The Social Security Administration awards disability benefits to people who have a severe medical condition that keeps them from working full-time for at least one year. In order to determine if your impairment is disabling, the agency will closely review your doctors' notes for information about your symptoms. This includes looking at your current and past medication lists to see how you've responded to any attempts at treating your condition.
There's no hard and fast rule that you need to be on medication in order to get disability benefits, but you'll have a very difficult time proving that you're disabled without taking any. With few exceptions, Social Security will conclude that if your condition doesn't bother you enough to take medication for it, then it's not so serious that it keeps you from working.
Furthermore, if you're not taking anything that might improve your symptoms, the agency can't tell if the medication would be effective enough in treating your condition that you'd be able to work. Social Security generally wants people to apply for disability as a "last resort," meaning they like to see evidence that you've tried reasonable measures to improve your health before you file for benefits. If you apply without having exhausted all your medical options, the agency will likely be skeptical about the claim that you can't work.
Part of any disability application—whether you're filing for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)—is Form HA-4632, the medication list. On the medication list, you're asked to provide the following information:
The form also provides a space for you to list any non-prescribed medications you're taking in addition to the ones doctors have prescribed for you. These can include over-the-counter pain relievers, herbal supplements, and vitamins. Keep in mind that Social Security typically considers prescribed medications to be stronger evidence of disability than those which don't require a doctor's approval.
There's no single "right" prescription that you can put on the medication list that will convince Social Security that you're disabled. Rather, the agency looks at your medical history as a whole to determine whether you meet a listed impairment or have a residual functional capacity that rules out all work. Part of that analysis includes seeing whether you're taking the proper kind of medication for your health condition, such as muscle relaxers for back pain or mood stabilizers for schizophrenia.
Social Security doesn't neglect the role side effects play in your daily functioning. For example, if you're taking blood thinners that successfully manage your heart disease but leave you feeling constantly fatigued, the agency must consider how your fatigue has an impact on the types of jobs you could perform.
Social Security may deny your disability application if you aren't taking prescribed medication that could clearly restore your ability to perform full-time work. Say you have epilepsy and your doctor prescribes you Lamictal (an effective, widely-used anticonvulsant) to treat your seizures. If you don't take the Lamictal, continue to experience seizures, and then file for SSI, your claim is likely to be denied—because Lamictal would probably control your seizures enough for you to engage in competitive employment.
In order for Social Security to deny you based on a failure to follow prescribed medication, the medication must have been prescribed by your regular doctor, as opposed to a consultative examiner or medical consultant for a stage agency. You also won't be denied for not making general recommended lifestyle changes, such as changing your diet or exercising more frequently. However, in some cases, medical advice to stop using drugs or alcohol can harm your claim.
Don't worry too much if you haven't been 100% compliant with your prescribed medications. Social Security won't deny you for minor deviations such as occasionally forgetting a dosage. And the medication must be so important to your health that not taking it makes the difference between whether or not you can work. Unless your doctor can state with confidence that the missing medication is the only thing keeping you from functioning at work, you have a good argument why your claim shouldn't be denied for failure to comply with treatment.
Social Security is aware that claimants may be justified in their refusal to take a prescribed medication, and have set out several "good cause" scenarios where a failure to follow treatment won't be held against you. Here's a few of the most common examples:
Social Security regulation SSR 18-3p specifically states that saying you were unaware that your doctor prescribed a medication is not considered a good cause for failure to follow treatment, so just saying you didn't know about it won't suffice. In this case, ignorance is definitely not bliss.
If Social Security already denied your claim for failing to take a prescribed medication, you should consult a disability attorney about your chances of winning on appeal. Your lawyer can help craft a successful argument for Social Security about why you were unable to take the medication, with reference to the good reasons listed above. And if your application was denied because you haven't had any consistent medical treatment at all, your representative can help you strengthen your claim by requesting a consultative examination.
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