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Medical Criteria Needed to Qualify with a Stroke

Experiencing a health crisis such as a cerebrovascular accident (CVA), or stroke, can be a devastating, life-altering moment. Not only are there physical and emotional challenges to deal with following a stroke, but the financial stress of being unable to work can be overwhelming.

Thankfully, there is help for those who qualify. The Social Security Disability Insurance (SSDI) disability program was designed to help individuals who have experienced a health crisis, such as a stoke, to get back on their feet.

While most stroke survivors will meet the disability eligibility requirements set forth by the Social Security Administration (SSA), not all individuals who apply for benefits will be awarded.

In fact, many post-stroke individuals have been denied SSDI benefits due to their inability to provide the medical evidence required by the SSA.

Understanding the Social Security disability process will help to ensure that you are doing everything that you can to earn the financial assistance that you deserve.

Your ability to provide timely, accurate, and complete medical records about your stroke and subsequent health will help your application to be processed more quickly.

The Importance of the “Blue Book”

To determine if your stroke is disabling, Social Security representatives will consult their medical guide of impairments, also known as the Blue Book.

A stroke is a neurological disorder that is listed in section 11.04, Vascular Insult to the Brain, of the Blue Book.

Additionally, injuries from your stroke may impact other body systems. For example, having a stroke may affect your psychiatric health. In which case, you would also be evaluated under section 12.00, mental disorders.

Some individuals may experience vision difficulties after a stroke, and thus would be assessed under section 2.00, Special Senses and Speech, to determine if they meet a listing in that category.

To help you with the information gathering process, here is the most relevant medical evidence that you will need to provide to give you the best chance of being approved for SSDI.

Medical Criteria Needed to Qualify with a Stroke

Evidence Needed Related to Your Stroke

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your stroke. You should be able to provide the following evidence:

  • A full history of your cerebrovascular accident, including emergency room records and your presenting symptoms.
  • Any imaging results that will speak to the type of stroke you have had, as well as subsequent imaging showing healing/progression of injury. Imaging results might include CT scans, MRI, or brain scans.
  • You should also have a full updated history and physical from your current neurologist.

According to the Blue Book, certain physical limitation criteria would make you eligible for disability benefits. Be sure that your neurologist documents any limitations you have with communicating or your motor function, including the following:

  • Any difficulty that you have with communication as a result of your stroke, including your ability to understand or convey your thoughts in a simple spoken language
  • Any difficulty that you experience talking or hearing
  • If you are unable to follow one-step commands or to tell someone about your basic needs without assistance, be certain that your physician carefully documents those limitations
  • Any difficulty that you might experience with movement of two extremities, such as your legs, arms, fingers, wrists, hands, or shoulders, especially as it relates to your ability to work.
  • Any difficulty that you might experience moving from a seated position to a standing position
  • Any troubles that you might have maintaining balance standing or walking, and if you require an assistive device, such as a cane, walker, or wheelchair
  • Any other physical functioning limitations should be carefully documented by your neurologist
  • These limitations must persist for at least 3 months after your injury

According to the Blue Book, certain neurological mental functioning deficits may occur as a result of your stroke that might make you eligible for benefits.

Be certain that your neurologist documents any mental limitations including, but not limited to, the following:

  • Any problems that you have understanding, remembering, or applying information.
  • Any challenges that you might have in interacting with others.
  • Any difficulty you might experience with concentrating, persisting, or maintaining pace with your work.
  • Any challenges that you have regulating your emotions in public.

While any doctor can provide this information, the SSA gives more weight to the opinion of medical specialists. Therefore, it is essential that you work with your neurologist to gather this medical information.

Evidence Needed Related to Your Stroke Treatments

The treatment for a stroke depends on the type of stroke, the severity, and the health of the individual. The SSA will need to know exactly what treatments you have received, your response to those treatments, and most importantly if your condition has worsened despite those treatments.

The Blue Book indicates that you need to have the above symptoms and that the symptoms must be unresponsive to medication for at least three consecutive months of treatment.

Be certain that your doctor has documented the following:

  • Any and all medications that you are receiving as a result of your stroke, as well as your response to the medications
  • Any surgical procedures that have been performed, including operative notes from the surgeon
  • All imaging records, such as CT scans or MRIs
  • Any physical therapy or other related therapies that you are receiving.

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

Some people who have had a stroke will not qualify for SSDI benefits through a Blue Book listing. If your stroke does not meet a listing or closely match with another listing, you may still be eligible for benefits through a medical vocational allowance.

To do so, your application and supporting medical documentation will need to illustrate that your physical or mental limitations are so severe that you are unable to maintain gainful employment.

The more specific that your doctor is about your limitations, the better your chances are of being approved for disability benefits.

Your physician may want to perform a residual functional capacity (RFC) assessment on your behalf. By doing so, all of your limitations will be addressed.

Steps You Can Take to Win Your Disability Claim

Many individuals who initially apply for Social Security disability benefits are initially denied, as they often fail to provide the medical evidence required by the SSA.

If you are one of those individuals, or if you have not yet applied, there are concrete steps that you can take to improve your chances for approval of your disability claim for a CVA.

First and foremost, you will want to meet with your neurologist to discuss your condition and to determine if you match any of the listings in the Blue Book. You may want to review several areas including those in 11.00, 2.00, and 12.00.

The entire book is available exclusively online. You can either print the listings you'd like to review with your doctor and bring it to your next appointment or review it together online.

You will need to ensure that all of your medical documentation is in order. You may need to contact the medical records office at your local hospital as well.

While you won’t need to provide all of the medical documentation to the SSA yourself, it’s helpful to know what information you have on hand and what may still be required.

There are several ways that your neurologist or primary care physician can help including:

  • Ensuring that your full medical history related to your stroke is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects

The SSDI application process can be overwhelming and time-consuming for the average healthy individual, and more so for someone with a disability. A Social Security disability attorney or advocate can assist you in ensuring that you claim for disability due to stroke is thorough, thus increasing your chances for approval.

Initial consults are always free, and disability lawyers are not compensated until you will your claim.