Some medical conditions can automatically qualify you for disability benefits. In its “Blue Book,” the Social Security Administration (SSA) lists the conditions it will consider for reviewing and approving disability claims.
"Disability" refers to any condition that prevents a person from performing a substantial gainful activity as a result of a medical or physical impairment, which can be expected to result in death or can be expected to last for a prolonged period of not less than 12 months.
Effects Of A Disabling Medical Condition
You may be facing several difficulties due to a medical condition, and these challenges may determine your eligibility for disability benefits. If you are disabled and unable to hold down a steady job or any employment, you may experience:
- Constant state of financial strain
- Excessive stress
- Inability to perform basic life tasks without assistance
- Mental and emotional suffering
- Inability to engage in most of the activities that you enjoy
- Difficulty in providing for your family
Disabling Medical Problems
SSA provides financial assistance to disabled people with limited income and resources. Social Security disability benefits may be granted to those with the following medical conditions:
According to the Social Security Administration, the most common diagnosis affecting disabled workers who receive disability benefits is the musculoskeletal system and connective tissue. More than 32% of workers who received disability benefits had these conditions. The conditions that fall under this disorder category include:
To be eligible for benefits under this medical diagnosis, a person with rheumatoid arthritis — a disorder of the immune system — must experience significant limitations on their ability to work.
This includes conditions wherein the spine is curved abnormally due to scoliosis, degenerative disc disease, a ruptured disc, or spinal disorders, which result in the impairment of other bodily systems and the ability to walk. When a disability diagnosis is based on back pain, function's intensity and limitations are considered.
People with fibromyalgia suffer from widespread pain in their joints, tendons, muscles, and soft tissues that last longer than three months. Claims reviewers will determine if there is enough evidence to show that a person has limited employment opportunities due to their condition.
Reflex Sympathetic Dystrophy (RSD)
RSD is a painful condition caused by trauma to one extremity characterized by intense burning or aching pain. This is usually caused by disease or surgery, and it comes with many identifiable symptoms.
SSA statistics show that nearly 20% of disability benefits are granted to people with qualifying mental disorders. There must be an extreme limitation in functioning independently due to a medically diagnosed mental illness to qualify for benefits. The SSA classifies mental disorders into the following categories:
Mood disorders include anxiety disorder, panic attacks, or depression. To be considered, the condition must prevent the individual from comprehending and applying information, concentrating, having social interactions, and managing oneself.
Schizophrenia Or Other Psychotic Disorders
Examiners of disability claims look for evidence that the individual is delusional, hallucinating, and disorganized as a direct result of their schizophrenia or other psychotic conditions.
Organic Mental Disorder
To be eligible for SSDI benefits under organic mental disorders, also known as organic brain syndromes, an individual must display one or more symptoms such as confusion, loss of intellectual ability, memory loss, etc.
Post-Traumatic Stress Disorder (PTSD)
These are anxiety disorders like post-traumatic stress result from trauma. If PTSD is properly documented, the person may have a disabling mood disorder.
Autism spectrum disorders may qualify for disability benefits under several conditions. Claims reviewers will check if they have deficiencies in verbal communication, non-verbal communication, social interaction, understanding, recalling and applying information, interacting with others, and managing oneself.
Alcoholism Or Drug Addiction
The disability claim will not be granted if drug or alcohol abuse contributes to the condition. The SSA does not classify drug or alcohol abuse as an organic mental disorder.
The Social Security Administration reports that approximately 10% of claimants awarded benefits had circulatory problems. There are circulatory disorders that affect blood circulation to and from the heart. Examples of cardiac and circulatory disorders include:
A claim of disability cannot be supported by chest pain alone. Angina is the most commonly occurring form of cardiac disease.
High Blood Pressure / Hypertension
Hypertension can lead to heart disease, stroke, and other cardiovascular conditions if not managed properly. The criteria that evaluate applicants with high blood pressure are the same as those with chronic heart disease or coronary artery disease.
Coronary Artery Disease
Myocardial ischemia is characterized by decreased blood and oxygen supply to the heart due to constriction of the coronary arteries from plaque buildup. Total functional impairment may result in coronary artery disease. When filing for disability benefits, claims examiners consider the impact on an individual's functional capacity.
Abnormal Heart Rhythm (Arrhythmia)
Arrhythmias can take many forms and can be identified by their location and effect on the heart's rhythm. The most severe arrhythmias originate in the lower chambers caused by heart disease.
Congenital Heart Defects
After undergoing surgical treatment (heart valve, lesions, or pacemaker insertion) for a congenital heart defect, an individual must wait for at least 12 months to qualify for disability benefits.
A tumor, also known as a lump, is an abnormal tissue mass. Depending on the type of tumor, it can be malignant (cancerous) or benign (not cancerous). It is estimated that 9.2% of the benefits granted in 2011 went to those with this type of disorder. Workers often develop mesothelioma and lung cancer as a result of their jobs.
According to the SSA, nearly 10% of the applicants awarded disability benefits have neurological disorders. The most common types of neurological disorders include:
Having Parkinson's disease may qualify you for disability benefits if you cannot work because of your condition. Individuals must have extreme limitations in motor function in their arms or legs, which results in limitations to standing from a seated position, balance while walking or using their arms, or physical limitations impacting their ability to interact with others.
