As of the latest data from the Social Security Administration (SSA), over 10 million individuals are currently receiving Social Security benefits based on disability. This figure encompasses 8.9 million disabled workers, more than 1 million disabled adults, and 259,000 disabled widows and widowers in 2015. Additionally, 141,000 spouses and 1.6 million student children of disabled workers are beneficiaries of these benefits.
Many health conditions, ranging from diabetes to anxiety, can make you eligible for Social Security disability benefits if they significantly impact your ability to work. The SSA’s comprehensive “listing of impairments” in the Blue Book details the conditions considered for disability and the corresponding medical evidence required for each.
The legal definition of “disability” underlines that an individual can be classified as disabled if they are incapable of engaging in any substantial gainful activity due to medical or physical impairments expected to result in death or lasting for a continuous period of not less than 12 months.
Essential Criteria To Qualify For Disability Benefits
Meeting the criteria for disability with the SSA involves demonstrating two key aspects:
- Your health condition prevents you from engaging in substantial work.
- The impact of your condition is expected to last for at least one year, making you unable to work.
For individuals below 50, the challenge is to prove the inability to work in any available job. Those over 50 must establish the incapacity to perform tasks in their prior fields of employment.
Specific medical requirements corresponding to your condition and technical requirements tied to your work history or income will be considered. Typically, having a work record of at least five out of the past 10 years helps meet these technical criteria.
Four Things You Must Know Before Applying For Disability
Consider these essential rules before applying for disability benefits:
- Eligibility centers on your ability to work, not just a specific diagnosis. Individuals with the same health issue might qualify differently based on the severity and impact on work capacity.
- The duration of your condition is crucial. Proving you’ll be out of work for at least one year is necessary, and since the application process takes time, long-term conditions have a higher likelihood of qualifying.
- Having multiple conditions can strengthen your case. If, for example, back pain limits manual labor, and severe anxiety causes panic attacks in customer-facing roles, the combination could disqualify you from more jobs than each condition alone.
- A recent treatment history is favorable. Actively seeking and following medical care for your condition enhances your application, demonstrating to the SSA that you are proactively managing your health.
Certain medical conditions may automatically qualify policyholders for Social Security disability benefits, including:
Musculoskeletal system and connective problems that qualify for disability include:
- Back pain
- Reflex Sympathetic Dystrophy (RSD)
- Back pain
- Severe sciatica
- Rheumatoid arthritis
- Inflammatory arthritis
- Arthritis: Arthritis is a common musculoskeletal condition characterized by joint inflammation, pain, and stiffness. There are various types of arthritis, such as osteoarthritis and rheumatoid arthritis, which can significantly limit an individual’s mobility and ability to work. For those with severe forms of arthritis, Social Security disability benefits may be available if the condition prevents them from engaging in substantial gainful activity.
- Fibromyalgia: Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in specific areas of the body. While its exact cause is unknown, fibromyalgia can be debilitating, making it challenging for individuals to maintain employment. Social Security recognizes fibromyalgia as a potentially disabling condition and may grant disability benefits if it can be shown that the symptoms are severe enough to prevent substantial work activity.
- Back Pain: Chronic back pain can result from underlying conditions, such as herniated discs, spinal stenosis, or degenerative disc disease. When back pain is severe and persistent, it can limit an individual’s ability to perform work-related tasks. Social Security evaluates back pain cases based on the extent of impairment and its impact on a person’s capacity to work. If the pain is deemed disabling, benefits may be awarded.
- Reflex Sympathetic Dystrophy (RSD): Reflex Sympathetic Dystrophy, also known as Complex Regional Pain Syndrome (CRPS), is a rare and painful condition that affects the nervous system. It can cause severe and chronic pain and other symptoms like changes in skin color and temperature. RSD can make it impossible for individuals to engage in substantial work activity, and those diagnosed with this condition may be eligible for Social Security disability benefits if they meet specific criteria.
Mental disorders that qualify for disability include:
- Borderline personality disorder (BPD)
- Developmental disorders
- Eating disorders
- Obsessive-compulsive disorder (OCD)
- Panic disorders
- Schizophrenia spectrum and other psychotic disorders
According to the SSA, nearly one-fifth of disability benefit recipients have qualifying mental disorders. To be eligible, individuals must have a medically diagnosed mental condition that significantly impairs their ability to function independently. The Social Security Administration broadly categorizes mental disorders, and the criteria for qualification depend on the specific disorder. These categories include:
- Mood Disorders (e.g., anxiety, depression, panic attacks): To qualify for disability, these disorders must severely limit an individual’s ability to understand and apply information, engage in social interactions, concentrate, and manage themselves effectively.
