According to the Centers for Disease Control and Prevention (CDC), approximately 26% of adults live with disabilities that may impact their ability to earn a livelihood. If you’re an individual living with a disability, you may be eligible for Social Security Disability Insurance (SSDI) benefits.
SSDI benefits provide financial assistance to those who are unable to work due to a disability. The Social Security Administration (SSA) has a comprehensive list of conditions that can qualify an individual for these benefits. This list, known as the Blue Book, serves as a guide for determining eligibility.
In this article, we aim to provide a detailed guide to the conditions that may qualify an individual for SSDI benefits. We will also discuss recent updates and changes to these conditions, providing you with the most current information to help you navigate the process of applying for disability benefits.
Whether you’re considering applying for benefits or are in the process of doing so, this guide can serve as a valuable resource.
Eligibility Criteria for SSDI
To qualify for SSDI, individuals must meet certain criteria. They should have a condition considered a disability by the SSA and have earned specific work credits based on their annual or self-employment income.
The SSA uses an income test called Substantial Gainful Activity (SGA) to determine eligibility. In 2023, to qualify as disabled, an individual’s income should not exceed $1,470 for non-blind individuals and $2,460 for blind individuals.
Technical Criteria for SSDI
U.S. citizens or lawful permanent residents who are unable to work due to a medical condition that is expected to last at least a year or is terminal may be eligible for SSDI benefits as per the Social Security Act. Both a medical condition and a job history are necessary to determine eligibility.
The program focuses on an individual’s previous work history and income rather than financial needs. Qualification depends on work credits earned through taxed employment, and the individual’s age also affects the benefit amount. Individuals over the age of 30 should have 20-40 credits, with at least 20 from within the last decade.
The SSA may prefer individuals over the age of 50 to look at how they can use their skills at work. However, medical proof of disability is also important to determine eligibility.
Medical Criteria for SSDI
Benefits based on health conditions require a comprehensive evaluation of the medical condition focusing on how the disability may limit work capacity. The SSDI program requires medical documentation of an illness that prevents engagement in any SGA.
While determining how health affects work capacity, other programs also consider the individual’s age, education, and previous work history. Understanding these requirements is crucial for eligibility.
Conditions that Qualify for SSDI
This section contains the categories of conditions included in Social Security’s Listing of Impairments.
Mental Health Conditions
The SSA recognizes a range of mental health conditions that may qualify an individual for SSDI benefits. These conditions, listed in the SSA’s Blue Book, include but are not limited to:
- Autism Spectrum Disorder
- Bipolar Disorder
- Depression
- Anxiety
- Borderline Personality Disorder
- Panic Disorder
- Personality and Impulse-Control Disorder
- Schizophrenia (and other psychotic disorders)
- Trauma-related and stress-related disorders like PTSD
It’s important to note that while a significant percentage of SSDI beneficiaries have mental health conditions, many individuals are approved for benefits because they have both mental health conditions and other health issues.
Obtaining SSDI benefits solely based on mental health conditions can be challenging, but it’s not impossible. Each case is evaluated individually, taking into account the severity of the condition, the individual’s work history, and other factors.
Musculoskeletal Disorders
If you experience pain or have limited mobility that affects your ability to perform basic physical tasks, you may be a strong candidate for Social Security benefits. In fact, 30.1% of individuals receive their benefits due to musculoskeletal issues affecting bones, muscles, and joints.
Many occupations become challenging if you’re unable to walk, stand, sit, or lift and carry items for extended periods. This applies regardless of the cause of your mobility issue, whether it’s acute (like back pain), chronic (like conditions resulting from burns), or related to soft tissue (like inflammatory arthritis).
Special Sense and Speech Disorders
Approximately 10% of individuals receiving Social Security benefits have qualified for disability due to deafness, blindness, or other sensory impairments. However, the regulations governing these qualifications can be complex and intricate.
Before consulting a medical professional, it may be beneficial to review the SSA handbook specifically addressing sensory impairments. This resource can provide valuable insights into the criteria used to evaluate these conditions.
Qualifying for benefits due to sensory or speech disorders follows the same process as other conditions. Essentially, if your condition hinders your ability to work, you may be eligible for benefits. This includes conditions that affect speech and balance.
Respiratory Disorders
About 2.4% of individuals receiving SSDI benefits are diagnosed with respiratory disorders. These conditions can be significantly debilitating, especially when severe.
Take asthma for example. While it can be managed with medication, it might make physical activities like walking or running challenging. However, it doesn’t necessarily prevent an individual from performing their job duties. But, frequent asthma attacks could potentially interfere with job performance and routine tasks.
