In order to receive Social Security Disability benefits, a person must have one of the Social Security disability qualifying conditions. Understanding the guidelines and qualifying conditions can be complicated. A Social Security disability lawyer can help people understand if their conditions qualify.
Understanding Social Security Disability Qualifying Conditions Is Difficult
To qualify for Social Security Disability Insurance (SSDI) benefits, disabled individuals must meet a number of requirements in a variety of areas. While Social Security Disability (SSD) benefits provide support to people who are unable to work because they suffer from disabling mental, physical or developmental conditions, qualifying for benefits can be challenging even for people with highly debilitating conditions. Because the Social Security Administration has such strict qualification guidelines, even people with severe impairments often have their claims denied if the impairments are not social security disability conditions.
The SSD Blue Book of Impairments and Its Role in Determining Disability Eligibility
The SSD “Blue Book” impairment listing is one important resource for Chicago disability applicants to understand. Formerly known as Disability Evaluation Under Social Security, this book is among the first measures the SSA uses to determine whether an individual is disabled. It lists what medical conditions qualify for social security disability benefits.
Blue Book overview
The Blue Book’s main audience comprises medical and SSD professionals. Physicians use the SSD blue book to determine whether patients meet Social Security disability conditions. SSA consultants reference the book when evaluating disability claims.
The SSD Blue Book contains information about SSD benefits and eligibility criteria. This includes:
- An overview of the program, SSA’s definition of disability, and the claim evaluation process.
- The standards for acceptable evidence.
- The listing of impairments. Adult and childhood listings are separated and divided into specific groups of conditions. Each listing is accompanied by requirements the condition must meet to be considered disabling.
Simply being diagnosed with a condition that is included in the Blue Book is typically not enough to meet the Social Security disability conditions. A person must also meet medical criteria and functional limitations as well.
Social Security only considers physical or psychological impairments disabling if they meet set medical standards. To qualify, objective evidence must point to some physiological or psychological factor that causes disability. The condition also must be expected to prevent the victim from working for at least 12 months or end in death. Short-term conditions are not eligible for SSD benefits, no matter how debilitating they prove. They are not social security disability qualifying conditions.
Social Security’s “Blue Book” of impairments contains a list of what medical conditions qualify for social security disability most frequently. If a person suffers from a listed condition and fulfills related requirements, the condition qualifies as disabling. In these cases, the condition is found disabling based exclusively on medical evidence.
Social Security uses two measures to judge whether people can work despite a potentially disabling physical or mental condition. First, Social Security determines whether the victim is performing “substantial gainful activity.” SGA guidelines and income limitations typically change every year and vary depending on the circumstances of each case. If a person is blind or self-employed, for example, income and work hours limitations will be different.
If it is determined that a person can perform SGA, Social Security will not consider the person to have social security disability conditions.
If a person is not performing substantial work, Social Security assesses whether the person could resume past work or perform new work. To do this, Social Security evaluates the following variables:
- Extent of education
- Work experience
- Job-related skills
- Functional restrictions
If the SSA determines that a person can perform the level of work he or she performed previously, the person is not considered disabled. According to the SSA, they do not have social security disability qualfying conditions. When a person cannot return to any past jobs, Social Security evaluates whether other forms of employment are available. Claims examiners use a set of medical-vocational guidelines to determine whether a person can perform or learn new jobs. When an individual’s background and limitations effectively preclude employment, the person’s condition may be considered disabling. The SSA considers all of these factors along with the blue book impairment listing.
Obtaining SSDI Benefits for Specific Conditions
Impaired individuals pursue claims for SSDI benefits for a variety of reasons and the criteria that must be met for each is unique.
Social Security Disability Qualifying Conditions – Stroke
A stroke occurs when blood flow to the brain is disrupted causing brain cell damage. About 795,000 people suffer a stroke each year in the U.S. Sadly, stroke victims in Illinois may face various lingering physical and mental complications. While these complications can be highly debilitating, people who suffer impairments from a stroke will not receive an immediate claim decision. Social Security defers the decision because the long-term effects of a stroke are not always immediately clear. A stroke does not always meet the criteria for social security disability qualifying conditions. Some early side effects may resolve in time, while others may prove persistent. As a result, Social Security always evaluates these claims at least three months after a stroke occurs.
