Table of Contents
- What Medical Conditions Automatically Qualify You For Social Security Disability?
- What Conditions Qualify For Disability Benefits?
- What If Your Condition Isn’t Listed?
- What Does it Mean to Automatically Qualify for Social Security Disability Benefits?
- How Do I Prove That I Automatically Qualify for Disability Benefits?
- The Importance of Medical Records For Automatically Qualifying for Disability
- The Financial Standpoint for Automatically Qualifying for Disability
- You Could Earn Up to $3,627 a Year! Get a Free Case Evaluation
- Sources & Additional Resources
You have probably heard that being approved for disability benefits can be challenging. The process can also be time-consuming which leaves many people wondering and worrying about what to do for income while waiting for disability. Documentation is the key to a successful claim. There are a lot of medical conditions, however, that do qualify for expedited approval. And some conditions automatically qualify for disability benefits if you have a confirmed diagnosis (i.e., a formal diagnosis). There are a few conditions that warrant such approvals.
Injuries can also qualify for disability benefits through the Social Security Administration (SSA). More specifically, if you’ve experienced a severe injury that has interfered with your ability to work, you might be eligible for disability Social Security benefits.
The SSA runs two disability benefits programs that are application-based and offer financial assistance to people who have a medical condition (i.e., a disability) that prevents them from working. These two programs are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
What Medical Conditions Automatically Qualify You For Social Security Disability?
The best way to tell which medical conditions automatically qualify you for Social Security disability is to consult the compassionate allowances list. This list has over 200 conditions so it is important to view it. If your condition is on the list, it is likely that your application process will be expedited.
What conditions automatically qualify you for disability? Some conditions that automatically qualify you for disability include:
- Cancers (advanced stages)
- Cardiovascular system disorders (chronic heart failure)
- Neurological disorders (ALS, multiple sclerosis)
- Early-onset Alzheimer’s disease
- Musculoskeletal system (spinal disorders)
- Organ transplantation
- Visual disorders (blindness)
A claim because of one of these conditions will get expedited attention, which means you might get a decision within a month of applying.
That is the fastest or as close to automatic as you can expect with a Social Security disability claim. There are a few conditions that are on the Listing of Impairments Manual used by the Social Security Administration (SSA) that will qualify for disability benefits if you can prove through medical records their existence or occurrence. Those conditions include:
- Kidney transplant
- Liver transplant
- Cochlear transplant
- Lung transplant
- Heart transplant
For those five automatic disabilities, the SSA will review the case at the end of a year, or three years for a lung transplant, to determine if the claimant is still considered disabled per the SSA guidelines.
What Conditions Qualify For Disability Benefits?
The conditions that qualify for disability benefits include:
- Musculoskeletal Disorders
- Special Senses and Speech
- Respiratory Disorders
- Cardiovascular System Disorders
- Digestive System Disorders
- Genitourinary Disorders
- Hematological Disorders
- Skin Disorders
- Endocrine Disorders
- Congenital Disorders that Affect Multiple Body Systems
- Neurological Disorders
- Mental Disorders
- Immune System Disorders
These can all be found in the SSA's Blue Book under the Adult Listings. Each category contains different conditions that may qualify for disability benefits as well as how each condition can qualify.
What If Your Condition Isn’t Listed?
Not all conditions automatically qualify for disability benefits. This leaves many people asking do I qualify for disability? Some conditions require more evidence and time to show that they qualify for disability benefits.
If your condition isn’t listed in the Blue Book, don’t panic. You still may be eligible for Social Security disability benefits. This is because your impairment doesn’t have to be in the SSA’s Blue Book in order for you to apply. Here are some examples of conditions that aren’t listed in the Blue Book that you can qualify for disability:
- Carpal Tunnel Syndrome
- Celiac disease
However, it is important to note that, the SSA has specific requirements for conditions that aren’t listed in the Blue Book in order for them to qualify for disability benefits. This is because conditions that aren’t listed need to be considered a “medically determinable impairment” by the SSA in order to qualify.
