Americans no longer able to work due to a mental or physical disability often wonder: “does my condition qualify for social security disability benefits?” Social security disability insurance is a federal government benefit earned by working and paying FICA taxes – just like social security retirement. Many who ask what conditions qualify for disability are under a mistaken impression that only certain mental or physical conditions are serious enough for disability payments. But the issue for social security disability is less about the name of the condition and more about the impact that condition has on the ability to work. Any legitimate medical condition – referred to in social security disability parlance as a “medically determinable impairment” – can be the basis for social security disability insurance benefits. To be a “medically determinable impairment” the condition must be diagnosed with medically acceptable criteria by a medical doctor or health professional, as well as supported by acceptable laboratory and objective medical evidence.
“The Listings” and the Blue Book
This confusion about social security disability benefits being limited to a “list” of diseases is an understandable one, given that at one point in the disability determination process reference is made to a set of criteria for specific diseases called “the Listings”. The Listings, however, should be thought of as a “short cut” to a favorable disability decision. The Listings are also referred to sometimes as the “blue book”, a manual containing the Listings used by medical professionals in the disability assessment process.
The following is a shortlist of the 2018 updated medical conditions listed in the blue book. Keep in mind that the items in the parenthesis are just some of the conditions under each specific group of illnesses; a more comprehensive list outlining additional conditions and the criteria that needs to be met for each are found in the actual manual itself. This manual is freely available to check on the SSA’s website and contains additional details that you need to know about specific types of illnesses.
- Cardiovascular conditions (ex. coronary artery disease, heart failure, etc.)
- Respiratory illnesses (ex. Chronic Obstructive Pulmonary disease, COPD, asthma, etc.)
- Musko-skeletal problems (ex. back-related injuries)
- Mental disorders (ex. anxiety, schizophrenia, depression, autism, etc.)
- Sense and speech issues (ex. vision loss, hearing loss, etc.)
- Immune system disorders (ex. lupus, rheumatoid arthritis, HIV or AIDS, etc.)
- Neurological disorders (ex. Parkinson’s disease, multiple sclerosis, etc.)
- Skin disorders (ex. dermatitis, psoriasis, etc.)
- Digestive tract issues (ex. IBD, liver disease, etc.)
- Kidney disease (ex. diabetes, renal disease, etc.)
- Hematological disorders (ex. hemophilia, Von Willebrand disease, etc.)
- Cancer (ex. colon cancer, esophageal cancer, etc.)
“Help, My Impairment Isn’t Listed!”
The Listings are not a complete list of the conditions for which disability benefits can be paid. For example, “common” conditions such as fibromyalgia, chronic fatigue syndrome, celiac disease, carpal tunnel syndrome, and chronic regional pain syndrome are not found in the Listings, yet disability benefits are routinely awarded in Chicago and throughout the nation for these and other conditions not found in the Listings. Anyone with a condition in the blue book should examine the criteria but they are cautioned to understand that the Listings represent the most serious and severe symptoms for a given disease.
If your condition is found in the Listings, yet does not meet the precise criteria set out, it is still possible for social security to make a favorable disability decision based upon the Listings by recognizing certain aspects of the condition as the medical equivalent of what is in the criteria for the specific condition concerned. This is referred to as “equaling a listing”. Usually “equaling a listing” is based upon the opinion of a medical professional. In essence the medical doctor finds as follows:
“The listing for Schizophrenia requires A, B, C, and D. The claimant has A, F, and G which in my opinion is just as bad as the A, B, C, and D required by the Listing. There the claimant meets the Listing for Schizophrenia.”
Medical Condition Requirements: Strict or Lenient?
If you are not able to meet or equal whatever criteria is in the blue book for your particular disease or condition, you can still be eligible for disability benefits for your condition based upon the functional limitations that condition imposes on your ability to perform basis work-related activities. For example, you will not find migraine headaches in the Social Security Administration’s blue book. Migraines often qualify for disability benefits, however, if their impact on functioning is severe enough. In another example, if medical treating sources agree that your back condition would not allow you to do any work other than sedentary work (“sit down work”), and you are over 55 years of age and have always been carpenter, social security will approve your claim for disability benefits if they cannot find that you acquired skills that you could transfer to sedentary work. These types of approval are sometimes called a “medical-vocational allowance”. In both instances the approval was not based upon the Listings.
It’s Not the Name of the Disease or Condition: It’s What That Disease or Condition Does to Your Ability to Work
The question “what conditions qualify for social security disability” may suggest a mistaken belief that it is the name of the condition that is really important. It’s not. As long as the condition or conditions are legitimate medical conditions diagnosed by qualified medical doctors, social security will not deny your case because of the “name” of your diagnosed condition. It is true, however, that some diseases or conditions get less “respect” from social security than others. For example, there is some skepticism in the medical community, and consequently with the social security administration, about conditions such as multiple chemical sensitivity, somatoform disorder, and chronic fatigue syndrome being “medically determinable impairments”.
The key to winning your social security disability is usually not your diagnosed condition: it’s how your diagnosed condition affects your ability to perform work-related functions such as standing, walking, lifting, carrying, sitting, and handling one to two step job instructions. Most importantly, these limitations must be grounded in medical evidence. Social security needs for you to establish that your symptoms “can reasonably be accepted as consistent with the objective medical and other evidence” in your medical records and the evidence you present. You need both a legitimate medical diagnosis and severe, work-limiting symptoms that are consistent with that medical condition and the evidence to win your social security disability case.