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How to Qualify for Social Security Disability Benefits

One of the most common questions we get is how to qualify for Social Security Disability (SSD) benefits. To receive benefits from the Social Security Administration, you must meet all these requirements to qualify:

  • You must have proof of a disability.
  • You must have enough work credits.
  • Your disability has lasted or is expected to last for at least one year, or will result in death.

Understanding what medical conditions meet the Social Security Disability qualifications can be challenging. Only certain disabling medical conditions qualify for disability coverage. You can also receive Social Security Disability benefits for a mental diagnosis. The key is to show that you meet the criteria and that you are receiving treatment.

We have more information on all of this below but qualification for Social Security Disability benefits is a very complicated topic. We have specialists standing by to help walk you through the process. Call the number at the top of the page for any questions you may have.

1. Factors That Affect Disability Benefits Qualification

There are several factors that affect SSD qualification. These factors include having proof of your medical condition from a qualified physician, meeting the SSA requirements for work credits, and having a recognized condition for a specific period of time.

Proof of Medical Condition

If your doctor says that you cannot work and are disabled, you could qualify for Social Security Disability benefits. However, you must have a medical condition that meets the Social Security’s definition of disability and must have been unable to work for a year or more.

It is important to remember that Social Security has a very strict definition of disability. Even if your doctor says you are disabled, that doesn’t mean SSA will automatically approve you for benefits.

You cannot obtain disability benefits solely on the basis of your doctor’s report. The SSA will consider your physician’s assessments, but it must be supported by clinical observations, test results, or other supporting medical evidence. Your doctor will need to explain how he or she arrived at their diagnosis and the assessment of your capabilities and limitations.

When you apply for benefits, Social Security representatives will obtain your application along with any related forms that describe your impairment(s), treatment sources, and other information that relates to the alleged disability from your doctor.

The field office will verify non-medical eligibility requirements such as your age, employment, and marital status. They will then send your case to DDS (Disability Determination Services) for evaluation of disability.

The DDS are state agencies responsible for developing medical evidence and rendering the initial determination on whether someone is disabled.

They will try to obtain evidence from your medical sources first. If that evidence is unavailable or insufficient to make a determination, the DDS will arrange for a consultative examination to obtain the additional information needed.

The consultative examination will use your doctor as a source but may obtain information from an independent source. After completing this “development of the evidence,” the trained staff at the DDS makes an initial determination. They will then return the case to the field office for appropriate action.

Work Credits

In addition to having a medical condition that meets the Social Security’s definition of disability, you must have been unable to work for a year or more.

You will also need to have worked long enough and recently enough to qualify. Your work credits are based on your total yearly wages and you can earn up to four credits each year. The amount of credits you need changes from year to year.

– For example, in 2019, you earn one credit for each $1,360 in wages or self-employment income. When you’ve earned $5,440, you’ve earned your four credits for the year.

The number of work credits you need to qualify for disability benefits depends on your age and when you become disabled. Normally you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.

You must also keep in mind that if you qualify now but stop working under Social Security, you may not continue to meet the disability work requirements in the future.

Length of Illness

If you have enough work credits to qualify for disability benefits, SSA uses a step-by-step process involving five questions to evaluate your qualifications for benefits. The five questions include the following.

  1. Are you working? If you are working in 2019 and your earnings average more than $1,220 a month, you generally cannot be considered disabled.
  2. Is your condition “severe?” Your condition must significantly limit your ability to do basic work for at least 12 months. If it does not, the SSA will find that you are not disabled.
  3. Is your condition found in the list of disabling conditions? If your condition is not on the list, the Social Security Administration will have to decide if it is as severe as a medical condition that is on the list. If it is, you will be found as disabled.
  4. Can you do the work you did previously? SSA will decide if your medical impairment(s) prevents you from performing any of your past work. If it doesn’t, they will determine you do not have a qualifying disability.
  5. Can you do any other type of work? If you can’t do the work you did in the past, SSA will see if there is other work you can do despite your impairment(s).

– The Social Security Administration considers your medical conditions and your age, education, past work experience, and any transferable skills you may have. If you can’t do other work, SSA will decide that you are disabled. If you can do other work, SSA will decide that you don’t have a qualifying disability and your claim will be denied.

2. List of Recognized Medical Impairments That Meet the Requirements for SSD Benefits Coverage

  • Musculoskeletal System
  • 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

Musculoskeletal System

Musculoskeletal impairment or functional loss is defined as the inability to perform fine and complex movements such as reaching, pushing, or pulling effectively on a sustained basis for any reason.

Musculoskeletal System disorders can result from several different sources including hereditary, congenital, and acquired pathologic processes. Common disorders include degenerative disc disease, arthritis, fibromyalgia, and scoliosis.

