Chronic illnesses, which are medical conditions that persist for a long period, can indeed qualify for Social Security Disability Insurance (SSDI). Many of these illnesses can be debilitating, significantly impacting an individual’s ability to work or perform daily activities.
The Social Security Administration’s (SSA) “Blue Book” lists many chronic illnesses for SSDI benefits. If your illness is listed and criteria are met, you may qualify. If not listed, a medical-vocational allowance may allow qualification considering your condition, age, education, work experience, and skills.
It’s important to note that the process of applying for SSDI benefits can be complex and requires substantial medical documentation. Therefore, it may be beneficial to seek guidance from a legal professional or an advocate who specializes in SSDI applications. They can help you understand the process, gather necessary documentation, and represent your interests effectively.
Continue reading below to find out how you can get SSDI for a chronic illness.
Defining Disability
A disability is a condition, either mental or physical, that limits a person’s ability to interact with the world around them. This limitation can affect various areas of functioning, including:
- Mental
- Physical
- Learning
- Intellectual
- Vision
- Communication
- Hearing
The World Health Organization (WHO) defines disability using three components: impairment, activity limitation, and participation restriction.
Impairment
An impairment is a significant deviation in a person’s physical structure or mental functioning that restricts their ability to move, sense, or engage in certain activities. For instance, some individuals may struggle with self-care due to physical or mental impairments such as a missing or underdeveloped limb, impaired hearing, or a mental health condition like depression.
Activity Limitation
Activity limitation, another characteristic of a disability, can inhibit a person’s capacity to engage in routine activities. This could include walking, talking, or mentally processing information.
Participation Restriction
Lastly, a disability can limit a person’s participation in important opportunities. This could include employment, socializing, attending events, and even receiving medical treatment. Having a disability can sometimes create barriers to these activities, but with the right support and accommodations, individuals with disabilities can lead fulfilling lives.
How Is Chronic Illness a Disability?
What is the relationship between chronic illness and disability? According to legal definitions, many chronic illnesses can lead to both temporary and permanent disabilities.
The Americans with Disabilities Act provides the federal framework for classifying different types of disabilities and how they should be accommodated in public life. The National Center for Chronic Disease Prevention and Health Promotion defines a condition as chronic if it:
- Lasts for at least a year
- Requires ongoing medical attention, causes significant limitations in daily life, or both
While chronic illnesses and disabilities can have similar impacts on your physical health, interpersonal relationships, and daily interactions, it’s important to note that not every individual with a chronic illness is also considered disabled.
How To Qualify for SSDI With a Chronic Illness
The SSA recognizes over 200 different types of illnesses or injuries that can qualify a person for disability benefits. These conditions are specified in the SSA’s Blue Book, which is available on their website.
To process a benefits application, an applicant must meet the specific criteria for each qualifying medical condition. This requires providing medical evidence that they meet the eligibility criteria.
Qualifying for disability benefits with a chronic illness can be challenging. However, the Blue Book does list certain chronic illnesses that qualify for disability benefits. For instance, Listing 14.02 in the Blue Book addresses chronic autoimmune conditions like lupus, vasculitis, scleroderma, connective tissue disease, and inflammatory arthritis.
To qualify, you need sufficient proof that your condition:
- Is medically determinable
- Is so severe that it prevents you from working
- Is unlikely to improve
However, if your chronic illness does not have a matching entry in the Blue Book, you still have the option of applying for a medical-vocational allowance. This is a provision for conditions not included in the Blue Book.
Medical-Vocational Allowance for Chronic Conditions
Medical-vocational allowances are special provisions that can qualify you for disability benefits, even if your condition doesn’t match any of the categories in the Blue Book. To be considered for this exemption, you will need a Residual Functional Capacity (RFC) form from your doctor.
The RFC allows your primary care physician to provide a detailed account of your chronic illness and its impact on your daily functioning. It’s important to communicate to your doctor exactly how your symptoms have affected your professional functionality.
Once completed, submit the RFC along with your medical records to the SSA as part of your disability claim. The SSA will consider factors such as your age, work history, RFC, and medical records when deciding on your claim. If the SSA determines that there is no work you can reasonably be expected to perform, they will approve your claim for disability benefits.
Chronic Conditions that Qualify for SSDI
The SSA recognizes several chronic conditions as disabling, potentially qualifying individuals for benefits. If you have any of the following conditions, it is highly recommended that you seek legal counsel:
- Cardiovascular failure
- Blood clotting disorders
- Crohn’s Disease
- Hepatitis
- Multiple types of cancer
- Post-Traumatic Stress Disorder
- Cerebral Palsy
- Epilepsy
- Fibromyalgia
Please note that this is not a comprehensive list of all eligible chronic conditions. Therefore, it’s advisable to seek legal advice even if your specific diagnosis isn’t listed here.
Is Chronic Pain a Qualifying Disability?
Determining whether chronic pain qualifies as a disability is not straightforward. To be recognized as a disability by the SSA, substantial evidence of a severe and medically determinable impairment, either physical or mental, must be provided.
This disability must be proven through medical evidence, which can range from formal laboratory tests to evaluations. Simply reporting symptoms, such as chronic pain, is not sufficient to receive SSDI benefits.
