Medical Eligibility for Disability Benefits

Medical Criteria for Disability Benefits

To qualify for either SSDI or SSI disability benefits, you must prove you have a severe, medically determinable disease, condition or impairment that limits your functioning to such an extent that you are not able to work on a full time, consistent basis.

Disability Determination Services (DDS) is a state agency that evaluates disability claims for the SSA, analyzing each disability claim with a five-step evaluation process.

The Basics of Medical Eligibility for Disability Benefits

How Do You Satisfy the Medical Requirements to Qualify for Social Security Disability or SSI?
Explanation of the different ways you can prove your medically determinable impairment (illness or condition) qualifies as a disability.

Common Medical Conditions and Impairments
The most common medical conditions that qualify for Social Security disability benefits.

Do You Have to Have a Permanent Impairment or be Permanently Disabled to Qualify for Social Security Disability?
Some claimants may still qualify for disability even after their medical condition improves.

What Is the One Year Rule for Social Security?
Social Security and SSI claims must satisfy SSA’s durational requirements, which means the Social Security Administration only pays benefits where the disabling condition has lasted or is expected to last at least 12 months.

What Medical Conditions and Impairments Qualify for Social Security Disability?
A medically determinable impairment must be severe enough to keep the claimant from working full time. The illness or disease does not necessarily need to be listed in Social Security’s “blue book” in order to qualify for disability benefits.

Ways to Get Approved for Disability Benefits

The Listed Impairments in Social Security’s “Blue Book”
Social Security has a Listing of Impairments, which is a listing of the most severe conditions. Conditions listed here are the quickest way to get disability benefits.

Reduced Residual Functional Capacity
Many medical conditions and illnesses cause an individual to have reduced functional abilities. The SSA may find you too disabled to work if the reduction in abilities is significant enough.

Grid Rules
Social Security has medical-vocational rules (which are set out on a grid and are therefore called the “grid rules”) that may apply to disability claimants over the age 50.

Specific Medical Conditions
Detailed articles on how various medical ailments qualify for disability benefits, including conditions like heart and back problems.

Factors That Can Affect Disability Eligibility

Your Credibility in Applying for Disability: How Social Security Assesses Your Subjective Complaints
Your credibility is an important part of the claims process. If there are questions about your credibility, then your Social Security disability claim will likely be denied.

Medical Compliance: How Failing to Comply with Your Doctor’s Recommendations Affects Your Disability Case
If you do not go to a doctor for your disability or if you fail to follow the doctor’s treatment orders, you weaken your claim and you can jeopardize your credibility.

Multiple Disabilities: If You Have More Than One Medical Condition, Social Security Must Consider the Combined Effects
If you have multiple impairments or disabilities, Social Security will consider the combined effects of all of your medical conditions when processing your SSDI and/or SSI disability application.

Chronic Pain in Disability Claims
Social Security will consider your subjective reports of pain as long as there is some objective medical evidence of a physical or mental impairment.

If I Refuse Surgery, Social Security Deny My Disability Claim?
If you refuse to undergo surgery that is likely fix your underlying medical problem, it is possible you might not be able to receive Social Security disability benefits.

Tips on Medical Eligibility From An Experienced Disability Lawyer

Here are some tips from an experienced Board Certified Social Security Disability Attorney on getting your disability claim approved:

Issues Social Security Does Not Usually Consider When Evaluating a Claim
You should not waste your time on issues that Social Security does consider important when evaluating an SSDI or SSI claim.

Seven Mistakes That Could Ruin Your SSDI Claim
List of common pitfalls in disability claims and what you can do to avoid them.

For Social Security, Being Able to Work Means Being Able to Work Full Time
You may qualify for SSDI or SSI if you are only able to do part time work. Social Security only cares whether you can work full-time. There is no partial disability.

Advanced Strategies to Prove Eligibility
There are many theories that experienced disability lawyers use to argue a disability claim.

Resources

Residual Functional Capacity Form (RFC)
Here’s an RFC form for physical conditions.

Mental Functional Capacity Form (RFC)
Here’s an RFC form for a mental health condition (psychiatric, cognitive or emotional condition).

RFC for Fibromyalgia
A medical assessment form for fibromyalgia.