A Primer on Qualifying Medical Conditions

Can I obtain social security benefits for my illness?

The media has been filled with reports of fraud in the Social Security Disability Insurance Program, but these cases are greatly overstated. In fact, qualifying for and obtaining SSDI or SSI (Supplemental Security Income) benefits can be quite complicated and certain conditions must be met.

In short you must have an illness or injury that is expected to last at least a year or more or lead to death. Moreover, the Social Security Administration has a list of specific medical impairments that automatically qualify for disability benefits.

The SSA Blue Book

The list of impairments is maintained in the SSA blue book, and there are lists for both children and adults. While these lists contain similar conditions, qualifying medical conditions include:

  • Musculoskeletal problems
  • Vision and hearing loss
  • Respiratory illnesses
  • Cardiovascular conditions
  • Digestive tract problems
  • Neurological disorders
  • Blood disorders
  • Mental disorders
  • Immune system disorders

In particular some of the specific illnesses that qualify for SSDI and SSI include back and joint injuries, cystic fibrosis, multiple sclerosis, cerebral palsy, depression, anxiety, schizophrenia, HIV/AIDS, lupus, rheumatoid arthritis, and kidney disease. There are many other illnesses that qualify. In short, if a medical condition or its equivalent is included in the blue book, an individual is considered disabled and eligible for benefits.

In addition, medical conditions that are not found in the blue book may still qualify provided that certain conditions are met. First, the impairment must “medically determinable.” This means that condition has been subjected to clinical and laboratory testing and is supported by medical reports. Further, residual functional capacity (RFC) must be limited.  RFC is an analysis of activities that can be performed despite the impairment, such as lifting, carrying, climbing, bending, the use of hands, and the capacity to handle emotional distress and environmental limitations.

Medical Evidence

An application for SSDI or SSI benefits must be supported by medical evidence including a physical exam, treatment notes and reports, radiological tests, blood work, mental health records. This must be recent evidence that covers the period from the time the disability occurred to the present.

The Takeaway

Navigating the SSA system can be complicated, there are confusing forms to complete and an benefits application requires significant support documentation. If mistakes are made on the application or the information is inaccurate or incomplete, the claim will be denied. Moreover, many illnesses and injuries may not rise to the level of a qualifying medical condition. In fact, nearly two-thirds of benefit claims are denied. In order to avoid these pitfalls and improve the likelihood of being approved, it is essential to engaged the service of an experienced social security disability attorney.