Question: 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 automatically approved for Social Security Disability?
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. Even if your impairment(s) are included in the Listing of Impairments or are one of the conditions recognized by the Compassionate Allowances (CAL) initiative, 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.