What Medical Disabilities Qualify for Disability Benefits?
Suffering an illness or injury that results in disability has numerous consequences, including medical expenses, an inability to work and earn an income, and the psychological toll that accompanies pain, physical limitations, and fear about one’s financial future. While living with a medical disability can be trying to say the least, one thing that can provide comfort and support in a time of need is Social Security disability benefits.
What Is Social Security Disability?
There are two types of Social Security disability programs: Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). The first provides monthly compensation for those who are disabled and of limited income and resources; the second provides monthly benefits for those who are disabled, but who have paid into Social Security during their working years and therefore have both a qualifying disability and earned work credits.
What Types of Medical Disabilities Qualify for Social Security Disability Benefits?
Regardless of whether a person is applying for SSI or SSDI benefits, they must have a qualifying disability. The Social Security Administration (SSA) defines disability as the “inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairments…” The definition continues to read that such impairment must have lasted, or is expected to last, for at least 12 months or result in death.
The SSA maintains a list of impairments/medical conditions that, if a person suffers from them, automatically meet the above definition of disability. This list is extensive, containing conditions ranging from musculoskeletal disorders to digestive system disorders to neurological disorders and many more.
What If I Suffer from a Medical Disability that’s Not Listed by the SSA?
While the number of medical conditions that are found on the SSA’s listing of impairments is extensive, it is not exclusive. Many people suffer from debilitating medical conditions that are not listed. If this is the case for you, you are not automatically excluded from receiving SSA disability benefits; instead, you will need to follow a specific process set forth by the SSA for disability determination. This process seeks to assess:
- Whether or not you can do work that you did before;
- Whether or not you can adjust to other work because of your medical condition; and
- Whether or not your disabling condition has lasted or is expected to last for at least one year or result in death.
If the SSA concludes that you cannot do work that you previously did, cannot adjust to other work as a result of your condition, and that your condition will be impairing for at least 12 months, then you will meet the eligibility requirements for a qualifying disability.
What Else Is Necessary to Receive Social Security Disability Benefits?
Unfortunately, proving that you suffer from a medical disability is just one of the many things that the Social Security Administration looks at when determining whether or not you are eligible for SSDI or SSI benefits. In addition to establishing proof of your disability, you will also need to prove that:
- You have earned enough work credits during your working years; or
- You are blind or vision-impaired; or
- You are of limited income and resources.
In some cases, a person may qualify for both SSDI and SSI benefits simultaneously.
Mental Health Conditions
If you have a mental health condition, you may be eligible for Social Security Disability benefits. Not all disabilities are obvious and noticeable. These are some of the mental health conditions that could make you eligible to receive these benefits:
- Bipolar disorder. Commonly known as manic depression, bipolar disorder can cause individuals to go through manic phases and depressive phases. Because it is not always easy to predict when these phases will occur, they can be very disruptive to a person’s life. For this reason, those with this disorder may be able to receive disability benefits.
- Borderline personality disorder. Those with borderline personality disorder often struggle with feelings of insecurity while acting out on impulsivity. These individuals tend to make random irrational decisions that can have serious consequences. Some people with this disorder suffer from depression and may even contemplate suicide.
- Severe anxiety. Most people will experience anxiety at some point in their lives, but some people have it much worse than others. Those that experience anxiety on a day-to-day basis with no real rhyme or reason to it may need to take anxiety medication to ease some of the symptoms of their condition. If it is too hard to hold down a job, someone with anxiety can get approved for disability benefits.
How Does the Social Security Administration Determine Whether a Person Is Disabled?
The definition provided for “disability” is found on the website of the SSA. This definition reads that a person is disabled if a medically determinable physical or mental impairment prevents them from being able to perform substantial gainful activity, and if that condition has lasted or is expected to last for at least 12 months or result in death.
Understanding this definition requires breaking down two key components of it and defining each component further: substantial gainful activity and a medically determinable impairment.
Substantial gainful activity (SGA) refers to activity (work) that earns an income that is above a certain threshold. In 2019, the SGA limit for non-blind individuals is $1,220 per month. If a person is earning more than this amount, they are considered to be engaging in SGA.
A medically determinable impairment is an impairment that has been found, through medically acceptable diagnostic techniques, to be a condition that results from anatomical, physiological, or psychological abnormalities. The SSA maintains a list of evidentiary requirements that must be produced in order to establish impairment.
The SSA also maintains a listing of impairments. If a person has a condition that is found on the list, they will automatically be considered disabled per the SSA’s guidelines. If a person suffers from a condition not found on the list, they can still be found disabled if they can prove that the condition is impairing, prevents them from performing substantial gainful activity, and is expected to last for at least one year or cause death.
