Does my impairment qualify for disability benefits?
Author: Attorney Greg Reed
If you have a disability that has impacted your ability to work, you may or may not be eligible for Social Security Disability benefits. Whether or not you qualify depends on several factors: the disability diagnosis, how severely the disability limits your functionality, the length of time the disability is expected to affect you, and your financial situation.
Social Security pays disability benefits to individuals who are not able to work because they have sustained an injury or developed a medical condition that causes severe limitations.
Disability is defined by the Social Security Administration as “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” The disability can be physiological, such as heart disease, muscular-skeletal disorders, or cancer, or psychological such as depression or schizophrenia, but the diagnosis must be confirmed by clinical and laboratory results – not just symptoms.
Social Security pays disability benefits under two programs and the medical requirements are the same for both programs.
Social Security Disability Income (SSDI) is paid to the claimant and certain family members if the applicant has worked long enough and paid Social Security taxes. Supplemental Security Income is paid to disabled adults and children who have limited income and financial resources.
If you have been denied disability don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.
To provide guidance on what medical disorders qualify for disability benefits, the Social Security Administration has created a manual called the Blue Book which lists impairments that are considered severe enough to prevent an adult from performing any gainful activity regardless of their age, education or work experience.
Applicants qualify for Social Security disability benefits, provided the applicant’s medical condition matches the criteria of a specific impairment. The Blue Book is divided into 14 sections according to body systems.
Each section summarizes how an impairment will be evaluated and the medical evidence necessary to meet the listing requirements.
- Musculoskeletal System (such as back injuries and soft tissue injuries)
- Special Senses and Speech (such as vision and hearing impairments)
- Respiratory Disorders (such as cystic fibrosis)
- Cardiovascular System (such as congenital heart disease and chronic heart failure)
- Digestive System (such as chronic liver disease or IBD)
- Genitourinary Disorders (such as chronic kidney disease)
- Hematological Disorders (such as anemia and bone marrow failure)
- Skin disorders (such as chronic skin infections or dermatitis)
- Congenital Disorders That Affect Multiple Body Systems (such as non-mosaic Down Syndrome)
- Neurological System (such as cerebral palsy and muscular sclerosis)
- Mental Disorders (such as schizophrenia and autism)
- Cancer (such as skin cancer and lymphoma)
- Immune System Disorders (such as lupus, HIV and rheumatoid arthritis)
- Endocrine Disorders (medical conditions that cause hormone imbalance are evaluated separately under listings for other body systems)
In order to be approved for disability benefits, an applicant must have a diagnosis of a specific medical disorder from a doctor.
A few conditions, such as ALS (amyotrophic lateral sclerosis), organ transplants, and certain cancers will be automatically approved. Other medical disorders must meet the specific criteria of the listing – which may be complicated. It is important to carefully review the requirements of each listing, including the required medical evidence as stated; i.e. laboratory tests, exams, functional limitations and treatments. An attorney who is knowledgeable about Social Security’s requirements and procedures can help evaluate your case and your potential for eligibility.
What to do if your particular disability is not
in the SSA’s list of covered disabilities.
Social Security’s Guidelines, also known as the Blue Book, lists many conditions that qualify for disability benefits. However, not everything that could possibly go wrong with the human body can be listed in a simple guide.
There are many illnesses and injuries that could prevent you from working. Adding to the confusion, some diseases are similar and can be mistaken for each other- this is especially true when it comes to mental illness. Thankfully, the Social Security Administration allows some subjectivity in the interpretation of the Blue Book listings through “Medical Equivalence”.
If your condition is similar to a Blue Book listing, you may be able to claim medical equivalence.
Medical equivalence means that your impairment is equal in severity and duration to a listed impairment. Each listed impairment has criteria that you must meet in order to be considered disabled under that impairment (For example, Asthma requires applicants to have a certain number of attacks annually). These criteria are called “findings”. There are three cases in which medical equivalence can be determined.
- If you don’t have one of the findings, or it is not as severe as the listing requires;
but you exhibit other symptoms that are as bad or worse as the listing requires.
- If you have a condition that is not listed in the Blue Book at all;
but your condition is just as debilitating as a similar listed condition.
- If you have multiple impairments, none of which are as severe as the listing requires;
but the combined ailments are as bad or worse as a listed impairment.
As you can see, determining medical equivalence is less black-and-white than determining if a condition meets a listing.