- Schizophrenia or Other Psychotic Disorders: Disability claims reviewers look for medical documentation indicating the presence of delusions, hallucinations, and disorganized thinking.
- Organic Mental Disorder (Organic Brain Syndrome): Criteria for Social Security Disability benefits related to organic mental disorders vary based on the specific disorder. Generally, it requires a doctor’s documentation of symptoms such as confusion, cognitive decline, and memory loss.
- Post-Traumatic Stress Disorder (PTSD): PTSD, an anxiety disorder, may lead to a disabling mood disorder if properly medically documented.
- Autism or Asperger’s Syndrome: Individuals on the Autism spectrum may qualify for disability benefits if they have documented deficits in verbal and non-verbal communication and social interaction, as well as limitations in understanding, recalling, and applying information, interacting with others, concentrating, and self-management.
- Alcoholism or Drug Addiction: Disability eligibility is not granted if drug or alcohol abuse contributes to the condition. Mental disorders arising from substance abuse are not categorized as organic mental disorders in this context.
Key reasons why it is hard to qualify for mental health disability
Qualifying for benefits with a mental health condition poses challenges for several reasons:
- Universal definitions of sufficient inhibition are elusive due to the variability of mental health symptoms from person to person, complicating evaluation by the SSA.
- Unlike physical symptoms, mental health symptoms lack measurable metrics through tests or standard medical methodologies familiar to SSA doctors.
- Mental health claims may face skepticism and bias from disability examiners and judges, adding an additional layer of difficulty to the application process.
Sense and speech disorders that qualify for disability benefits include
Blindness, deafness, and other sensory disorders can be grounds for disability, with 10% of SSDI recipients experiencing at least one of these conditions. However, navigating the rules can be complex and technical. We advise consulting the SSA guide on sensory disorders and discussing them with your doctor. Ultimately, qualification for these conditions follows a similar principle: if they hinder your ability to work, they may make you eligible for disability benefits.
There are special disability rules for people who are blind or have limited vision, recognizing the effect of blindness on an individual’s ability to work. You are considered blind under Social Security’s definition if your vision cannot be corrected to better than 20/200 in your better eye. If you are blind, you may earn some money and qualify for disability benefits.
You may qualify for disability benefits if you are profoundly deaf, but moderate hearing loss does not qualify as disabling hearing loss, according to the SSA.
Skin disorders that may qualify for benefits
Skin disorders, although constituting only 0.2% of disability recipients, can still qualify for disability benefits. The duration and recurrence of flare-ups are crucial considerations. For instance, in the case of a burn, if the recovery time extends beyond a year, or for dermatitis, whether skin lesions or flare-ups persisting for at least three months.
Specific conditions like
- Bullous diseases
- Burns (especially those treated with skin grafts)
- Various forms of dermatitis, genetic sensitivity disorders (present from birth)
- Hidradenitis suppurativa
are examples that may qualify for disability benefits.
Genitourinary disorders that may qualify for disability
Genitourinary disorders, with chronic kidney disease being the predominant condition, are eligible for disability benefits, encompassing 1.7% of existing SSDI recipients. Individuals undergoing dialysis due to renal failure typically qualify for automatic disability benefits.
It is advisable to contact your Disability Determination Services (DDS) office during the application submission, potentially expediting the approval process.
Digestive system disorders that may qualify for disability
Various severe or challenging-to-treat digestive system disorders qualify for disability benefits, constituting 1.4% of disability recipients. Conditions like
- Crohn’s disease
- Chronic hepatitis
- Chronic liver disease
- Inflammatory bowel disease
- Ulcerative colitis
fall under this category.
The SSA considers symptoms and surgeries as indicators of disability, such as weight loss due to a digestive disorder, liver transplant, or gastrointestinal hemorrhaging requiring a blood transfusion. Qualification may extend beyond the specific underlying condition based on these criteria.
Hematological disorders that may qualify for the benefits
Hematological conditions are often substantiated by thorough lab tests, which the SSA prioritizes in its evaluation. A conclusive lab report endorsed by a physician or, at a minimum, a physician’s report confirming the specific disorder is typically required. Hematological disorders constitute 0.3% of individuals on disability, with prevalent conditions including:
- Aplastic anemia
- Disorders of bone marrow failure
- Sickle cell disease
- Hemolytic anemias
Respiratory conditions that qualify for disability include
- Chronic pulmonary hypertension
- Cystic fibrosis
- Long COVID
Conditions when your respiratory illness will qualify for disability
You might be eligible for disability benefits if you meet any of the following criteria:
- Recent hospitalization.
- Consultation with a pulmonologist.
- Dependency on oxygen.
- Diagnostic tests indicate airflow obstruction.
- Recent respiratory failure.
