What Are The Qualifying Conditions for SSDI?

Social Security Disability Insurance (SSDI) benefits are available to disabled workers that meet all medical and technical qualification rules.

To get benefits through this Social Security Administration (SSA) disability program, you must have worked and paid into the Social Security system through taxes. You must additionally be able to meet a disability listing for one of the many qualifying conditions for SSDI. Complete the Free Case Evaluation above to get assistance with your SSDI claim.

 

Disability Listings in the Blue Book

 

Disabling conditions that meet the severity level requirements for approval are found in the SSA’s Blue Book. Physicians utilize the Blue Book when helping patients know if they meet disability requirements.

Disability claims examiners additionally use this manual when reviewing applications for eligibility.

The Social Security Administration (SSA) refers to a medical guide called the Blue Book to determine the qualifying conditions for SSDI. Each section lists the eligible medical conditions, as well as describes the severity of symptoms required to receive financial assistance.

A team of medical examiners from the SSA reviews the medical records that you attach to your claim and then compares the records to the standards established by the Blue Book.

The Blue Book comes into play during the initial claim, as well as the first stage of the appeals process called reconsideration. Here is an overview of the SSDI listings:

 

1.00 Musculoskeletal Disorders: Disorders of the spine or the upper/lower extremities that influence the functioning of the musculoskeletal system.

2.00 Special Senses: Abnormalities of the eye that cause a loss of vision.

3.00 Respiratory Disorders: Restriction or obstruction of the lungs that impairs breathing.

4.00 Cardiovascular System: Any medical condition that negatively impacts the functioning of the heart or the circulatory system.

5.00 Digestive System: Complications of the digestive system that undermine the performance of other systems of the body.

6.00 Genitourinary Disorders: Medical conditions that result in chronic kidney disease.

7.00 Hematological Disorders: Medical conditions that disrupt the development of red and white blood cells, as well as platelets and clotting-factor proteins.

8.00 Skin Disorders: Any disorder, whether hereditary, congenital, or acquired through pathological processes, that impedes the development of healthy skin.

9.00 Endocrine Disorders: A disorder that produces a hormonal imbalance that generates too much or too little of a specific hormone.

11.00 Neurological Disorders: Causes the deterioration of motor function and communication skills that can indicate the presence of early-onset Alzheimer’s disease.

12.00 Mental Disorders: This category is arranged into 11 sub-categories that include autism, bipolar, and depression disorders.

13.00 Cancer: Covers all cancers except those associated with an HIV infection.

14.00 Immune System Disorders: Dysfunction of one or more components on the immune system.

 

Medical Evidence Requirements

 

In addition to listing qualifying conditions for SSDI, the Blue Book also outlines the medical evidence required for approval with disability. Essential pieces of medical evidence are detailed under the individual listing for each condition.

There is also information provided at the beginning of each major section of the Blue Book, describing how the SSA evaluates disabilities that fall under that body system. This introductory information commonly includes the tests and other crucial details the SSA must see in your medical records in order to grant approval for disability benefits.

For this reason, it’s important for you, your doctor, and/or your disability advocate or attorney to not only look at the qualifying conditions for SSDI, but also the introduction of the Blue Book section where your condition is listed. This will give you insight into how the SSA reviews claims like yours and it will often tell you the exact tests and other medical proof need for you to be approved for benefits.

 

Meeting or Matching a Listed Condition

 

You may be wondering what conditions qualify for disability? Listed conditions include physical, intellectual, and psychological impairments. Regardless of which type of disability you have, there are standard processes the SSA uses in reviewing applications. They first compare your medical records to disability listings, attempting to determine if your condition meets the outlined criteria for one of the many qualifying conditions for SSDI.

If you’re unable to exactly meet Blue Book requirements, then the SSA will compare your medical records for a “severity level match” to a listed impairment. If your disability equals a qualified condition, then you’re eligible for benefits.

 

Approval Through an RFC

 

If you cannot meet or closely match a listing, you can still be approved for benefits through a “residual functional capacity” or RFC evaluation. During an RFC, the SSA looks at looks at your physical and mental limitations to determine if they prevent you from working. If this evaluation shows you cannot work in any job, then you will be approved despite not meeting or matching one of the qualifying conditions for SSDI.

What is the Compassionate Allowance Program?

If you do not meet the SSDI qualifying conditions for a certain category, you might qualify for financial assistance under the Compassionate Allowance Program (CAP).

CAP represents an expedited process that grants SSDI applicants quicker access to financial resources than they would ordinarily receive. A majority of the Social Security disability qualifying conditions for CAP are defined as rare diseases, although some medical conditions are more commonly diagnosed.

The medical and scientific communities suggest new additions to the CAP list, and individuals also can recommend medical conditions to join the list of CAP diseases and illnesses.

Every medical condition that makes the CAP list is considered a serious ailment, with many of the medical conditions labeled as terminal illnesses.

To get the green light for CAP financial assistance from the SSA, you must present persuasive evidence that includes the results of every diagnostic test conducted for your particular ailment.

For example, diagnostic tests that demonstrate the rapid spread of a type of cancer can help you gain approval for a CAP application.

One of the benefits of applying for a compassionate allowance is the SSA decides on your claim much quicker than if you went through the standard SSDI claim process. You might decide to work with a Social Security Disability advocate or a Social Security attorney to ensure your CAP claim includes the most convincing medical evidence possible.

Applying for Social Security Disability Benefits

 

You can apply for disability on your own or with the help of a friend, family member, disability advocate, or Social Security attorney. Applications for SSDI can be filled out and submitted online, via the SSA’s website, or you can apply in person at your local SSA office.

Your doctor is a ally of central importance when you apply for benefits as well. He or she can ensure your medical records are shared in a timely manner with the disability examiner that reviews your claim for benefits. Your doctor can additionally help you understand the various listings for qualifying conditions for SSDI and under which listing you’re most likely to be approved for benefits.