Which Medical Conditions Qualify for Social Security Disability?

Which Medical Conditions Qualify for Social Security Disability?

The process to determine whether you qualify for Social Security disability benefits includes the use of two lists, one for adults and the other for children, of physical and mental impairments. The fact that you have a listed medical condition does not automatically make you eligible for benefits, nor does the absence of your condition from the list mean you cannot qualify for benefits.

Determining whether you qualify for benefits may also depend on the severity of the medical condition, your work history, and other factors, including which of the two disability programs administered by the Social Security Administration you apply to for benefits. The information that follows will give you a better understanding of the SSA process for deciding whether a medical condition qualifies for benefits.

What is a disability?

The SSA has two programs that pay monthly benefits to people who qualify as being disabled: Social Security disability insurance and Supplemental Security Income. A person applying for benefits through the SSDI program is disabled when unable to engage in substantial gainful activity due to a physical or mental impairment that is medically determinable. The impairment must be expected to last or has lasted for at least 12 consecutive months or it must be expected to cause death.

Adults applicants applying for benefits through the SSI program must meet the same definition of disabled that applies to applicants for SSDI. Social Security uses a different definition of disabled when a child who is under 18 years of age applies for SSI. The child must have a medically determinable mental or physical impairment causing severe functional limitations. The impairment must have existed or be expected to exist for at least 12 consecutive months or be expected to cause the child’s death.

Proving the existence of a medically determinable impairment requires evidence that may include the following:

• Reports from doctors and other health care professionals.
• Results of clinical medical or psychological examinations.
• Results of laboratory and diagnostic testing.

The SSA makes it a point to remind people that the success of an application for Social Security disability depends upon the medical evidence available to prove the existence of an impairment. Merely listing your symptoms and claiming to be disabled because of them will not lead to a favorable decision on your application unless you have the records and reports of doctors and other medical professionals establishing the existence of a medically determinable impairment.

What are the SSA listings of impairments?

To provide physicians and other health care professionals with guidance about the process used by SSA to determine what conditions qualify for Social Security disability, the agency publishes its Listings of Impairments. Separate lists for adults and children offer descriptions of impairments for each major system of the body that would prevent an adult from engaging in a gainful activity or, for a child on whose behalf an application for SSI benefits is under consideration, would cause marked and severe functional limitations.

A diagnosis by a doctor that you have one or more of the conditions from a Listing of Impairment may not automatically result in an approval for Social Security disability. The condition must satisfy criteria qualifying it as disabling.

For example, reconstructive surgery of a major weight-bearing joint, such as a knee or hip replacement, is one of the conditions included in the listing under the musculoskeletal system. It is not, however, sufficient on its own for you to qualify for disability benefits. There must also be evidence that your ability to effectively move about has not returned and left you with an inability to ambulate effectively.

The listings provide a detailed explanation of what is meant by “an inability to ambulate effectively.” Your medical records must include X-rays or other types of imaging along with a clinical record establishing that the condition failed to improve over time.

Examples of a few of the many medical conditions from the Listing of Impairments for adults include the following:

• Lupus, HIV/AIDS, and other immune system disorders.
• Joint and bone dysfunction, back and spine disorders, and other musculoskeletal conditions.
• Asthma, chronic obstructive pulmonary disease, and other respiratory disorders.
• Chronic heart failure, vein or artery disorders, and other impairments of the cardiovascular system.
• Vision and hearing disorders and impairments.
• Epilepsy and other neurological disorders.
• Loss of visual acuity, statutory blindness, and other sensory and speech disorders.

If you have a medical condition that is not among those on a Listing of Impairments, you still may qualify for Social Security disability benefits as long it can be proven through examinations, tests, and other evidence contained in your medical records. It must also be shown to limit what the SSA refers to as residual functional capacity, which considers exertional levels for various types of work ranging from sedentary to work requiring heavy lifting and other strenuous activity.

Consult a Disability Lawyer for Help Regarding Questions You Might Have

The rules and regulations controlling the process to determine if you have a medical condition making you eligible for Social Security disability payments are complex and can be confusing. A consultation with an experienced disability lawyer provides trusted legal advice and skilled representation to help you at all stages of the process from pre-application through appeals.