Social Security Disability Benefits
How Disabled Must You Be to Receive Social Security Disability Benefits?
Only certain medical conditions qualify as sufficiently disabling to entitle you to Social Security Disability benefits.
While many conditions are certainly serious enough to affect one’s ability to earn a steady living, only certain conditions meet the Social Security Administration’s criteria for benefits entitlement.
What are those conditions, and how are they determined by the SSA?
The SSA’s List of Disabling Medical Conditions
The Social Security Administration maintains a very comprehensive list of medical conditions that it considers sufficiently serious to qualify as a “disability” for benefits purposes.
This list is known as the disability “blue book.” It breaks down various conditions by affected body system.
The majority of the listed conditions are serious enjoy to not only prevent you from engaging in what the SSA calls “gainful activity” (income-earning activity) but are also those that are likely to be permanent and likely to potentially result in death.
Other conditions listed which are not so gravely serious require you to provide evidence that the condition is long-lasting, persisting continuously for 12 more months
Generally, the thrust of the SSA blue book listings is that SSD benefits are available only for those with the most serious possible conditions. The listing is specifically designed as a means of excluding less serious conditions—and less serious circumstances.
Step 1 of the Social Security Disability application review process, for the SSA, is finding a reason to deny the application, after all.
That said, the blue book listing is broken into 2 parts: Part A and Part B.
Part A of the Social Security Administration Blue Book Condition List
Part A of the listing is a catalog of impartments, sub-categorized in the following manner, according to body system:
- 1.00 – Musculoskeletal Disorders
- 2.00 – Special Senses and Speech
- 3.00 – Respiratory Disorders
- 4.00 – Cardiovascular System
- 5.00 – Digestive System
- 6.00 – Genitourinary Disorders
- 7.00 – Hematological Disorders
- 8.00 – Skin Disorders
- 9.00 – Endocrine Disorders
- 10.00 – Congenital Disorders that Affect Multiple Body Systems
- 11.00 – Neurological Disorders
- 12.00 – Mental Disorders
- 13.00 – Cancer (Malignant Neoplastic Diseases)
- 14.00 – Immune System Disorders
Each of these categories is further divided by the SSA into specific disorder descriptions.
For example, Category 1.00, Musculoskeletal Disorders, is further sub-divided into the following sections:
- 1.15 – Disorders of the skeletal spine resulting in a compromise of a nerve root(s)
- 1.16 – Lumbar spinal stenosis resulting in compromise of the cauda equina
- 1.17 – Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint
- 1.18 – Abnormality of a major joint(s) in any extremity
- 1.19 – Pathologic fractures due to any cause
- 1.20 – Amputation due to any cause
- 1.21 – Soft tissue injury or abnormality under continuing surgical management
- 1.22 – Non-healing complex fracture of the femur, tibia, pelvis, or one or more of the talocrural bones
- 1.23 – Non-healing or complex fracture of an upper extremity
However, that your condition may seem to fall into one of these sub-categories is no guarantee of your entitlement to disability benefits.
The SSA will evaluate your medical condition for specific detriments to ensure that you are entitled to benefits.
With regard to the musculoskeletal conditions above, the SSA will require evidence from an acceptable medical professional to determine whether you will qualify for benefits.
Your doctor, as well as other non-medical sources, will need to verify the specific symptoms of your condition to assure the SSA of the condition’s severity and long-term nature.
A physical examination will be required, as well as other objective clinical assessments. The results of imaging and other diagnostic tests will need to support your claim that the condition will persist for 12 or months, at least.
You may be required to submit to a specific consultative examination for purposes of determining the severity of your disability.
If you’ve received treatment for your condition, the SSA will require documentation describing the treatment, its frequency, your response to the treatment, the temporary or long-term effects of the treatment, and so on.
Likewise, records of and the effects of prosthesis used are required by the SSA. Also required will be documentation regarding any surgery that may have taken place, with supporting evidence required for any assertion that your future ability to earn an income will be affected.
Once the SSA has all of the information it requires regarding your condition and its treatment, it applies that information to its criteria for disability.
With regard to musculoskeletal conditions, it applies the information to what is known as “functional criteria,” which define the impairments—in this example—to extremity-specific abilities. Those criteria are then compared to your prospective work environment to determine whether you have a true inability to perform work-relation functions.
Part B of the Social Security Administration Blue Book Condition List
Part B of the Blue Book listing contains a catalog of additional impairments specific to those under the age of 18.
Conditions listed under Part B are evaluated similarly to those in Part A.
If your condition, on the other hand, clearly meets disability standards, the SSA provides a simplified path forward known as a compassionate allowance.
This standard is appropriate for blue book-listed conditions. It is an expedited process, requiring a minimal amount of medical documentation.
Examples of conditions that qualify are Adult Non-Hodgkin Lymphoma, Liver Cancer, Thyroid Cancer, and others.
A full list of compassionate allowance conditions is maintained here.
Next Steps In Determining Disability Benefits Eligibility
If you think that your condition qualifies you for Social Security Disability Benefits, the next step is to consult your physician.
A knowledgeable doctor is better qualified to determine whether or not your condition rests easily within the Blue Book parameters or whether further review is necessary.
Even if your condition is not explicitly defined in the SSA Blue Book, it may still be determined to be a disabling condition regardless.
This will require more work to prove to the SSA that you’re not able to perform your prior or equivalent work function, but it is possible.
Nevertheless, the condition must be one that is able to be identified medically and supported by clinical report evidence.
If you need to climb this slightly steeper hill to obtain your rightful SSD benefit award, it may be time to consider retaining an experienced Orlando Social Security Disability Attorney.
How Can a Florida Disability Attorney Help
A Florida Disability Attorney can assist you with everything that you will need to do to prove your case to the Social Security Administration.
At The Law Offices of Shea A. Fugate, PA, we assist you with the information gathering that will underpin a successful SSD application.
While most applications are routinely denied by the SSA, an Orlando Disability Lawyer can maximize your odds of success. If the application is denied, an attorney already on the job for you can move quickly to appeal the denial and, hopefully, obtain the benefits award for you that you deserve and need.
In particular, we will guide you through the SSA’s 5-Step process of determining whether or not you are eligible for benefits.
We help you to respond to the SSA’s questions regarding the severity of your condition, whether it is a blue book-listed impairment, and, if not, whether it is equivalent in severity to a listed impairment.
In addition to assisting you in gathering the medical records, testing records, surgical outcome documentation, and other required hard evidence supporting your claim, we will ensure that you are prepared for any hearing you may need to attend.
A Florida Disability Attorney can, above all else, explain in clear language what is happening at every step of the lengthy benefits application process.
What Is a Medical Disability?
The question of what is and what is not a sufficiently disabling condition is going to depend upon who is asking it.
Surely, if you are exploring this topic, you are at least on the cusp of defining yourself in that manner. You’re not feeling as you once did … You’re not working or not working well. You can no longer participate in many or most or even all of the recreational activities you once did.
Your family life is suffering.
You feel pretty disabled.
The Social Security Administration, on the other hand, will take a very different view of the question. It will run through its 5-step analysis in, yes, a clinical manner.
Preparing yourself to view your situation as the SSA will—purely legally—is a good mental first step to take when entering this process. The initial rejection or push-back or umpteen record requests will not fluster you. Or fluster you less.
At the end of the day, it’s the SSA’s definition that controls this question. It will be up to you and your Florida Disability Attorney to convince them that your condition is the answer they are looking for.
If you are considering filing for Social Security Disability Benefits, contact The Law Offices of Shea A. Fugate, PA 407-539-0123 to schedule your free initial analysis.