In order to prove that a person has a disability that meets the SSA’s criteria, they must produce a number of different evidence types. These evidentiary requirements are provided by the SSA, and include:
- Objective medical evidence from an acceptable medical source (i.e. a licensed healthcare professional);
- Evidence that speaks to the nature of the disability, the extent of the disability, and for how long the disability has lasted and is expected to last; and
- Evidence that details whether or not the affected individual can still perform any work.
An individual who is applying for disability benefits will first submit their application with evidence from their own doctor. In the event that the evidence is not strong enough, the SSA may request that the individual submits to a consultative examination, which will be conducted by either the patient’s own doctor or an independent medical examiner. The purpose of these examinations is to gather more evidence in order to make a determination about a disability.
Is Being Disabled and Unable to Work Enough to Qualify Me for Benefits?
Many people mistakenly assume that if they are disabled and unable to work, even if they have a disability that meets the Social Security Administration’s definition of disability, they will automatically be able to recoup Social Security disability benefits. However, this is not the case. In addition to being disabled, a person must:
- Have earned enough credits through the Social Security Administration during their working years (for SSDI benefits); or
- Be of limited income and resources (for SSI benefits); or
- Be blind or aged (for SSI benefits).
Am I Disabled Enough to Qualify for Benefits?
The SSA Blue Book defines which disabilities qualify for SSDI.
You may know for a fact that you can no longer work as you did before and you will be asked to prove you cannot do the work you did previously. You will be asked if there is other work you can do instead.
The definition used by the Social Security Administration requires that you can no longer perform substantial gainful activity due to your physical or mental disability, which must be very serious.
In order to receive SSDI benefits, your disability should be serious enough that it is expected to result in your death or to continue for the rest of your life.
There are hundreds of different qualifying conditions listed in the Blue Book. Examples might include:
- You can no longer stand, and your work required you to travel to various work sites and carry heavy equipment.
- You have experienced amputation and can no longer do the tasks necessary for you job that involved using your arms.
- You are confined to a wheelchair due to muscular dystrophy or MS and can no longer function in the workplace.
- You are bipolar or experience manic depression and cannot predict when you can professionally converse with others on your team or in an office setting.
- You have experienced congenital, cardiovascular, musculoskeletal, respiratory, neurological, or immune system disorders that have rendered you disabled.
Your doctor will play an important role in providing the records needed to help establish your disability. Regular doctor visits improve your chance of being approved for benefits and your doctor may be willing to advocate for you in establishing your condition.
Still, expect that 70% of applications are denied the first time. Don’t be discouraged. The SSA uses a strict definition and expect it is more difficult for younger workers to establish that they are permanently disabled.
There is now a four-step appeals process as the Alabama Disability Determination Services reconsiders your application.
Questions SSA Asks to Determine Disability
The questions that the SSA will ask you to determine whether or not you are disabled include the following:
- Are you working? If you are working this year and you average more than $1,220 per month in earnings, you are not considered disabled. If it’s determined that you are not working, your application for benefits will be forwarded to the Disability Determination Services office.
- Is the condition you have severe? The condition from which you suffer must severely limit your ability to conduct normal work tasks. These include lifting, moving, sitting, standing, walking and memory. The condition must cause issues with these tasks for no less than 12 months.
- Is the condition you have found in the SSA’s disabling conditions list? Now that you have moved to question number three, you need to determine if the condition you have is found in the disabling conditions list created by the SSA. If the condition cannot be found on the SSA list, the agency will have to determine if it is as severe as any of the other conditions found on the list. If the agency determines it to be as severe as another condition listed, you will be declared disabled. If not, you will move to question four.
- Are you able to perform the work you previously held? The SSA will examine your ability or inability to perform the work you previously held. If you cannot perform this work, you will need to move to the fifth question assessed by the SSA. If you can perform the work, you will not be declared disabled.
- Do you have the ability to perform any other type of work? The SSA will now look to find other type of work you might be able to perform if you cannot perform your previous work. The SSA will take into account your physical condition, age, prior work history, education, and skills that can transfer to a new job. If suitable work cannot be found that you can perform, the SSA will declare you disabled.
Hire a Skilled Disability Benefits Lawyer in Alabama
Suffering from a medical condition that prevents you from working can put a major physical, emotional, and financial strain on sufferers and their loved ones. If you are in need of disability benefits in order to support yourself and your family, attempting to navigate the process of filing a claim on your own can be trying, especially because the SSA denies thousands of disability benefit claims every year.
To improve the chances of your claim for disability benefits being approved, we strongly recommend working with a skilled Alabama disability benefits lawyer. At Walton Law, LLC, we can review your case for free help determine what will be needed to qualify for benefits. And if you have already been denied benefits, we can provide assistance with the appeals process. Call our office today at 251-455-5819 or send us a message through our online contact form.