SSDI & SSI Disability Qualifying Conditions

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Living with a disability presents numerous challenges that can significantly impact every aspect of your life, especially when it renders you unable to work. Navigating daily life can be difficult enough without the added stress of being unable to pay your bills. This is where Social Security Disability (SSD) benefits come in. They can be a lifeline for those facing such challenges; however, obtaining these benefits can be difficult.

For individuals seeking Social Security Disability benefits, the importance of submitting a well-documented application cannot be overstated. Many initial applications are denied simply because applicants don’t provide sufficient medical documentation to support their claim. Other times, applicants overlook important documents or miss deadlines.

The Social Security Administration (SSA) has a strict disability review process. It’s easy to get overwhelmed by the complex medical language and legal requirements. Understanding what the qualifying conditions are for disability and corresponding medical criteria is crucial to filing a successful claim.

Ficek Law, PC, is dedicated to assisting individuals navigate the intricacies of applying for SSD. Our experienced disability attorney in North Dakota understands how critical these benefits are for people. That’s why we work personally with every client to build their case.

If you’re unsure whether or not your disability is considered a qualifying condition, continue reading or contact us to schedule a free consultation.

Qualifying SSD Conditions & Criteria

The SSA has lists of qualifying impairments for both adult and child applicants. These impairment listings include conditions that automatically qualify for Social Security Disability.

Adult Listing of Impairments

The adult impairment listings apply to adults aged 18 and older. The categories are listed below.

  • Musculoskeletal Disorders
  • Special Senses and Speech
  • Respiratory Disorders
  • Cardiovascular System
  • Digestive System
  • Genitourinary Disorders
  • Hematological Disorders
  • Skin Disorders
  • Endocrine Disorders
  • Congenital Disorders that Affect Multiple Body Systems
  • Neurological Disorders
  • Mental Disorders
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders

Childhood Listing of Impairments

The childhood impairment listings apply to children under the age of 18. The categories are listed below.

  • Low Birth Weight and Failure to Thrive
  • Musculoskeletal Disorders
  • Special Senses and Speech
  • Respiratory Disorders
  • Cardiovascular System
  • Digestive System
  • Genitourinary Disorders
  • Hematological Disorders
  • Skin Disorders
  • Endocrine Disorders
  • Congenital Disorders that Affect Multiple Body Systems
  • Neurological Disorders
  • Mental Disorders
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders

The qualifying conditions for Social Security Disability are carefully laid out in the SSA’s Blue Book. The Blue Book explains the specific medical criteria claimants must meet to qualify under a listing. In addition, the Blue Book describes any necessary medical testing the claimant will need to undergo for the SSA to evaluate their claim.

For all disabilities and claimants, the following eligibility criteria must also be met:

  • The claimant must be unable to perform Substantial Gainful Activity (SGA) due to their disability
  • The disability must be expected to last at least 12 months or result in death
  • The disability must be a diagnosed medical condition

There are two disability programs available to applicants. These include Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). For adults applying for SSDI, their disability must prevent them from performing the same work they did previously and adjusting to a new type of work in order to receive benefits.

Applicants must also have worked long enough and recently enough to qualify. Without a substantial work history and applicable work credits, a claimant is ineligible for SSDI. Disability benefits are also not available for partial or short-term disabilities.

Examples of Specific SSDI & SSI Qualifying Conditions

Qualifying medical conditions are listed under broad health categories. Each impairment listing comes with its own set of criteria for qualification. Among these, the SSA considers a range of conditions, such as:

  • Heart failure
  • Crohn’s disease
  • Parkinson’s disease
  • Spinal cord injuries
  • Lupus
  • Rheumatoid arthritis
  • Schizophrenia
  • Anxiety disorders
  • Autism spectrum disorder

These examples represent just a fraction of the disorders that could potentially make someone eligible for disability benefits.

