Social Security Disability Eligibility: Are You Disabled?

There is a lot of confusion about social security disability insurance benefits. But one thing is for certain: getting social security disability benefits is not an easy road.

We all have an idea of what we think it means to be “disabled”: we generally believe we know it when we see it. This is, however, not always the case.

Consider world-renowned astrophysicist and cosmetology Stephen Hawking, who died in 2018.  Hawking was wheelchair bound early in life due to a motor neuron disease related to amyotrophic lateral sclerosis (ALS).  As he lost more and more motor function, Hawking eventually could only communicate via small cheek movements translated into speech by a sophisticated machine.

Americans unfamiliar with Stephen Hawking  would  doubtless view his iconic pictures – frail, unable to hold his head up and looking like a rag doll tossed in his wheelchair – and consider him “disabled”.

On the other hand, many of us know a person receiving social security disability that to us appear anything but disabled. While it is true that there are many who receive social security disability benefits that should not have been approved, it is more likely that the outward appearance of these disability recipients does not reflect their actual limitations and that they in fact are unable to work.

Entitlement to social security disability insurance benefits is not based on a claimant’s appearance.  Rather “disability” is a precise legal definition under the Social Security Act.  But before we consider that definition of what it means to be “disabled”, let’s consider some prerequisites to social security disability insurance entitlement.

Legal Status in US

To be eligible for social security disability insurance benefits, a disability claimant most be a United States citizen or national, or fall within specific classifications of an “Alien” ( a legal term for a noncitizen).

Insured Status

Social security disability insurance (SSDI)  is just what it says:  insurance.  It is insurance coverage for disability that you pay for via your FICA taxes.  Insurance requires that you pay your premiums  Therefore, you must have “insured status” for SSDI via payment of FICA taxes..

Insured status is a two part test.

  1. you have earned at least 20 QCs during the last 10 years (“recent coverage”), and
  2. you are fully insured.

For most Americans who have worked all their lives there is no problem with insured status – particularly the “fully insured” test.  But the “recent coverage” can be problematic for those who have not worked for a long time.  That is, those who have not worked at least 5 of the last 10 years may have a problem with meeting the “recent coverage” leg of the insured status test.   Those who file, fail to appeal, and refile repeatedly for social security disability insurance are in particular danger of losing their insured status.

Definition of “Disabled” under the Social Security Act

In most cases, insured status for social security disability insurance benefits is not a concern.  The main issue in a disability case is whether the person meets the legal definition for disability under the Social Security Act.  Here is that definition:

“The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

But here is a more understandable summary of what the Social Security Act means by “disabled”.


  • You have a real honest-to-goodness physical or mental condition (such as bipolar disorder or depression)  or disease (i.e., recognized in the medical world as legitimate) supported by medical testing and findings .
  • This condition or disease has been diagnosed by the appropriate medical specialist.
  • You are receiving ongoing medical treatment.
  •  Even though you follow your doctor’s orders and don’t abuse alcohol or drugs your medical condition prevents you from doing ANY  8 hour, 5 days a week job on God’s green earth.

Who decides if I am “Disabled”?

As you have already guessed, the social security administration determines whether your medical condition imposes such significant restrictions on your ability to perform work-related activity that your condition fits the definition of “disabled” under the Social Security Act. Folks here in Texas are often confused if not angry when they file a claim for social security disability benefits at the suggestion of their physician and still get turned down.  “My doctor says that I am disabled – how can they say that I am not”!

Other sources and decision determining disability do not necessarily mean that social security will find someone disabled under the social security act.  Those sources include:

  • Favorable disability finding under a Short Term or Long Term Disability Policy;
  • Favorable disability rating from the Veteran’s Administration;
  • High workman’s compensation rating;

It should be noted, however, that these other favorable disability finding, and the supportive opinions of treating physician’s is very important evidence for social security.  Social security regulations provide that they must consider these types of evidence and get good reasons if they disregard them.

Key Social Security Disability Regulations: How the Social Security Act definition of “Disabled” is  Really Determined

Those not familiar with administrative law might assume  that the language from the Social Security Act defining “disability” that I cite in quotes above would be what social security decision-makers and Administrative Law Judges refer to day-in, day-out in deciding disability cases. That assumption would be wrong.  Social security has created pages and pages of regulations designed to implement the Social Security Act.  In determining disability, social security uses the regulation at CFR § 404.1520. “Evaluation of disability in general” referred to as the 5-step  Sequential Evaluation Process. This graphic illustrates how the Sequential Evaluation Process.    The Kaiser Permanente Foundation also has a good graphic on the steps social security follows in determining qualification for social security disability insurance or supplemental secure income benefits.  Also, take a look at our Frequently Asked Questions about social security disability.

¿Usted trabaja en una “Actividad sustancial y lucrativa” (es decir, está trabajando)? Por lo general, si gana más de una cantidad especifica de dinero, se le considerará que no está incapacitado. Este monto aumenta un poco cada año. Si no está trabajando o gana menos que este monte límite, la agencia estatal analizará su padecimiento médico en el paso dos.
Su padecimiento médico es lo suficientemente “grave” como para interferir con las actividades básicas relacionadas con el trabajo y cumple con el requisito de duración. Su capacidad para realizar incluso las tareas básicas del trabajo debe estar significativamente limitada por su padecimiento médico durante por lo menos un año. Si el padecimiento no se considera grave, no se considerará que usted está incapacitado. Si el impedimento o la combinación de impedimentos es lo suficientemente grave, la agencia procederá al tercer paso.
¿Su padecimiento estáen la lista de impedimentos? Los padecimientos que están en la Lista de Impedimentos se consideran tan graves que una persona con una de ellas se considera automáticamente incapacitada. Si su padecimiento está en la lista, o si no está en la lista pero es igual a la severidad de los impedimentos listados, se le encontrará incapacitado. Si no, la agencia continuará con el cuarto paso.
¿Puede realizar alguno de sus trabajos relevantes del pasado (el trabajo que ha desempeñado en los últimos 15 años)? Si no puede volver a ese tipo de trabajo, la agencia considerará el quinto paso.
¿Puede hacer otro tipo de trabajo? Para este análisis, la administración del seguro social examinará su edad, educación, experiencia laboral anterior, habilidades relacionadas con el trabajo y padecimiento médico para averiguar si puede adaptarse a un trabajo diferente. Si usted puede hacer otro trabajo, no se le considerará incapacitado. Si no puede adaptarse a un nuevo trabajo, se le considerará incapacitado


15 minute phone disability "Strategy Session"


Attorney Denman will talk with you when you call or return your call by the end of the day


Leave this field blank


Programe una consulta telefónica de 15 minutos gratis con el abogado Denman.


El abogado Denman hablará con usted cuando llame, a menos que esté con un cliente o en una audiencia.


Leave this field blank