Stroke victims must document specific side effects to meet the listing requirements. Victims must struggle to form or understand words and, as a result, experience difficulty speaking or writing. Alternately, victims must struggle to control two extremities, resulting in issues with walking, fine motor movements or gross movements. These effects must be evident at least three months after the stroke occurs.
If a stroke causes other disabling conditions or impairments, a victim may qualify for benefits under another Blue Book impairment listing. For example, a person who experiences visual field loss due to a stroke may seek benefits under that listing. In this case, the individual would focus on documenting the visual loss, rather than the other effects of the stroke.
Social Security Disability Qualifying Conditions – Fibromyalgia
Fibromyalgia is a disorder that causes various debilitating symptoms, including muscle pain, joint aches, and fatigue. Fibromyalgia has no known cure and can be highly disabling. People who suffer from this disorder and cannot work gainfully may be eligible for Social Security Disability benefits.
Establishing a legitimate diagnosis of fibromyalgia can be challenging because many symptoms are subjective and self-reported. Furthermore, some physicians may incorrectly diagnose other cases of inexplicable chronic pain as fibromyalgia. Due to these issues, the SSA establishes specific medical requirements for applicants with fibromyalgia.
Fibromyalgia is considered a disabling impairment if applicants meet three requirements. Applicants must document full-body pain that has persisted for at least three months. They also must provide objective tests used to rule out other diagnoses. Finally, applicants must test positive for 11 out of 18 trigger points or document six established symptoms.
The SSA assesses medical records and evidence from other sources to determine whether a person has a disabling impairment due to fibromyalgia. However, applicants do not automatically qualify for benefits at this point. Applicants still must meet general requirements and prove their conditions prevent employment for fibromyalgia to be one of the social security disability qualifying conditions.
Social Security Disability Qualifying Conditions – Spinal Cord Injuries
Between 12,000 and 20,000 people will sustain spinal cord injuries this year, according to the Centers for Disease Control and Prevention. Another 200,000 people, including many Chicago residents, already live with these injuries. While recovery is possible after some spinal cord injuries, severe injuries may cause paralysis and other permanent complications. If a spinal cord injury significantly restricts a person’s daily functioning and ability to work, the victim may be eligible for Social Security Disability benefits.
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People with spinal cord injuries may qualify for SSD benefits by meeting the terms of two different blue book impairment listings.
- A spinal cord injury may meet the blue book impairment listing requirements for a disorder of the spine. Medical evidence must show that the injury affected the spinal cord and caused nerve root compression. This compression must also be evident through pain, limited mobility, and muscle weakness or atrophy. Loss of reflexes and sensation must accompany the muscle weakness or atrophy.
- A spinal cord injury that results in paralysis may be one of the social security disability qualifying conditions under the blue book impairment listing for spinal cord injury or nerve root lesion. The injury must cause impaired motor function in two extremities. This impaired function may manifest as paralysis, tremors, sensory loss or loss of coordination.
When a person does not meet the terms of either blue book impairment listing, the SSA evaluates how all of these symptoms and effects might collectively limit the disabled individual from working. If the individual cannot reasonably perform any kind of work, the SSA awards benefits through a medical-vocational allowance. If an individual can still do certain types of work, the SSA considers whether performing the work is reasonable for the individual, based on non-medical factors.
Social Security Disability Qualifying Conditions – Back Injuries
Low back pain is the second most common reason for doctor visits in the U.S. It is also the leading cause of disability among Americans over 45, leaving an estimated 5 million people temporarily or permanently disabled. Chicago residents who cannot work due to back injuries may need to collect Social Security Disability benefits. Unfortunately, claiming benefits for back injuries presents unique challenges.
The Social Security Administration only awards benefits for back injuries that are severe. To qualify for benefits, an applicant must meet an impairment listing and relevant criteria in the SSA Blue Book.
