Determining What Medical Conditions You can Apply and Qualify For

Published on: April 24, 2015

Social Security ApplicationWondering if your medical condition qualifies you for Supplemental Security Income (SSI) or Social Security Disability Income (SSDI)? The Social Security Administration (SSA) uses medical evidence, as well as objective financial eligibility requirements (for SSI), to determine whether you qualify or not. Keep in mind, this is dependent on a multitude of factors (such as work credits, if applicable), and eligibility for SSDI is not based upon need.

However, once the SSA checks up on your financial eligibility requirements, your application is forwarded to state agencies, usually going by the name of Disability Determination Services, or DDS. They evaluate your impairment under conditions such as:

  • Whether or not your condition is classified as “severe”

  • If it affects your ability to work

  • If your disability is expected to last at least one year, or exceed that year or has already lasted one year; 

  • A diagnosis by an accredited physician (or other applicable doctor)

The Impairment Framework

The SSA and DDS’s frame of reference for approved medical criteria lies in the “Blue Book,” which is a nickname for the administration’s collective list of impairments. Conditions are categorized under 14 sections, of which a few are listed here:

  • 1.00: Musculoskeletal System

       - Such as: spinal arachnoiditis, spinal stenosis and osteoarthritis

  • 2.00: Special Senses and Speech

       - Such as: hearing loss and loss of visual acuity

  • 3.00: Respiratory System

       - Such as: cystic fibrosis or chronic obstructive pulmonary disease

  • 4.00: Cardiovascular System

       - Such as: chronic heart failure or ischemic heart disease

Depending on what your impairment is, the DDS representative will review your medical evidence and history, alongside your impairment, such as they do for ischemic heart disease. There is no guarantee that you will receive benefits due to having ischemic heart disease — there are specific parameters the DDS will evaluate, as they do with “sign- or symptom-limited exercise tolerance tests,” that possess a “workload equivalent to 5 METs or less,” according to the official SSA website.

What if my Medical Condition Isn’t in the Blue Book?

If your condition isn’t in the Blue Book, does this mean you can’t get benefits? Not at all. It’s important, if you are unsure of your impairment or its qualifications, to contact a trained disability expert who can process your claim and respond to all of your concerns and questions.

There are other exceptions, however, such as disability eligibility for children (this is when functional equivalence would come into play) or an adult that falls short of the listing eligibility requirements. In these cases, which requires more elaborate explanation elsewhere, you can then request a medical-vocational allowance, or a med-voc allowance

What do I do now?

According to the Patient Advocate Foundation, up to 60% of all claims filed for disability are denied the first time they are submitted.

Don’t go through the application process for SSDI or SSI benefits alone — allow a disability expert to do all the heavy lifting and increase your chances of receiving the maximum amount of benefits you deserve for your impairment. Even if you are denied, our professionals will assist you in the next steps of the appeals process, and represent you in court for a hearing.

We don’t collect anything unless you do; that being said, there is no time to waste, as a social security application can take up to five months to process. Read up on our other blog articles to learn if your medical conditions or impairments will qualify when you apply for benefits.


Contact Us

New Call-to-action