Presumptive Disability & Compassionate Allowances

A presumptive disability allows SSI applicants to receive disability payments before their claim is evaluated due to the seriousness of their condition. The Social Security Administration approves certain conditions for this expedited process, including but not limited to:

  • Total blindness
  • Post-stroke impairments affecting mobility or hand/arm use after 3 months
  • Conditions like cerebral palsy, muscular dystrophy, or muscular atrophy causing difficulties in mobility, speech, or hand/arm coordination
  • HIV or AIDS
  • Terminal illnesses with a life expectancy of 6 months or less
  • End-stage renal disease (ESRD)
  • Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease

Compassionate Allowances (CAL) are another way in which the SSA provides benefits quickly to applicants in need. The program ensures that if a SSI or SSDI applicant’s condition clearly aligns with the SSA’s eligibility criteria, their claim is expedited.

The types of conditions that qualify for CAL primarily include specific cancers, rare diseases that affect children, and adult brain disorders.

Meeting the SSA’s Criteria to Qualify

Having a condition listed in the Blue Book doesn’t mean you’ll automatically receive disability benefits. Other factors, such as your age, education, and past work experience, can influence whether or not you’re eligible.

Also, there are conditions not specified in the Blue Book that can qualify for benefits if they’re considered equal in severity to a listed impairment. Each application is subject to its own thorough review process.

Medical Criteria: Supportive Evidence & Tests

To qualify for SSD, an applicant must demonstrate that their impairment meets the medical criteria in the Blue Book for that listing. Often, specific testing is required to further evaluate a claim.

Applicants must provide substantial medical evidence when filing for benefits. Medical records and other evidence must be substantiated by medical professionals, such as speech-language pathologists or licensed physician assistants.

Some examples of evidence that may be included in a disability claim include:

  • Diagnostic evidence
  • Test results
  • Imaging results
  • Operative reports
  • Previous and current treatment protocols and outcomes
  • And more

Non-Medical Evidence

Comprehensive evidence is crucial to establish the extent of your disability and its impact on your ability to perform SGA. Non-medical evidence can help support your case, especially when paired with appropriate medical records. This may include such things as the following:

  • Testimonials from neighbors, coworkers, caretakers, or family members describing the limitations your condition places on you
  • A journal or other personal record detailing your condition, limitations, types and frequency of symptoms, etc.
  • Testimonials from friends, caretakers, family members, or others close to you describing the symptoms of your condition

What if My Disability Isn’t Listed in the Blue Book?

If your disability isn’t specifically listed in the Blue Book, you might feel unsure about your eligibility for benefits. However, there is still a pathway for you to qualify. The SSA acknowledges that there are many conditions that can be just as disabling as those in the Blue Book.

The key factor in unlisted impairment cases is demonstrating that your condition or conditions significantly limit your ability to work. This involves providing comprehensive medical evidence. You may also have to complete a residual functional capacity (RFC) assessment.

This evaluation measures your ability to perform work-related activities such as sitting, standing, lifting, and remembering instructions. The goal is to determine the most demanding level of work you’re capable of doing, if any.

If your disability doesn’t meet or equal a Blue Book listing in severity but it’s proven that you’re still unable to work, you may qualify for benefits through a medical-vocational allowance.

Remember, each disability case is unique, and the SSA looks at more than just the name of your condition. They consider the severity of your impairment and its impact on your life. A disability attorney can help you understand your options, gather necessary evidence, and present your case in the most effective way possible.

Why Hire A Social Security Disability Lawyer

If you’re wondering how to qualify for benefits with a specific disability, a Social Security Disability lawyer can help. An experienced attorney can help you through the application process. Their knowledge of the SSA’s complex regulations and procedures will aid in accurately preparing and submitting your claim.

At Ficek Law, PC, we work to secure the benefits you deserve while also alleviating the stress involved in navigating the claims process.

Contact Ficek Law, PC

Our firm is committed to helping clients submit thorough disability applications. By providing detailed guidance on how to present a compelling case, we can help increase your chances of claim approval. If your initial claim was denied, our attorney can also help you through the appeals process.

Making sure your application for Social Security Disability benefits is properly supported with the right type of evidence is critical to success. At Ficek Law, PC, our disability attorney Anton G. Ficek will review your case and the evidence you have. He will then identify and seek additional documentation to bolster your claim.

Contact us online today or call (701) 241-8525 to schedule a free initial consultation.

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