Thorough medical records will be very helpful for comparing your condition(s) to the listings. One of the best ways to help your claim is to have accurate, complete and current records. If Disability Determination Services does not have enough evidence to make a determination of medical equivalence based on your records, they may refer you to a state-approved doctor for further evaluation.
It is important to note that only health care professionals are qualified to perform medical evaluations.
When you first file your application, a “designee of the commissioner” (usually a licensed, state-approved, medical professional) will make the determination of equivalence. If your claim is denied and appealed, an administrative law judge or council will have the final say on whether or not a listing is met, but they are required to consider a health care professional’s opinion. The judge may ultimately disagree with the health care professional, but they are required by federal law to explain the impact of the expert’s medical opinion on their judicial decision.
The issue of medical equivalence can only be determined with medical evidence.
In March 2006, the Social Security Administration modified its rules regarding how medical equivalency is determined. Previous to the rule change, all evidence (age, income, previous work) could be considered in an equivalency determination. Now, the Social Security Administration keeps non-medical evidence from influencing medical determinations.
Before you apply for Social Security Disability benefits, if you have long-term disability insurance, either through your employer or purchased on your own, you should file a claim with your insurance company.
Review your policy first and know your insurer’s definition of “disabled” and “partially disabled.” Though the medical conditions covered by your long-term disability policy are similar to Social Security, the insurance carrier may evaluate the severity of your injury or illness differently than Social Security. There may be requirements and limitations in the policy that exclude pre-existing conditions, mental and nervous conditions and illness caused by drug or alcohol abuse. If your claim is approved, there will be a waiting period before you begin receiving payments and your insurer may require that you also apply for Social Security Disability benefits.
If you are disabled and unable to work you may be eligible for Social Security Disability benefits whether or not your particular medical condition is listed as an impairment by Social Security.
Following is a list of disorders that are commonly determined as disabilities by Social Security. A qualified disability attorney can help you decide if your disability might qualify for benefits. Bemis, Roach and Reed is here to help, just give us a call at 512-454-4000 to schedule a free case evaluation and get started on your claim today. There is absolutely no obligation and never any out-of-pocket costs.
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
Bemis, Roach & Reed has helped clients who are disabled from a wide variety of medical conditions. If you are unable to work due to any of the following conditions and have been denied disability benefits, contact us. We would like to help.
- AIDS / HIV
- Amyotrophic Lateral Sclerosis ("ALS")
- Autoimmune Disorder
- Back Pain
- Bipolar Disorder
- Bladder Control
- Blood Disorder
- Brain Aneurysm
- Brain Tumor
- Breast Cancer
- Bulging / Herniated Disc
- Cancer (all kinds)
- Car Accident
- Carpal Tunnel Syndrome
- Cerebral Atrophy
- Cerebral Palsy
- Cervical Disc Disease
- Chronic Fatigue Syndrome
- Chronic Obstructive Pulmonary Diseases
- Chronic Pain Syndrome
- Congestive Heart Disease
- Congnitive Dysfunction
- Coronary Dysfunction
- Crohn’s Disease
- Cystic Fibrosis
- Degenerative Disc Disease
- Down Syndrome
- Epstein-Barr Virus
- Essential Tremor
- Falls and disability
- Gastrointestinal Reflux
- Hearing Impairment
- Heart Failure
- Hepatitis C
- Herniated / Bulging Disc
- High Blood Pressure/Hypertension
- Hip Replacement
- Hodgkin’s Disease
- Huntington’s Disease
- Interstitial Cystitis
- Irritable Bowel Syndrome
- Ischemic Heart Disease Disability
- Kidney Disease
- Knee Disorder/Replacement
- Liver Cancer
- Liver Disease
- Lumbar Disc Disease
- Lumbar Radiculopathy
- Lung Cancer
- Lyme Disease
- Macular Edema/Degeneration
- Memory Disorder
- Menieres Disease
- Mental Illness
- Multiple Myeloma
- Multiple Sclerosis
- Muscular Dystrophy
- Myofascial Pain Syndrome
- Neurocognitive Disorder
- Parkinsons Disease
- Peripheral Neuropathy
- Post-Traumatic Stress Disorder (“PTSD”)
- Prostate Cancer
- Reflex Sympathetic Dystrophy (“RSD”)
- Rheumatoid Arthritis
- Seizure Disorder
- Sjorgen's Syndrome
- Skin Cancer
- Sleep Apnea
- Spinal Stenosis
- Systemic Sclerosis
- Temporal Mandibular Joint Dysfunction
- Throat Cancer
- Traumatic Brain Injuries
- Vision Impairment
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