I really need my disability claim to be approved right away and need to know if I will automatically be eligible for disability. Are there certain medical conditions, illnesses or diseases that are guaranteed to be approved automatically?
Answer: There are no “automatic” wins in disability. That being said, some conditions are more likely to win than others, and some conditions are more likely to win earlier in the disability review process than others.
No matter what the illness, ailment or injury, Social Security follows a Five Step Sequential Process in evaluating a claim for disability benefits.
In short, the diagnosis of a particular illness or injury will not by itself qualify you for disability benefits. It is not just whether you have a specific condition. Instead, Social Security is more concerned with how your condition (or combination of conditions) limits your ability to perform work activity.
Perhaps an example will be helpful in understanding this concept. Because back pain is the most common physical disorder in disability applications, we’ll use an example of a back pain condition involving herniated discs in the low-back or lumber-spine (L-Spine). Let’s say you have two men, Alex and Brad, who each have herniated discs at L4-L5 and L5-S1, with exact same amount of disc protrusions. Both men are construction workers by trade. Alex has a high pain tolerance, and he really only has little discomfort or limitations from his herniated discs. He rates his pain as a 3 or 4 on a scale of 1-10. He can take Lortab in the morning and feel well enough to perform a full day of work (although he is in some pretty good pain by the time he gets home). Bradley, however, has a very low pain tolerance. He rates his pain as an 8 or 9 on a 1-10 pain scale. Even after he takes his Lortab, his pain is at a 7. The pain radiates to his arms and legs. He has numbness and tingling in his hands, limiting his grip strength and ability to handle objects. He can barely get out of bed due to his pain, and the pain interferes with his ability to maintain focus and concentration on even routine things. Alex would not qualify for disability benefits because he can still perform work activity. However, Brad may qualify for benefits given the extent and severity of his back condition.
The same concept applies to mental conditions such as anxiety and depression.
Some patients diagnosed with depression perform pretty well on a day-to-day basis with counseling and medications. However, others who have been diagnosed with severe depression may have difficulty with concentration, persistence and pace, have a hard time being around other people, and breakdown pretty easily in stressful situations – even while undergoing counseling and taking proper medications.
In short, it is not the diagnosis you have but it affects you as a whole and limits you from performing work activity.
Because your specific condition will not alone predict whether you will win or lose your Social Security Disability claim, you should speak with an attorney who has lots of experience in handling many Social Security Disability cases. The lawyer will help you present your case in a way that showcases how the limitations you have from your illness or injury limit your ability to work.
The Listing of Impairments
The Listing of Impairments describes impairments for each of the major body systems that Social Security considers severe enough to prevent a claimant from doing any gainful activity, regardless of his or her age, education, or work experience (you can find these impairments on our website in our article on the disabilities “Listings”). Disability claimants who “meet” or satisfy all of the the severity requirements for one of these listed conditions can be approved for benefits somewhat easily. However, the disability evaluation process, even for these “listing-level” impairments, is never automatic as nothing is ever guaranteed with Social Security.
Each body system section in Parts A and B of the Listing of Impairments is in two parts: an introduction, followed by the specific listings. The introduction to each body system contains information relevant to the use of the listings in that body system; e.g., examples of common impairments in the body system and definitions used in the listings for that body system. The specific listings follow the introduction in each body system, after the heading, “Category of Impairments.” Within each listing, Social Security specifies the objective medical and other findings needed to satisfy the criteria of that listing. If the criteria required to qualify for the listed condition are not evidenced in the medical records (for example, the doctor’s office did not produce required test results or otherwise left out important information), the claimant will be denied benefits even though his or her condition is one listed as medically eligible for Social Security benefits. Social Security will, of course, have to include a rationale in the denial letter as to why benefits were denied, and the claimant can submit the missing information in an appeal for reconsideration review.
Social Security will find that an impairment(s) meets the requirements of a listing when it satisfies all of the criteria of that listing, including any relevant criteria in the introduction, and meets the duration requirement.
Most of the listed impairments are permanent or expected to result in death. For some listings, Social Security states a specific period of time for which an impairment(s) will meet the listing. For all others, the evidence must show that an impairment(s) has lasted or can be expected to last for a continuous period of at least 12 months.
If an impairment(s) does not meet the criteria of a listing, it can medically “equal” the criteria of a listing.
If a claimant’s impairment(s) does not meet or medically equal the criteria of a listing, Social Security may find that he or she is disabled or still disabled at a later step in the sequential evaluation process.
If the claims examiner at DDS finds that there is sufficient medical evidence in your record to qualify for benefits under a Listing of Impairment, your file will be sent back to the field office to make sure that you are still eligible for SSDI or SSI and that you still are not working above the SGA level. If this final check goes well, your file will be sent to a payment center and you will be sent an award notice with an estimated date of when your payments will begin (for SSDI, this will be after the five-month waiting period). Finally, you will receive your first disability check and any past due benefits owed.
Compassionate Allowances
Social Security recognizes that it has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards.