Here are some examples of respiratory disorders that could potentially qualify an individual for SSDI benefits:
- Sleep Apnea
- Emphysema
- Long COVID
- Chronic Pulmonary Disorders
- Cystic Fibrosis
- Asthma
Cardiovascular System Disorders
Cardiovascular conditions, which affect the heart or the circulatory system, account for just over 10% of all SSDI applications. These conditions can disrupt the proper function of these systems and can be quite debilitating.
Here are some common cardiac and circulatory disorders that may qualify an individual for disability benefits:
- Aneurysms: This condition qualifies when you consistently experience chest pain.
- Congestive Heart Failure: This condition qualifies when you have to be hospitalized.
- Coronary Artery Disease: This is a condition that reduces blood flow to the heart muscle.
- Postural Orthostatic Tachycardia Syndrome: This is a condition where standing up from a reclining position causes an abnormally large increase in heart rate.
The SSA generally expects that you have the following health problems due to a cardiovascular disorder:
- Central Cyanosis
- Chronic Heart Failure or Ventricular Dysfunction
- Pain due to Myocardial Ischemia
- Reduced Cardiac Output
- Pulmonary Vascular Disease
- Near Syncope or Syncope
Digestive System Disorders
SSDI benefits are available for individuals with disorders related to the digestive system, particularly when these conditions are difficult to treat. Approximately 1.4% of SSDI beneficiaries have issues related to the digestive system.
Here are some common digestive system disorders that may qualify an individual for disability benefits:
- Crohn’s Disease
- Severe Hepatitis
- Inflammatory Bowel Disease
- Irritable Bowel Syndrome
- Ulcerative Colitis
The SSA takes into account the symptoms and surgical procedures related to these disorders when determining disability. For example, you may qualify if:
- You have experienced significant weight loss due to a digestive disorder.
- You have undergone a liver transplant.
- You have experienced hemorrhaging that required a blood transfusion.
- You use a colostomy bag.
Genitourinary Disorders
Disabilities related to the genitourinary system, which includes the reproductive organs and the urinary system, are relatively common among SSDI beneficiaries. In fact, 1.7% of SSDI beneficiaries receive their benefits due to these conditions, with kidney disease being the most prevalent.
Patients undergoing dialysis for end-stage renal disease are automatically qualified for Social Security benefits. If you’re in this situation, it may be beneficial to reach out to Disability Determination Services (DDS) before submitting your application. They may be able to expedite the process of receiving disability benefits.
Hematological Disorders
Hematological disorders refer to conditions that affect the blood. The SSA primarily focuses on laboratory evidence of hematological disorders, such as sickle cell disease and bone marrow failure. They may require a report signed by a doctor or a statement from a doctor confirming that you are suffering from a hematological disorder.
Approximately 0.3% of individuals with disabilities suffer from hematological disorders. Some common conditions include:
- Aplastic Anemia
- Bone Marrow Failure Disorder
- Granulocytopenia
- Hemolytic Anemias
- Myelodysplastic
- Myelofibrosis
- Thalassemia
- Sickle Cell Disease
Treatments involving bone marrow and stem cell transplantation for hematological disorders are also considered treatment-related problems by the SSA.
Skin Disorders
Skin conditions can indeed qualify for disability benefits, but only a small fraction of beneficiaries, specifically 0.2%, receive disability benefits due to skin disorders. The duration and persistence of your skin problem and symptoms are crucial factors in determining eligibility.
For instance, if you are experiencing severe burns, will your recovery period exceed a year? If you have dermatitis, have you experienced skin lesions or flare-ups persisting for at least three months?
Here are some examples of skin conditions that might qualify for disability benefits:
- Bullous Disease
- Burn (when treated with a skin graft)
- Dermatitis
- Genetic Sensitivity Disorder
- Hindradentis Suppurativa
- Ichthyosis
Endocrine Disorders
Endocrine disorders, such as diabetes, are a common cause of SSDI benefits. In fact, 2.3% of SSDI beneficiaries suffer from endocrine disorders.
Here are some other conditions that might qualify for disability benefits:
- Adrenal Gland Disorder
- Hyperglycemia
- Disturbances of parathyroid gland
- Diseases of the thyroid gland
The SSA often considers the impact of endocrine disorders on other organs and tissues when determining disability. For instance, if you suffer from cognitive impairment, mood swings, and anxiety due to a thyroid gland disorder, the SSA will treat them as if they were caused by a mental health condition. If the calcium level in your bones is altered due to a parathyroid gland disorder, the SSA will likely treat your condition as a musculoskeletal disorder.