The chronic pain caused by trigeminal neuralgia can be excruciating and may occur suddenly. This condition is often challenging to diagnose. It is important to consult an SSDI attorney to determine whether you qualify for benefits based on your diagnosis.
Chronic Fatigue Syndrome (CFS)
This disorder is characterized by a wide range of symptoms of variable severity and duration. There is a substantial reduction in work, social, and personal activities caused by excessive fatigue that lasts for at least six months. When supported by medical evidence, chronic fatigue syndrome can be regarded as a disability.
Blind or partially sighted people have special disability rules because of the effect blindness has on employment. The Social Security definition of blindness is when your vision cannot be corrected to 20/200 or better in your other eye. You may qualify for disability benefits even if you are already earning money.
A compressed or irritated sciatic nerve can cause severe pain in your lower back and shooting pains in the legs. The pain may prevent you from standing on your feet for long periods, thus making it hard to hold down a job. In determining whether the claimant has sought sufficient treatment, claims examiners will weigh the extent of the treatment.
According to the Social Security Administration, while profound deafness may qualify you for disability benefits, a moderate hearing loss does not qualify as a disability.
You may also qualify for SSDI benefits if you suffer from one of the following conditions:
- Consistent migraines
- Autoimmune system disorders like Lupus
- Digestive system disorders like Crohn’s disease or irritable bowel syndrome
- Genitourinary system disorders like kidney disease
- Respiratory system disorders like emphysema, asthma or chronic obstructive pulmonary disease, or COPD
According to the Social Security Administration, specific impairments are considered so severe they automatically qualify a person for disability benefits, as long as all other criteria are met. There are 30 conditions described in the "Blue Book" defining the medical evidence required to prove impairment.
It is also possible to be declared disabled if you suffer from a condition equally severe as one of the impairments listed above. Suppose you can demonstrate that your condition prevents you from working or doing any other type of work. In that case, you may qualify for disability benefits even if you don't have a listed impairment or one equal in severity to a listed impairment.
Impairments Not On The SSA’s List
Some conditions not listed on Social Security listing of impairments may still qualify you for disability benefits. Among such conditions are celiac disease and carpal tunnel syndrome.
The SSA requires a formal diagnosis showing that your condition causes a "medically determinable impairment" that prevents you from functioning on a full-time basis. In other words, you must be unable to perform your daily activities due to your illness, also referred to as “residual functional capacity.”
Your disability might be considered equal to a listed condition if it meets the SSA's requirements. Your doctor must provide you with a diagnosis to prove your condition, but it does not mean you will automatically be approved for benefits.
Severe Medical Conditions
The SSA must recognize your impairment to award benefits, regardless of whether or not they are listed. Your diagnosis and medical records must meet SSA's medical requirements for a specific condition.
Ensure the medical evidence you present corresponds to the symptoms, signs, and other impairment criteria. You can still submit medical evidence if you do not meet all the criteria of a listed condition.
As part of its review, the SSA can determine if the symptoms are equivalent to an impairment they consider severe.
Challenges In Applying for Disability Benefits
According to the SSA, many disability benefits applications have been denied for various reasons, including technical problems or disqualification based on medical information.
The disability benefits application process can be challenging for many applicants. If you need help completing your Social Security Disability application, you can consult with a third party who can help review your application, saving you time and helping you avoid errors that could delay your application.
How A Lawyer Can Help You File For Disability Benefits
Understandably, the Social Security Administration's list of medical impairments that qualify for disability benefits can be confusing for those seeking disability benefits. If the administration denies you SSDI, you can hire an attorney to appeal the decision.
It will take some time to prove your disability, but you do not have to do it alone. The Social Security Administration lets you designate a representative who can:
- Correspond with the SSA on your behalf
- Compile medical records to apply for benefits
- Fill out legal paperwork on your behalf
- Accompany you to interviews or hearings to complete your application
In the case of applying for SSDI or SSI, an attorney will make sure your application is accurate. A security disability attorney handles every aspect of the claim, from filing the claim to appealing the decision so that clients can focus on their health and well-being.
They will provide you with legal information about the Social Security Administration's designated conditions and medical requirements, as well as your disability claim status. The doctors can advise you if further evaluations are necessary to establish your disability.
Additional Information For Disability Benefits Eligibility
The SSA outlines some of the requirements to apply for SSDI and SSI benefits. As part of your application, they will request additional information beyond these basic requirements. You may obtain benefits depending on how you answer these questions and how you present documentation.
Checklist for Online Adult Disability Application questions include the following:
- How old were you when you became disabled?
- How many years did you serve in the workforce before the disability?
- What is the nature and severity of your medical condition?
- What is your marital status?
- Do you have any dependents?
- Can you work to earn an income?
- What is your education and work history?
An experienced disability attorney or advocate may increase your chances of being awarded benefits. They can help you complete paperwork, ensure all deadlines are met, and represent you at a hearing. To learn what conditions automatically qualify you for disability, you can refer to the SSA's Blue Book.Are you interested in learning more about the various social security programs that help people with disabilities? Read more of Disability Help’s resources on our website!