Does Social Security Consider Genetic Testing When Evaluating a Disability Claim?

by | Published on Jun 1, 2016 | Social Security Disability

When evaluating a disability claim, the SSA performs a medical record review considering all the medical evidence they receive including genetic test results. A genetic test can be used to confirm a hereditary disease. Typically, medical professionals order this test to diagnose a particular disorder/disease and help predict the extent of disease features or the risk of a person developing a condition. These provide valuable information that can be used for research and treatment purposes.

However, this test alone is not sufficient to prove that one is eligible for SSA disability insurance. Social Security does not order these tests as part of a CE or Consultative Examination. A genetic test does not describe how severe the condition is or prove that a person’s ability to work is impaired. SSA requires applicants to present evidence about their medical impairment (s) for a period of at least 12 months that precede the month in which a person files an application.

Genetic test results are considered objective medical evidence that constitute lab findings. However, these tests are not required for a finding of disability. Typically, the SSA receives genetic test results from clinical geneticists or physicians specializing in the diagnosis and management of hereditary disorders, other physicians and genetic counselors. Genetic test results from all sources, medical and otherwise are considered when available. A complete medical records review including genetic test results is made when setting diary dates for a continuing disability review or CDR. However, genetic tests are so diverse and the information they provide are of different types. Therefore the impact of genetic test results on diary lengths may vary.

In its recent ruling, Social Security Ruling, SSR 16-4p; Titles II and XVI: Using Genetic Test Results to Evaluate Disability, the SSA describes how it uses genetic tests to determine eligibility for SSDI and SSI benefits.

Genetic tests act as a useful complement to the other relevant medical evidence presented along with a disability claim. These must be supported by the other medical facts to prove that the particular condition severely limits one’s ability to work. It is important that the testing is recommended and performed by an Acceptable Medical Source (AMS). SSA will not accept tests performed by non-medical genetic counselors, or results obtained from over-the-counter home test kits.

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