Specific conditions like sleep apnea may have additional criteria. You could qualify if it affects cognition and behavior or results in low blood oxygen or pulmonary vasoconstriction.
Cardiovascular conditions and circulatory disorders that qualify for disability
Around 10 percent of individuals receiving Social Security Disability benefits suffer from circulatory disorders, according to SSA data. These disorders involve the proper flow of blood to the heart and the rest of the body. Examples include:
- Angina: Although chest pain alone is insufficient to establish disability, angina is a common cardiac disorder.
- High Blood Pressure (Hypertension): Poorly managed high blood pressure can lead to heart disease, stroke, and other cardiovascular complications. Disability applicants with high blood pressure are evaluated based on chronic heart disease and coronary artery disease criteria.
- Coronary Artery Disease: This condition, characterized by narrowed coronary arteries due to plaque buildup, is a significant cause of reduced blood and oxygen supply to the heart (myocardial ischemia). Coronary artery disease can lead to total functional impairment and claims examiners assess its impact on an individual’s ability to function when determining disability eligibility.
- Abnormal Heart Rhythm (Arrhythmia): Arrhythmias can take various forms depending on where they occur in the heart and their impact on heart rhythm. Arrhythmias originating in the lower chambers due to heart disease are particularly concerning.
- Congenital Heart Defects: Individuals who undergo surgery for congenital or acquired heart defects may qualify for disability benefits for at least 12 months following procedures such as heart valve or lesion surgery or pacemaker insertion.
Neoplasms (Cancer) that qualify for disability benefits
Neoplasms, abnormal masses of tissue commonly referred to as tumors, can be either malignant (cancerous) or benign (non-cancerous). In 2011, the SSA awarded benefits to 9.2 percent of individuals with disorders falling under this category. Workers often report cancers such as mesothelioma and lung cancer as they seek Social Security Disability benefits due to the debilitating effects of these diseases.
- Parkinson’s diseases
- Breast Cancer
- Lung Cancer
- Prostate Cancer
- Stomach Cancer
If you have been diagnosed with Parkinson’s Disease or Parkinsonian syndrome and can no longer work, you may qualify for disability benefits. Individuals must exhibit extreme limitations in motor function in arms or legs, resulting in limitation in the ability to stand from a seated position and impacts understanding or applying information and interacting with others.
This chronic pain related to trigeminal neuralgia affects part of your face and can be sudden and excruciating. Neuralgia can be difficult to diagnose.
Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis. (ME)—CFS is a systemic disorder involving complex symptoms that vary in severity and duration. It causes prolonged fatigue that lasts six months or longer and substantially reduces work, personal, and social activities. When accompanied by appropriate medical evidence, a diagnosis of chronic fatigue syndrome may be the basis for a disability finding.
If your sciatic nerve is irritated or compressed, you may suffer severe pain, including lower back pain and shooting pain in the legs. Sciatica can limit your ability to handle the physical demands of a job or stay on your feet for any length of time. The question claims examiners will weigh whether the individual has sought sufficient treatment.
Endocrine disorders that qualify for disability benefits
Endocrine disorders, with diabetes being the most prevalent, often qualify for Social Security disability benefits, accounting for 2.3% of recipients. Other potential qualifying conditions encompass
- Adrenal gland disorders
- Parathyroid gland disorders
- Pituitary gland disorders
- Thyroid gland disorders
Immune disorders that qualify for Social Security disability benefits
Immune disorders, such as lupus, gout, and HIV/AIDS, are eligible for disability benefits, with certain conditions like AIDS being expedited in the application process. Additional qualifying immune conditions include:
- Raynaud’s phenomenon
- Systemic sclerosis
- Systemic vasculitis.
Nervous System Disorders that may qualify for the benefits
According to the SSA, approximately 10 percent of claimants awarded disability benefits in 2015 had neurological disorders. Examples include:
- Carpal tunnel
- Cerebral Palsy
- Peripheral neuropathy
- Traumatic brain injury
- Migraines (in severe cases)
- Multiple Sclerosis
Infectious diseases, injuries, and other disorders
Injuries, infectious diseases, and additional disorders may qualify you for disability benefits. When uncertain, if your condition significantly hinders or renders it impossible to work for an extended period, it’s advisable to apply for disability.
In cases where the injury or illness is not anticipated to last a year but impedes your ability to work, alternative options include
- Exploring state-specific short-term disability programs
- Checking if your workplace provides short or long-term disability insurance
- Assessing worker compensation eligibility in the event of a work-related sickness or injury.
Disability Benefits Denied? Contact a disability lawyer
A Social Security Disability Lawyer can assess your situation to determine if you have a valid claim for disability benefits. They’ll review your medical records, work history, and other relevant information to gauge the strength of your case