If you have a condition that’s not listed in the Blue Book, the SSA requires that you provide them with a formal diagnosis and thorough documentation of your condition that reveals it is a “medically determinable impairment” that prevents you from being able to function at full capacity. This essentially means your condition must be severe enough to interfere with and prohibit your ability to engage in gainful activity (e.g., working, performing daily tasks, etc.). This reduction in capacity is also known as the “residual functional capacity.”
The term, “medically determinable impairment,” refers to a physical or mental health condition that can be diagnosed and confirmed through medically acceptable clinical and laboratory diagnostic techniques. In other words, it is an impairment that results from anatomical, psychological, or physiological abnormalities that can be objectively demonstrated by objective medical evidence from an acceptable medical source(s). A mere statement about an individual’s symptoms is insufficient to qualify as a medically determinable impairment.
A condition must meet the following criteria for the SSA to consider it a medically determinable impairment:
- It must result from anatomical, psychological, or physiological abnormalities.
- It must be capable of being shown through medically acceptable laboratory and clinical diagnostic techniques.
The SSA will not approve applications for disability benefits based solely on reported symptoms. There must be laboratory or clinical findings that confirm the existence of the impairment.
For children, the impairment must be both medically determinable and severe enough to cause marked and severe functional limitations.
In order to prove that your condition meets the above criteria, the SSA requires applicants to provide objective medical evidence from an acceptable medical source(s).
Here are some examples of objective medical evidence:
- Imaging tests: X-rays, MRIs, or CT scans
- Electrocardiogram (EKG or ECG) to evaluate heart rhythm issues or coronary artery disease
- Electroencephalogram (EEG) to both confirm and record the electrical activity of the patient’s brain to diagnose epilepsy, brain tumors, head injuries, etc.
- Nerve conduction studies (e.g., electromyography (EMG)) to determine the efficiency of an individual’s nerves to transmit electrical signals to their muscles
- Spinal tap to diagnose neurological conditions and infections
- Pathological findings: biopsies
- Laboratory findings: pulse rate, blood testing, blood pressure, and chemical levels
- Mammography to detect breast cancer
among many other diagnostic, clinical, and laboratory tests that produce objective findings of physical, cognitive, psychiatric, and neurological disorders.
And, here are some examples of acceptable medical sources (AMS):
- Licensed physician (osteopathic or medical doctor)
- Licensed psychologist, including:
- An independently practicing psychologist who’s licensed or certified; and
- A certified or licensed school psychologist or an individual with another title who fulfills the same role as a school psychologist within a school setting, specifically for cases involving intellectual disability, learning disabilities, and borderline intellectual functioning only.
- Licensed optometrist
- Licensed podiatrist
- Certain speech-language pathologists who are certified
- Licensed audiologists
- Licensed Advanced Practice Registered Nurses (APRN)
- Licensed physician assistant
If you have a medical condition that is not listed in the Blue Book and you wish to apply for disability benefits, it is essential to provide the SSA with a formal diagnosis and thorough documentation of your condition. This documentation should clearly demonstrate that your condition significantly limits your ability to function at full capacity. This is necessary for the SSA to consider your condition as a medically determinable impairment that may qualify for disability benefits.
When a disability meets the SSA’s requirements for eligibility for disability benefits, it means that the SSA recognizes your condition as being equivalent to a condition that’s listed in the Blue Book.
This is a critical step toward potentially qualifying for disability benefits. However, the approval process involves additional steps, including a formal application and evaluation by the SSA, and approval is not guaranteed solely based on meeting these requirements. The decision ultimately depends on the severity of your impairment and its impact on your ability to work.
What Does it Mean to Automatically Qualify for Social Security Disability Benefits?
When the SSA refers to conditions that automatically qualify for Social Security disability benefits it is referring to the list of disabilities that qualify for the Compassionate Allowances program.
Common conditions that automatically qualify for disability through a compassionate allowance are advanced-stage cancers, ALS, and paralysis. However, those are just 3 out of 200+ conditions that automatically qualify for Social Security disability benefits.
