By Marcello Cherchi, MD PhD
Disability is a legal status. The Social Security Administration (SSA) defines disability as the, “inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months” (https://www.ssa.gov/disability/professionals/answers-pub042.htm, accessed 11/7/22).
Given those criteria, who judges whether a person is disabled? “The determination of disability under the law ultimately depends on the SSA [Social Security Administration]” (Blake 2011). This is explicitly stated by the SSA: “A determination as to whether a claimant is disabled as defined in the law is made for SSA by a team, composed of a physician/psychologist and a disability examiner, working in the disability determination services (DDS) of the State in which the claimant lives” (https://www.ssa.gov/disability/professionals/answers-pub042.htm, accessed 11/7/22).
This means that your treating physician does not make a determination about whether you are disabled. Rather, the physician’s role is to provide the patient with objective information (such as from physical examination and/or from tests), which the patient then submits (either directly to the SSA, or through an attorney).
What sort of “objective information” is the SSA looking for? As far as disorders of equilibrium are concerned, the SSA refers to this as, “Disturbance of labyrinthine-vestibular function” (see section 2.07 of https://www.ssa.gov/disability/professionals/bluebook/2.00-SpecialSensesandSpeech-Adult.htm#2_07, accessed 11/7/22). Specifically, the SSA takes into account information relating to, “Disturbed function of vestibular labyrinth demonstrated by caloric or other vestibular tests.” Caloric testing is merely one of many vestibular tests, so the SSA leaves this description open-ended with the phrase, “other vestibular tests.” The specific vestibular tests that are relevant in a particular circumstance is decided by your physician.
In Illinois, on 1/1/2023 the state legislature (senate bill 03216) wrote into law that physical therapists can determine an individual’s driving disability (https://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=102-1011, accessed 1/9/23).
References
Blake, V. (2011). “A Physician’s Guide to Social Security Disability Determinations.” Virtual Mentor 13(12): 885-889.