Special Senses and Speech

The common types of sensory impairments primarily deal with those individuals who are affected by blindness, deafness, and speech incapability.

There are several tests for these conditions — such as blindness tests — that determine whether an individual is considered blind. By the SSA’s standards, their vision must be 20/200 or less in the better eye.

Testing for deafness will also be administered to show hearing loss and the severity. Common conditions associated include macular degeneration and Meniere’s disease. Conditions that cause vertigo are also considered under this section.

Respiratory System

Respiratory systems impairments originate from respiratory disorder based on symptoms, physical signs, and laboratory test abnormalities.

The Social Security Administration may require further testing to establish the abnormalities and severity of the impairment. Frequent conditions related with respiratory impairments include asthma, sleep apnea, and chronic obstructive pulmonary disease (COPD).

Cardiovascular System

According to the Social Security Administration, cardiovascular impairments include any disorder that affects the proper functioning of the heart of the circulatory system. Disorders in this system are generally defined as a disorder that prevents the heart from functioning properly. Specifically, any arteries, veins, and capillaries that may cause impairments to arise in other parts of the body such as the kidneys or liver.

Common conditions related to the cardiovascular system include ventricular dysfunction, high blood pressure, chronic heart failure, and coronary artery disease.

Digestive System

Common digestive system disorders include conditions such as inflammatory bowel disease, gastrointestinal hemorrhage, and malnutrition. These conditions can also lead to additional complications within the body or may be accompanied by other impairments in other systems.

Conditions that sometimes are associated with these digestive system disorders include Crohn’s disease, short bowel syndrome, and liver disease.

Genitourinary Impairments

Impairments that commonly involves this system are kidney diseases, interstitial cystitis, and certain forms of nephropathy.

The SSA will require medical records including laboratory findings, treatments, and documentation of the responses to these activities. If the claimant has undergone a kidney transplant, the SSA considers the patient disabled for a minimum of 12 months of recovery following the procedure.

Hematological Disorders

The SSA only acknowledges hematological impairments if the condition is persistent and has lasted a minimum of 3 months and severely impact the life of a claimant.

Common conditions associated with hematological disorders include sickle cell disease, chronic thrombocytopenia, and chronic anemia. The SSA is unusually strict with hematological disorders and requires that specific guidelines be met by requiring monthly documentation of blood transfusions.

Skin Disorders

Disorders of the human integumentary system (skin) result from congenital, hereditary, or acquired pathological processes. Due to the fact that most skin disorders have treatments available, the SSA reviews several potential factors while assessing skin disorders, including frequency of flare-ups, stress factors, familial incidence, onset, suration, history of exposure to toxins, and seasonal variations.

Impairments that are covered by the SSA are dermatitis, Ichthyosis, malignant skin tumors, shingles, burns, hidradenitis, chronic infections of mucous membranes, and cellulitis. Unfortunately, due to the effectiveness of certain treatments for these conditions, the SSA brings much subjectivity to their determination process.

Endocrine Disorders

Impairments to the endocrine system involve hormonal imbalances that cause complications for the major glands in the system.

Common conditions associated with the endocrine system include diabetes, arrhythmia, pancreatitis, weight-loss or gain, and other imbalances in the pituitary, adrenal, and thyroid glands.

Congenital Disorders that Affect Multiple Body Systems

There are two impairments that fall into this category: Non-mosaic Down’s Syndrome and all other conditions that affect multiple body systems. Non-mosaic Down Syndrome is Down Syndrome in which all of the body’s cells (chromosome 21) are affected and can cause impairments in vision, hearing, the heart, and more.

Other conditions that affect multiple body systems are congenital disorders that cause deviation or interruption to the normal function or development of the body. Other recognized condition that affect multiple body systems include Caudal Regression syndrome and Fragile X syndrome.

Neurological Diseases

Impairments that directly affect the brain, spinal cord, or nerves total more than 600 neurological diseases. Common impairments include difficulties with speaking, breathing, learning, or moving properly along with memory, mood, or sense problems.

A central nervous system disorder will require medical documentation noting either severe loss of motor functions or speech; while epilepsy is evaluated in presence of tongue bites, duration of seizures, and severity. Other conditions include traumatic brain injury (TBI), Lou Gehrig’s disease, Cerebral Palsy, and multiple sclerosis.

Mental Disorders

A mental illness or psychiatric disorder is a mental or behavioral pattern or anomaly that causes either suffering or an impaired ability to function in ordinary life and is not developmental or social norm.

There are nine diagnostic categories of mental disorders, ranging from schizophrenia to substance addiction. Common conditions associated with mental disorders include bipolar disorder, post-traumatic stress disorder (PTSD), Autism, and schizophrenia.