To begin, you’ll need formal evidence of your chronic pain. This could include physical exams, lab tests, x-rays, or any other documentation that demonstrates how your pain limits your ability to function in the workplace.
Keep in mind that you could have a condition like fibromyalgia, which can be diagnosed by identifying specific pain points. Alternatively, you could have a mental impairment that results in psychologically induced pain symptoms. In both cases, a formal diagnosis is required, and your pain must be severe enough to prevent you from performing your job duties for at least a year.
Interestingly, chronic pain is not listed among the disabilities covered by the SSA’s Blue Book. However, the Blue Book does include a variety of conditions, some neurological, some somatoform, and others, that can lead to chronic pain. Chronic pain is also associated with inflammatory arthritis, back injuries, irritable bowel syndrome/inflammatory bowel disease, and chronic renal disease.
Can I Qualify for SSDI with a Fluctuating Condition?
Qualifying for Social Security benefits requires a person to have been unable to work due to illness or injury for a full year. However, most medical conditions don’t follow such a linear pattern. The severity of conditions can fluctuate, with individuals experiencing periods of worsening and improvement.
Consider a person who suffers a disc rupture, undergoes surgery, and then engages in physical therapy for recovery. Suppose that after six months, the patient improves enough to be released from the doctor’s care. After two months of returning to regular activity, the patient falls and re-injures their back, leading to over seven months of inactivity.
In such a scenario, there’s a risk that the patient could lose their Social Security disability benefits because they returned to work for two months. For this reason, most administrative law judges scrutinize such periods of activity to ensure they do not constitute a break in the disability before deciding on the claim. An Administrative Law Judge (ALJ) may rule that a claimant was still unable to return to work after two months due to ongoing medical rehabilitation and recovery.
What To Do if My SSDI Application Is Denied
SSDI is a financial program designed to assist individuals who are unable to work due to illness. However, getting approved for SSDI benefits can be a complex process. Applicants are required to provide evidence of their symptoms and demonstrate how these symptoms prevent them from performing their job duties.
Unfortunately, the SSA denies the majority of applications, often because applicants fail to provide the necessary information for approval. Following a denial, many individuals give up and do not attempt to appeal the SSA’s decision.
However, it’s important to note that many people who initially have their SSDI applications denied are eventually approved with the help of a Social Security disability attorney. These attorneys specialize in such cases and have a deep understanding of what the SSA needs to see in order to overturn a denial. They know how to present evidence in a way that clearly demonstrates the applicant’s disability.
So, if your SSDI application has been denied, don’t lose hope. Consider seeking the assistance of a disability attorney who can guide you through the appeal process.
Tips To Get Approved for SSDI
While the decision of the SSA is beyond your control, there are several steps you can take to improve your chances of getting an SSDI approval.
Consult a Competent Disability Lawyer
Working with an experienced lawyer can enhance your chances of successfully obtaining Social SSDI benefits. They understand the system and can assist you in securing approval efficiently. The process may seem daunting, but a lawyer specializing in SSDI can simplify it for you. Ensure you choose an SSDI attorney with substantial experience.
Submit Your Application as Soon as Possible
The processing time for an SSDI application can be quite lengthy. Therefore, it’s recommended to submit your application promptly. If the filing process takes longer than necessary, it could lead to additional expenses. Ensure your application includes everything the SSA might need, such as proof of disability and medical records.
Get Regular Medical Care
Receiving appropriate medical care can significantly improve your chances of being approved for SSDI benefits. Ensure all prescribed tests have been conducted and that you retain the documentation. Submitting these records strengthens your case and increases the likelihood of your request being granted. Disability benefits are often denied due to insufficient proof.
Don’t Go Back To Work
After applying for SSDI, it’s crucial to focus on your case. It’s easier for individuals who appear unable to work to qualify for SSDI benefits. If you return to work, you risk contradicting the claims made in your case.
When To Expect To Hear From the SSA
Understanding the timeline of the SSA response after the SSDI application process can help alleviate anxiety and prepare you for what lies ahead. Here’s a general timeline:
Initial Claim
If you apply for SSDI benefits, you can typically expect to hear back from the SSA within three to four months on average. However, be prepared for the possibility that it could take up to eight months or longer, as Social Security is chronically underfunded and understaffed.
Request for Reconsideration
If the SSA rejects your application for benefits, you have the option to submit a request for reconsideration. The response to your initial appeal may take around three to four months.
ALJ Hearing
If you’re dissatisfied with the decision on your request for reconsideration, you can request to present your case in front of an Administrative Law Judge (ALJ). The timeline for this stage can vary significantly, so it’s best to consult with your attorney or the SSA for a more accurate estimate.
Please note that these timelines are estimates and actual times may vary. It’s always a good idea to check with the SSA or a legal professional for the most accurate information.
Conclusion
Chronic illnesses can qualify for SSDI, but the application process can be complex and requires substantial medical documentation. The SSA’s “Blue Book” lists many qualifying chronic illnesses. If an illness is not listed, one may still qualify through a medical-vocational allowance.
Legal professionals specializing in SSDI applications can provide valuable guidance throughout the process. If a specific chronic condition does not match a listing in the Blue Book, consulting a disability attorney could be beneficial.