Cancers
Cancer is a significant health concern, with 0.3% of SSDI beneficiaries suffering from this disease. The SSA expedites applications for individuals diagnosed with stage 4 cancer, as they automatically qualify for SSDI at this stage.
Here are some common types of cancer that may qualify an individual for SSDI:
- Leukaemia
- Breast Cancer
- Lung Cancer
- Lymphoma
- Stomach Cancer
- Prostate Cancer
Certain cancers qualify for fast-track approval due to their severity and impact on the individual’s ability to work. These include:
- Acute Leukaemia
- Esophageal Cancer
- Liver Cancer
- Non-Small Cell Lung Cancer
- Ovarian Cancer (with far-reaching metastases, or it is unresectable or inoperable )
- Pancreatic Cancer
- Small Cell Cancer (thymus, lung, large intestine)
Immune System Disorder
Immune system disorders, such as HIV/AIDS, lupus, and gout, can result in significant impairment and may qualify an individual for SSDI benefits. Like applicants with cancer, those with AIDS can also be fast-tracked due to the severity of the condition.
Here are some other immune disorders that may qualify an individual for SSDI benefits:
- Raynaud’s Phenomenon
- Polymyositis Dermatomyositis
- Systemic Sclerosis
- Systemic Vasculitis
Neurological Disorders
Neurological disorders, each unique in its symptoms, response to treatments, and impact on daily life, can be quite disabling for the patient. A significant number of these disorders, such as stroke, can qualify an individual for SSDI benefits. Certain neurological diseases, like ALS (Lou Gehrig’s disease), automatically qualify the sufferer as disabled.
Here are some neurological disorders that may entitle you to SSDI benefits:
- Carpal Tunnel Syndrome
- Cerebral Palsy
- Epilepsy
- Insomnia
- Migraines (in severe cases)
- Multiple Sclerosis
- Narcolepsy
- Parkinson’s disease
- Peripheral Neuropathy
- Stroke
- Traumatic Brain Injury
There are a wide variety of other injuries and illnesses that could qualify you for disability. As a general rule of thumb, applying for disability benefits is a good idea if your medical condition prevents you from working for an extended period of time.
If your injury or illness won’t keep you out of work for over 12 months but is still preventing you from doing your job, you may have other options:
- Your state might have its own temporary disability insurance plan.
- Your company might provide you with disability insurance, either temporary or permanent.
- If you become sick or injured on the job, you could be eligible for workers’ compensation benefits.
Remember, each case is evaluated individually, considering the severity of the condition, the individual’s symptoms, and the impact on their ability to work. It’s always important to consult with a medical professional for a thorough evaluation and guidance on applying for SSDI benefits.
Medical Conditions that Automatically Qualify for SSDI
SSDI approval can be automatic for two types of medical conditions: those qualifying for a compassionate allowance and Terminal Illness (TERI) cases. However, employment history or income requirements must still be met.
Compassionate allowance requires a severe condition, disabling based on diagnosis alone, such as Coffin-Lowry syndrome, early-onset Alzheimer’s disease, and various cancers. TERI cases are expedited if a terminal illness is claimed and supported by medical evidence.
Examples of TERI conditions include AIDS, ALS, inpatient or at-home hospice care, chronic dependence on a cardiopulmonary life-sustaining device, chronic pulmonary or heart failure requiring continuous home oxygen, a coma lasting for 30 days or more, and lethal genetic or congenital defects in newborns.
Conclusion
The SSA recognizes a broad range of medical conditions as potentially disabling. These conditions span various categories, including but not limited to, cardiovascular disorders, respiratory illnesses, neurological conditions, mental disorders, and more.
If you believe that you qualify for SSDI, it’s crucial to ensure that you meet the other technical requirements set by the SSA. These requirements typically relate to your employment history, income level, and the severity of your disability.
Before submitting an application for SSDI, it’s advisable to thoroughly review the SSA’s criteria for disability benefits. This includes understanding the specific medical criteria for your condition as well as the non-medical criteria such as your work history and income.
Consulting with a disability lawyer can also be beneficial. They can provide valuable insights into the SSDI application process, help you understand whether you qualify for benefits, and guide you through the application process. A disability lawyer can also assist in gathering the necessary medical evidence and can represent you in case of an appeal if your initial application is denied.
Remember, each case is unique and is evaluated individually by the SSA. Therefore, it’s important to provide comprehensive and accurate information in your application to increase your chances of approval. It’s always recommended to seek professional advice when dealing with complex processes like applying for SSDI benefits.