Malignant Neoplastic Diseases

Neoplasm is an abnormal growth of tissue, and when also forming a mass is commonly referred to as a tumor. The SSA defines impairments in this section as malignant tumors that spread to other parts of the body and include various forms of cancer and cancer related illnesses.

Common conditions include leukemia, lymphoma, and cancer of numerous body parts such as breast, lung, and liver.

Immune System Disorders

The proper function of the immune system is to detect a wide variety of agents, known as pathogens, from viruses to parasitic worms and distinguishes them from the organism’s own healthy tissue.  Any impairments to this system can cause serious health problems.

Common conditions associated with immune system disorders include acquired immune deficiency syndrome (AIDS), human immunodeficiency virus (HIV), and Lupus.

3. List of Recognized Mental Disorders

The Social Security Administration recognizes nine main categories of mental disorders:

  • Affective Disorders
  • Anxiety Disorders
  • Autism and related disorders
  • Mood Disorder
  • Organic Mental Disorders
  • Personality disorders
  • Schizophrenia, paranoia and psychotic disorders
  • Somatoform disorders
  • Substance addiction

Affective Disorders

The requirements vary by the type of affective disorder. However, in general, you must have medical documentation showing that — despite undergoing treatment — the disorder affects your ability to function. For affective disorders, you must show that:

  • You have been in treatment for two years and cannot function outside of a supportive environment or
  • You have medical documentation giving sufficient evidence that your condition hinders you from reasonably being expected to function in any work environment.

Anxiety Disorders

With anxiety disorders, your medical evidence must show that you have at least one of the following.

  • Persistent anxiety with appropriate symptoms
  • Constant irrational fear
  • Recurring, unpredictable panic attacks at least weekly
  • Recurring compulsions and obsessions leading to significant distress

Autism and Related Disorders

For autism or similar extensive developmental disorders, you must show that the condition limits your ability to communicate, engage in activities, and interact socially.

Mood Disorder

You may qualify for Social Security Disability benefits if you provide medical documentation showing dependence for personal needs such as bathing, eating, getting dressed, and using the toilet. Or, that your IQ is less than 60, or less than 70 if combined with other mental or physical conditions.

Organic Mental Disorders

To qualify for benefits, the medical evidence needs to show that your disorder has continued for two years or more despite treatment. You may also qualify if you have at least one condition from the list below.

  1. Time and place disorientation
  2. Impaired Memory (short or long term)
  3. Hallucinations or delusions
  4. Personality changes
  5. Mood disturbances
  6. Severe emotional swings
  7. Significant limitation of daily living activities
  8. Significant limitation in social situations
  9. Difficulty concentrating or keeping pace
  10. Extended and repeated periods of decompensation
  11. Loss of 15 or more points of IQ

Personality Disorders

With a personality disorder you will need evidence showing that your condition causes you to be unable to adapt to social or work situation and that it has caused long-term problems. The disorder must cause at least one of the symptoms below:

  • Autistic thinking
  • Seclusion
  • Inappropriate hostility
  • Inappropriate suspiciousness
  • Odd thought, speech, behavior or perception patterns
  • Aggressiveness
  • Dependence
  • Passiveness
  • Constant mood disturbances
  • Impulsive, damaging behavior, especially regarding relationships

Psychotic Disorders (including Paranoia and Schizophrenia)

For psychotic disorders, you must have medical documentation for two or more years showing that your condition limits your ability to function in a work environment. You may also qualify if you have one of the following conditions:

  • Hallucinations
  • Delusions
  • Catatonia
  • Disorganized behavior
  • Incoherence
  • Illogical thinking
  • Speech significantly affected by blunt effect, inappropriate affect, or flat affect
  • Isolation and emotional withdrawal

Somatoform Disorders

To qualify to receive Social Security Disability benefits you will need medical documentation showing that by age 30 you had a history of having unexplained physical symptoms that lasted for several years.

You will generally qualify for disability if the symptoms involve loss of sight, hearing, speech, movement, loss or heightening of sensation, or loss of use of one or more limbs.

Substance Abuse

You will need medically documented evidence that your substance abuse issue causes you to meet the requirements for one of the other mental disorders above.

Other Mental Conditions

Other conditions may qualify under the mental disorders evaluation:

  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Bipolar Disorder
  • Depression
  • Intellectual Disability
  • Memory loss
  • Panic Attacks
  • Post Traumatic Stress Disorder (PTSD)

Assistance With Social Security Disability Qualifications

If you are suffering from any of these physical or mental conditions, or if you are unsure whether your condition fits the criteria for disability benefits, Crest SSD can help!

Our Social Security Disability experts will review your case and help you file your disability claim. Call us today at the number above to see if you qualify.

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