Compassionate Allowances (CAL) are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate Allowances allow Social Security to target the most obviously disabled individuals for allowances based on objective medical information that it can obtain quickly. Compassionate Allowances is not a separate program from the Social Security Disability Insurance or Supplemental Security Income programs.
CAL conditions are selected using information received at public outreach hearings, comments received from the Social Security and Disability Determination Services communities, counsel of medical and scientific experts, and Social Security’s research with the National Institutes of Health (NIH). Also, Social Security considers which conditions are most likely to meet its current definition of disability.
As of 2013, Social Security has held seven Compassionate Allowances public outreach hearings. The hearings were on rare diseases, cancers, traumatic brain injury (TBI) and stroke, early-onset Alzheimer’s disease and related dementias, schizophrenia, cardiovascular disease and multiple organ transplants and autoimmune diseases.
As a result of the foregoing, Social Security has identified the following list of Compassionate Allowances Conditions:
- Acute Leukemia
- Adrenal Cancer – with distant metastases or inoperable, unresectable or recurrent
- Adult Non-Hodgkin Lymphoma
- Adult Onset Huntington Disease
- Aicardi-Goutieres Syndrome
- Alexander Disease (ALX) – Neonatal and Infantile
- Allan-Herndon-Dudley Syndrome
- Alobar Holoprosencephaly
- Alpers Disease
- Alpha Mannosidosis – Type II and III
- Alstrom Syndrome
- Alveolar Soft Part Sarcoma
- Amegakaryocytic Thrombocytopenia
- Amyotrophic Lateral Sclerosis (ALS)
- Anaplastic Adrenal Cancer – with distant metastases or inoperable, unresectable or recurrent
- Angelman Syndrome
- Aortic Atresia
- Aplastic Anemia
- Astrocytoma – Grade III and IV
- Ataxia Telangiectasia
- Batten Disease
- Beta Thalassemia Major
- Bilateral Optic Atrophy- Infantile
- Bilateral Retinoblastoma
- Bladder Cancer – with distant metastases or inoperable or unresectable
- Breast Cancer – with distant metastases or inoperable or unresectable
- Canavan Disease (CD)
- Carcinoma of Unknown Primary Site
- Caudal Regression Syndrome – Types III and IV
- Cerebro Oculo Facio Skeletal (COFS) Syndrome
- Cerebrotendinous Xanthomatosis
- Child Neuroblastoma – with distant metastases or recurrent
- Child Non-Hodgkin Lymphoma – recurrent
- Child T-Cell Lymphoblastic Lymphoma
- Chondrosarcoma – with multimodal therapy
- Chronic Myelogenous Leukemia (CML) – Blast Phase
- Congenital Lymphedema
- Cornelia de Lange Syndrome
- Corticobasal Degeneration
- Creutzfeldt-Jakob Disease (CJD) – Adult
- Cri du Chat Syndrome
- Degos Disease – Systemic
- DeSanctis Cacchione Syndrome
- Dravet Syndrome
- Early-Onset Alzheimer’s Disease
- Edwards Syndrome (Trisomy 18)
- Eisenmenger Syndrome
- Endometrial Stromal Sarcoma
- Endomyocardial Fibrosis
- Ependymoblastoma (Child Brain Tumor)
- Erdheim Chester Disease
- Esophageal Cancer
- Ewing Sarcoma
- Farber’s Disease (FD) – Infantile
- Fatal Familial Insomnia
- Fibrodysplasia Ossificans Progressiva
- Follicular Dendritic Cell Sarcoma – metastatic or recurrent
- Friedreichs Ataxia (FRDA)
- Frontotemporal Dementia (FTD), Picks Disease -Type A – Adult
- Fryns Syndrome
- Fucosidosis – Type 1
- Fukuyama Congenital Muscular Dystrophy
- Fulminant Giant Cell Myocarditis
- Galactosialidosis – Early and Late Infantile Types
- Gallbladder Cancer
- Gaucher Disease (GD) – Type 2
- Glioblastoma Multiforme (Adult Brain Tumor)
- Glioma Grade III and IV
- Glutaric Acidemia – Type II
- Head and Neck Cancers – with distant metastasis or inoperable or unresectable
- Heart Transplant Graft Failure
- Heart Transplant Wait List – 1A/1B
- Hemophagocytic Lymphohistiocytosis (HLH) – Familial Type
- Hepatoblastoma
- Hepatopulmonary Syndrome
- Hepatorenal Syndrome
- Histiocytosis Syndromes
- Hutchinson-Gilford Progeria Syndrome
- Hydranencephaly
- Hypocomplementemic Urticarial Vasculitis Syndrome
- Hypophosphatasia Perinatal (Lethal) and Infantile Onset Types
- Hypoplastic Left Heart Syndrome
- I Cell Disease
- Idiopathic Pulmonary Fibrosis
