Trying to understand how the Social Security Administration evaluates medical conditions meeting the requirements for SSDI disability benefits can be overwhelming when you’re dealing with a severe medical health issue. It’s not any easier when applying for benefits for SSI disability.
The SSA uses a multi-step evaluation process to determine whether an individual with a disability meets the requirements for the Social Security Disability Insurance or Supplemental Security Income programs. Instead of focusing solely on a diagnosis, the SSA looks at the severity of the condition and the limitations it imposes on your ability to work.
A disability evaluation process and the SSA’s listing of impairments, commonly called the “Blue Book,” are significant in determining whether the SSA approves or denies a claim for disability benefits. This guide from the disability professionals at the Clauson Law Firm explains the disability evaluation process and what disabilities meet the requirements for SSDI benefits and for disability benefits through SSI.
Social Security uses a five-step sequential evaluation process to determine whether a person with a disability should be approved to receive SSDI or SSI benefits. The evaluation process focuses on determining whether an applicant has a medically determinable physical or mental impairment that prevents them from doing substantial gainful work activity. The impairment or impairments must be expected to result in death or be expected to last for at least 12 consecutive months.
1. Is a person doing substantial gainful activity? If an applicant works when applying for benefits, are they doing substantial gainful activity (SGA)? Each year, the SSA sets a monthly earnings threshold for SGA. Exceeding the threshold means a person is doing SGA, and they are not disabled.
2. Is the physical or mental impairment severe enough to last for at least one year or result in death? If it is not, the SSA may determine you are not disabled.
3. Does your impairment or impairments meet or equal a listed impairment? If it does, then it’s severe enough for SSA to find that you have a disability meeting its definition.
4. If you do not meet or equal a listed impairment, do the physical and mental limitations of your condition allow you to do past relevant work? If you can, then you are not disabled.
5. Do your physical or mental limitations, combined with your age, education, and work experience, allow you to do other types of work. If you cannot adjust to other forms of work, the SSA may find that you are disabled.
You may still receive SSI or SSDI disability benefits even with a medical condition that does not meet or equal a listed impairment, but it requires additional steps in the evaluation process. At the Clauson Law Firm, our disability benefits team strives, when possible, to present medical evidence proving a condition recognized by the SSA as severe and disabling.
The SSA recognizes many conditions as severe and meeting the federal disability definition. Some of the most common ones from the listing of impairments include the following:
· Musculoskeletal disorders: Common conditions that affect strength and movement include degenerative disc disease, herniated discs, spinal stenosis, and joint dysfunction.
· Neurological disorders: Listed conditions producing cognitive and other limitations include epilepsy, traumatic brain injury, peripheral neuropathy, stroke, multiple sclerosis, and Parkinson’s disease.
· Mental health disorders: Mental impairments can be as disabling as physical ones. Mental health conditions include: PTSD, anxiety disorder, bipolar disorder, depressive disorder, autism spectrum disorder, and schizophrenia.
· Cardiovascular and respiratory disorders: The listings include several conditions affecting the heart, circulatory system, and lungs, including: Congestive heart failure, coronary artery disease, asthma, and COPD.
· Immune disorders: Listed conditions include lupus, HIV/AIDS, psoriatic arthritis, rheumatoid arthritis, and lupus.
Disorders affecting a person’s speech and senses, cancer, digestive disorders, and other conditions are included in the adult listings. A separate listing, Part B, contains childhood conditions that would be used to evaluate applications seeking benefits for SSI disability for a child.
Approval based on a listed condition requires more than a diagnosis. The listing of impairments includes symptoms and other criteria for each physical and mental health condition.
Claims examiners look for evidence proving that applicants meet the medical criteria for a particular listing. The disability benefits team at Clauson Law works diligently to gather medical records to support a diagnosis, including specialist evaluations, lab and imaging reports, and examination findings with the physician’s notes.
SSDI and SSI benefits can change your future, so act now. Contact the disability professionals at the Clauson Law Firm today for a free consultation.