The SSD Blue Book recognizes various spinal conditions involving degeneration, inflammation or nerve issues. These include:
- Disc problems, such as degenerative disc disease or herniation
- Inflammation due to rheumatoid arthritis, spinal arachnoiditis or spondylitis
- Spinal stenosis
These conditions are considered disabling under Blue Book impairment listing criteria if they cause nerve compression. This must be evident through symptoms such as limited motion, pain or loss of sensation, reflexes, or motor skills. Alternately, people with spinal arachnoiditis or lumbar spinal stenosis may qualify for benefits by meeting condition-specific medical criteria listed in the Blue Book.
If an applicant does not meet Blue Book criteria, the Social Security Administration may consider the applicant’s functional capacity. Benefits may be awarded if an individual’s Residual Functional Capacity is limited enough to preclude all employment.
Social Security Disability Qualifying Conditions – Vision Loss (Blindness)
The Social Security Administration considers people with total vision loss disabled. Individuals with other visual impairments are not eligible unless their conditions worsen into statutory blindness. People with total vision loss will receive benefits if they meet non-medical criteria when applying for SSD benefits. Individuals with limited remaining vision may still meet the definition of blindness or otherwise qualify for benefits.
The SSA may consider the following conditions disabling:
- Statutory blindness- If corrected vision in the better eye is 20/200 or less, the individual is considered legally blind. Visual field contraction to an angle of 20 degrees or less in the better eye also constitutes statutory blindness.
- Poor visual efficiency- The SSA includes visual efficiency as a recognized impairment in the Blue Book. Efficiency less than 20 percent is automatically considered disabling, as is a visual impairment value greater than 1.00.
- Low vision- People who do not meet the above criteria can still qualify for benefits through a medical-vocational allowance. The SSA will evaluate the person’s ability to work despite the vision impairment before awarding benefits.
Individuals who are considered disabled due to their vision loss qualify for special programs and provisions. People with statutory blindness can earn greater monthly income without losing eligibility for SSD benefits. When considering blindness and disability, the SSA also lifts hourly work restrictions for self-employed individuals. In contrast, self-employed people with other disabilities cannot receive benefits if they work over 80 hours per month.
If blind individuals start working enough to exceed the monthly income limit, they are treated differently than other SSD recipients. Rather than terminating benefits, the SSA suspends payments. Then, during any month in which earnings fall below the threshold, benefit payments resume. To qualify, individuals must be older than 55. They also must perform less-skilled work than they did before the disability began.
Social Security Disability Qualifying Conditions – Drug Addiction
While the SSA does not consider drug addiction a disabling condition, drug use does not automatically prevent a person from receiving benefits. Substance abuse or addiction, however, can complicate an SSD claim. The Social Security Administration recognizes numerous substance addiction disorders including depression, anxiety, liver damage and pancreatitis. Someone who suffers from one of these conditions or another condition unrelated to the addiction may still qualify for benefits.
To be approved for SSD benefits while suffering from drug addiction, the claimant must be impaired with another qualifying condition that is expected to last at least one year or end in death. To receive benefits, the SSA must determine that drug use is not a “material factor” causing the existence or severity of the other condition. Drug use does not affect eligibility in the following situations:
- If a condition is disabling regardless of drug use, a person may receive benefits.
- Previous drug use contributed to the medical condition. The SSA can only consider the way ongoing drug use affects the disability.
- Drug use indirectly caused the condition. For instance, a person could become disabled after suffering an accident while under the influence. The circumstances do not prevent the person from receiving benefits.
If the SSA determines that the condition would improve in the absence of drug use, benefits aren’t awarded. To make this determination, the SSA evaluates how the drug addiction interacts with the disabling condition. For example, drug use and mental illness are often correlated. People with mental illnesses may use drugs to self-medicate. In turn, drug use can worsen existing mental health conditions. Establishing that a mental illness is independently disabling may prove challenging.
Other cases involving less readily visible or obvious disabilities may present similar issues. This makes preparing a strong, well-documented claim essential for anyone seeking benefits while living with a drug addiction.