- Infantile Free Sialic Acid Storage Disease
- Infantile Neuroaxonal Dystrophy (INAD)
- Infantile Neuronal Ceroid Lipofuscinoses
- Inflammatory Breast Cancer (IBC)
- Jervell and Lange-Nielsen Syndrome
- Junctional Epidermolysis Bullosa – Lethal Type
- Juvenile Onset Huntington Disease
- Kidney Cancer – inoperable or unresectable
- Krabbe Disease (KD) – Infantile
- Kufs Disease – Type A and B
- Large Intestine Cancer – with distant metastasis or inoperable, unresectable or recurrent
- Late Infantile Neuronal Ceroid Lipofuscinoses
- Left Ventricular Assist Device (LVAD) Recipient
- Leigh’s Disease
- Leiomyosarcoma
- Lesch-Nyhan Syndrome (LNS)
- Lewy Body Dementia
- Lissencephaly
- Liver Cancer
- Lowe Syndrome
- Lymphomatoid Granulomatosis – Grade III
- Malignant Brain Stem Gliomas – Childhood
- Malignant Gastrointestinal Stromal Tumor
- Malignant Germ Cell Tumor
- Malignant Melanoma – with metastases
- Malignant Multiple Sclerosis
- Mantle Cell Lymphoma (MCL)
- Maple Syrup Urine Disease
- Mastocytosis – Type IV
- MECP2 Duplication Syndrome
- Medulloblastoma – with metastases
- Menkes Disease – Classic or Infantile Onset Form
- Merkel Cell Carcinoma – with metastases
- Merosin Deficient Congenital Muscular Dystrophy
- Metachromatic Leukodystrophy (MLD) – Late Infantile
- Mitral Valve Atresia
- Mixed Dementias
- MPS I, formerly known as Hurler Syndrome
- MPS II, formerly known as Hunter Syndrome
- MPS III, formerly known as Sanfilippo Syndrome
- Mucosal Malignant Melanoma
- Multicentric Castleman Disease
- Multiple System Atrophy
- Myoclonic Epilepsy with Ragged Red Fibers Syndrome
- Neonatal Adrenoleukodystrophy
- Nephrogenic Systemic Fibrosis
- Neurodegeneration with Brain Iron Accumulation – Types 1 and 2
- NFU-1 Mitochondrial Disease
- Niemann-Pick Disease (NPD) – Type A
- Niemann-Pick Disease-Type C
- Nonketotic Hyperglycinemia
- Non-Small Cell Lung Cancer – with metastases to or beyond the hilar nodes or inoperable, unresectable or recurrent
- Obliterative Bronchiolitis
- Ohtahara Syndrome
- Ornithine Transcarbamylase (OTC) Deficiency
- Orthochromatic Leukodystrophy with Pigmented Glia
- Osteogenesis Imperfecta (OI) – Type II
- Osteosarcoma, formerly known as Bone Cancer – with distant metastases or inoperable or unresectable
- Ovarian Cancer – with distant metastases or inoperable or unresectable
- Pancreatic Cancer
- Paraneoplastic Pemphigus
- Patau Syndrome (Trisomy 13)
- Pearson Syndrome
- Pelizaeus-Merzbacher Disease-Classic Form
- Pelizaeus-Merzbacher Disease-Connatal Form
- Peripheral Nerve Cancer – metastatic or recurrent
- Peritoneal Mesothelioma
- Peritoneal Mucinous Carcinomatosis
- Perry Syndrome
- Phelan-McDermid Syndrome
- Pleural Mesothelioma
- Pompe Disease – Infantile
- Primary Cardiac Amyloidosis
- Primary Central Nervous System Lymphoma
- Primary Effusion Lymphoma
- Primary Progressive Aphasia
- Progressive Multifocal Leukoencephalopathy
- Progressive Supranuclear Palsy
- Pulmonary Atresia
- Pulmonary Kaposi Sarcoma
- Retinopathy of Prematurity – Stage V
- Rett (RTT) Syndrome
- Rhabdomyosarcoma
- Rhizomelic Chondrodysplasia Punctata
- Roberts Syndrome
- Salivary Tumors
- Sandhoff Disease
- Schindler Disease – Type 1
- Severe Combined Immunodeficiency – Childhood
- Single Ventricle
- Sinonasal Cancer
- Small Cell Cancer (of the Large Intestine, Ovary, Prostate, or Uterus)
- Small Cell Lung Cancer
- Small Intestine Cancer – with distant metastases or inoperable, unresectable or recurrent
- Smith Lemli Opitz Syndrome
- Spinal Muscular Atrophy (SMA) – Types 0 and 1
- Spinal Nerve Root Cancer-metastatic or recurrent
- Spinocerebellar Ataxia
- Stiff Person Syndrome
- Stomach Cancer – with distant metastases or inoperable, unresectable or recurrent
- Subacute Sclerosing Panencephalitis
- Tabes Dorsalis
- Tay Sachs Disease – Infantile Type
- Thanatophoric Dysplasia – Type 1
- The ALS/Parkinsonism Dementia Complex
- Thyroid Cancer
- Transplant Coronary Artery Vasculopathy
- Tricuspid Atresia
- Ullrich Congenital Muscular Dystrophy
- Ureter Cancer – with distant metastases or inoperable, unresectable or recurrent
- Usher Syndrome – Type I
- Walker Warburg Syndrome
- Wolf-Hirschhorn Syndrome
- Wolman Disease
- Xeroderma Pigmentosum
- Zellweger Syndrome