There are many conditions that automatically qualify for disability. If you have a condition that automatically qualifies for disability through a compassionate allowance, it helps the SSA speed up the determination process for your disability benefits eligibility.
When you submit your application, and it shows that you have a condition that qualifies for a compassionate allowance, your application will be processed faster than those with conditions not on the compassionate allowances list.
It also means that you can start receiving your payments a lot sooner. You could receive Compassionate Allowance benefits from a few weeks to 2 months after the application is received.
That is compared to the 6-12 month timeframe for normal Social Security disability benefits applications for conditions that don’t automatically qualify for benefits.
How Do I Prove That I Automatically Qualify for Disability Benefits?
Having a condition on the compassionate allowance list does not guarantee automatic qualification for Social Security disability benefits. In other words, merely telling the SSA that your condition is on the list isn't sufficient to get these benefits. Unfortunately, this is true even if your condition is something like Stage IV breast cancer.
This is because you still need to provide all your medical documentation, diagnostics tests, and doctor’s notes to show that your diagnosis does indeed meet the requirements of the compassionate allowance listing.
Providing supporting medical evidence to prove your diagnosis is the key to automatically qualifying for disability benefits.
The more medical evidence you have to show that your condition does match its listing in the compassionate allowance, the more likely you are to automatically qualify for disability benefits.
The SSA uses a guide called the “Blue Book” which lists conditions it will consider for review for people applying for Social Security disability benefits.
The Blue Book listings are divided into sections for adults and children, reflecting the different ways Social Security examiners evaluate the impact of a disability on those under the age of 18 and those beyond the age of 18. Part A, the adult component, is organized into 14 categories that represent various bodily system illnesses or diseases.
The Importance of Medical Records For Automatically Qualifying for Disability
Even for these conditions that get automatic approval for disability benefits, the proper medical records are needed. Without hard medical evidence, any claim will be denied disability. Be sure to look out for the signs that you will be denied for disability.
You must provide Disability Determination Services will all your medical records to show evidence of your diagnosis along with the necessary supporting information.
The Disability Determination Services (DDS) office is the agency responsible for finishing the disability decision for the SSA. They do this by gathering and evaluating medical and other relevant information about an individual’s condition to determine their eligibility for Social Security disability benefits.
As such, if your physician left out important supporting details, your claim could be denied although your condition is classified as medically eligible for disability benefits. Your denial notice will explain why your claim was denied, and you can then appeal and provide the additional details needed to support your claim.
Further Reading: “Who decides if I have a qualifying disability?” section of the SSA’s Disability Booklet.
The Financial Standpoint for Automatically Qualifying for Disability
Even if you have a condition that will automatically qualify for Social Security disability benefits, the SSA will consider your financial situation. If you are working enough to exceed the limits for substantial gainful activity (SGA), your claim will be denied.
Often, claimants continue working part-time to cover some basic living expenses. If their income exceeds the SGA, their claim will be denied because the SSA believes the individual can continue working and earn a sufficient living.
You Could Earn Up to $3,627 a Year! Get a Free Case Evaluation
You may want to seek the help of a disability attorney if you are looking to file a claim for Social Security disability. Disability attorneys are kind of like a disability help center because they can really help you navigate the process of applying for disability benefits through a compassionate allowance in order to help you get your benefits as soon as possible.
Take our SSDI calculator to see how much you could earn in disability benefits.
Your disability attorney or disability advocate may be able to know what paperwork, tests, and other medical evidence you will need in order to prove to the SSA that you will automatically qualify for Social Security disability benefits. Ultimately, disability attorneys and advocates can offer invaluable disability benefits help.
- Disability Evaluation Under Social Security (Blue Book), Listing of Impairments – Adult Listings (Part A) – Social Security Administration
- Disability Booklet – Social Security Administration
- Disability Evaluation Under Social Security, Part I – General Information – Social Security Administration
- Consultative Examinations: A Guide for Health Professionals, Part II – Evidence Requirements – Social Security Administration
- Program Operations Manual System (POMS), Evaluating Objective Medical Evidence – Social Security Administration