Social Security Disability Qualifying Conditions – Mental Disorders
Mental disorders affect tens of millions of people in the U.S, according to the National Institute of Mental Health. For many Chicago residents, these disorders are highly debilitating. Approximately 10 million American adults suffer from mental disorders resulting in impairments significant enough to interfere with life activities.
Mental disorders can cause numerous cognitive issues, emotional changes, and physical effects. Fortunately, the Social Security Administration recognizes the severe impact of mental disorders. Social Security Disability benefits are available to victims who meet certain criteria.
The SSA includes numerous categories of mental disorders in its “Blue Book” impairment listing. If an individual suffers from a listed disorder and meets the associated severity criteria, the condition is presumed to be disabling. If the individual meets non-medical criteria, the SSA awards benefits without directly evaluating the individual’s ability to work.
The Blue Book contains three sets of criteria for every mental disorder, except intellectual and substance addiction disorders. An individual must only meet one set to qualify. The first criteria focus on symptoms or medical indicators of the specific disorder. The other sets of criteria establish functional limitations that would substantially affect an individual’s ability to work or perform daily activities.
If a person does not meet these criteria but suffers from symptoms or limitations of equal severity, the person may “equal” a listing and receive benefits. People who cannot “equal” listings may still receive benefits, based on the SSA’s evaluation of their Residual Functional Capacity.
People suffering from mental disorders often benefit from seeking the help of a Social Security Disability attorney. Understanding the qualifying criteria and documenting these disorders is often challenging, and claim denial is not uncommon. Partnering with an attorney can reduce the risk of filing missteps, improper documentation and other errors that result in denial.
Social Security Disability Qualifying Conditions – Autism
Autism and autism spectrum disorder (ASD) are general medical terms for a complex set of brain development disorders. The disorders are generally characterized by difficulties in social interaction, verbal communication, nonverbal communication, and repetitive behaviors, all in varying degrees.
According to Autism Speaks, approximately 1 in 88 American children are on the autism spectrum – ten times the number of children with autism 40 years ago. Studies show that boys are three to four times more likely than girls to develop autism, with an estimated 1 out of 54 boys and 1 in 252 girls diagnosed with autism in the United States.
For autism to be one of the social security disability conditions, the applicant must show that he or she exhibits deficient reciprocal social interaction, deficient communication/imagination, and a restricted repertoire of activities and interests. In addition, these deficiencies much cause serious limitations in at least two of the following categories:
- communicative/cognitive functioning
- social functioning
- personal functioning, and/or
- sustaining concentration, persistence, or pace.
Social Security Disability Qualifying Conditions – Down Syndrome
Down syndrome is a genetic disorder that affects mental, muscular and skeletal development. A small number of Down syndrome cases are mosaic, with the genetic abnormality only apparent in some cells. However, most cases are non-mosaic. Non-mosaic Down syndrome impacts every cell and can be highly debilitating. This condition can prevent victims from working gainfully or caring for themselves. Social Security Disability benefits may be available to people who have a non-mosaic Down syndrome.
The Social Security Administration automatically considers non-mosaic Down syndrome disabling. However, people seeking benefits must provide adequate medical evidence of the condition. The SSA requires one of the following forms of documentation:
- Karyotype analysis — a physician must sign the analysis or provide an accompanying statement that the person suffers from Down syndrome.
- A description of the analysis — if karyotype analysis was performed previously, a physician may give a statement describing it. The physician should also note any physical features the person has that support a diagnosis of Down syndrome.
- An independent report — in lieu of karyotype analysis, a physician may furnish a statement describing the person’s physical features. The statement should also include evidence that the person shows the same functional abilities as someone with Down syndrome.
Social Security Disability Qualifying Conditions – Early-Onset Alzheimer’s
Alzheimer’s is classified as early-onset when it develops before the age of 65, according to the SSD Blue Book. This neurological condition can have various detrimental effects on short-term memory, communication skills, reasoning, and behavior. Since Alzheimer’s is degenerative, victims often gradually lose the ability to work and even care for themselves. When this occurs, victims may be eligible for Social Security Disability benefits.
