Appeals Council will either remand the case to a different administrative law judge, issue a new, independent decision, or issue an order dismissing the hearing request.  (SSR 19-01p, March 15, 2019.)

The Social Security Administration (SSA) has issued a new ruling about evaluating disability cases involving obesity.  This ruling rescinds and replaces Social Security Ruling 02-01p.

Obesity can be a medically determinable impairment when established by objective medical evidence from an acceptable medical source.  Social Security will not use a diagnosis or a statement of symptoms to establish a medically determinable impairment.  Signs and laboratory findings that may establish obesity as a medically determinable impairment include measured height and weight, measured waist size and body mass index, each measured over time.

Obesity is defined as a body mass index of 30.0 or higher.  No specific weight or body mass index establishes obesity as a medically determinable impairment or a severe impairment for purposes of the Social Security disability program.  If a person’s body mass index is within the normal range, they may still have obesity if their waist measurement is high.

In determining whether obesity is a severe impairment, Social Security considers all symptoms such as fatigue or pain that could limit functioning.  Social Secuity also considers functional limitations from obesity and any other physical or mental impairment.  If a person’s obesity, alone or in combination with other impairments, significantly limit physical or mental ability to do basic work activities, the impairment is severe.

Although obesity is not a listed impairment, the functional limitations caused by medically determinable impairment of obesity, alone or in combination with another impairment, may medically equal a listing.

Social Security must consider the limiting effects of obesity when assessing a person’s residual functional capacity.  Social Secuity assesses residual functional capacity to show the effect of obesity upon the person’s ability to perform routine movement and necessary physical activity within the work environment.  The combined effects of obesity with another impairment may be greater than the effects of each impairment considered separately.  (SSR 19-02p, May 20, 2019.)