Victims of early-onset Alzheimer’s may receive SSD benefits by proving they meet criteria in the Social Security Administration’s “Blue Book.” The book includes a listing of organic mental disorders, which claims examiners use when evaluating claims involving any form of dementia.
Early-onset Alzheimer’s may be considered disabling if victims can document one recognized symptom of reduced cognitive function. Acceptable symptoms include memory problems, IQ loss, personality changes and loss of awareness of time and place. In addition to one of these symptoms, people seeking SSD benefits must document two of the following issues:
- Inability to act appropriately in social environments
- Difficulty maintaining focus and pace to complete tasks
- Limited ability to perform regular daily activities, including self-care
- Recurrent episodes in which symptoms become markedly worse
People seeking SSD benefits must support their diagnoses and claims with objective evidence. For victims of early-onset Alzheimer’s, this evidence could include laboratory tests or brains scans that reveal the condition. Statements from medical professionals and personal sources can also help establish the symptoms and functional limitations an applicant experiences.
If a person doesn’t meet the relevant SSD Blue Book terms, the SSA may find that the person’s impairments equal those listed. The SSA also may award a medical-vocational allowance based on a direct assessment of the applicant’s ability to work.
Early-onset Alzheimer’s qualifies for the SSA’s Compassionate Allowances program. This initiative provides quicker claim processing for common social security disability qualifying conditions. In Compassionate Allowances claims, minimal evidence is needed to support a final decision. Moreover, the SSA offers expedited processing and approval of these claims.
Applicants must provide adequate documentation to establish the existence and severity of the condition. If medical or supporting evidence is inadequate, the SSA may deny the claim.
Social Security Disability Qualifying Conditions – Lead Poisoning
Lead poisoning is caused when lead builds up in the body over an extended period of time. Lead poisoning can be caused by even small amounts of lead, and children under the age of six are most susceptible to the dangers of lead poisoning because their bodies are still developing.
Lead poisoning can lead to a number of developmental problems and medical conditions, including:
- learning impairments
- brain damage or mental illness
- severe exposures can result in death.
Lead poisoning can be diagnosed through a simple blood test, and all children from 6 months through 6 years of age are required to be tested when they enter daycare, preschool, or kindergarten.
In severe cases of lead poisoning, the child’s family may be eligible for Supplemental Security Income (SSI). The application process for obtaining SSI benefits can be complex, time-consuming, and confusing. For these reasons, consulting with an experienced disability attorney before pursuing a claim for Social Security disability benefits can be beneficial.
Social Security Disability Qualifying Conditions – Asbestos Exposure
Asbestos is a set of minerals that occur naturally in the form of fiber bundles. Today, asbestos is recognized as a health hazard and closely regulated. However, asbestos has been used in various products, and exposure can still occur. This risk is especially high among construction and shipyard workers.
According to the Occupational Safety and Health Administration, no level of asbestos exposure is safe. Each incidence of exposure can cause lung disease or scarring, which can lead to difficulty breathing. Exposure over just a few days can cause mesothelioma. Given these serious health effects, asbestos exposure victims frequently may qualify for Social Security Disability benefits.
The Social Security Administration considers many asbestos-related diseases disabling. These diseases are listed in the “Blue Book” of impairments. Individuals who suffer from listed conditions automatically qualify for benefits on a medical level. The following lung conditions appear in the Blue Book:
- Malignant mesothelioma. This cancer is considered disabling if victims document mesothelioma of the pleura or mediastinum tumors that treatment cannot control.
- Lung cancer. The listing includes small-cell carcinoma, severe cases of non-small cell carcinoma and certain cases of superior sulcus cancer.
- Pulmonary insufficiency. The SSA uses lung capacity tests to determine whether asbestosis or other lung-restricting diseases qualify as disabling.
Asbestos-related diseases that affect other parts of the body may also appear in the Blue Book. Exposure victims must provide thorough documentation to prove they suffer from these conditions and meet associated requirements. A diagnosis, medical history, and objective testing can help establish the condition. In claims involving cancer, biopsy results and notes from surgical procedures are also appropriate forms of evidence.