If you’re familiar with the Social Security Disability Insurance (SSDI) program, then you probably know a few basics about how it helps disabled workers support themselves and their families.
You may also know about the Social Security Administration’s (SSA’s) blue book that details the specific conditions that can qualify for disability. The blue book lists 14 categories of adult impairments and 15 categories of childhood impairments.
These listings are fairly comprehensive and cover a wide variety of conditions. But, not every single specific disabling condition can be found in there. Some people may suffer from a condition that’s every bit as disabling as any found in the blue book but hasn’t been catalogued in there as of yet.
This is why many people ask Disability Experts of Florida: what if my condition isn’t in the blue book? Can I still get benefits?
Can You Get SSDI Benefits if Your Condition Isn’t Listed in the Blue Book?
The short answer to this question is: “yes, you CAN get SSDI benefits for a condition not specifically listed in the blue book.”
Basically, as long as your condition meets the following criteria, it could qualify you for SSDI, even if it isn’t specifically listed in the blue book:
- Preventing you from engaging in “substantial gainful activity” (SGA);
- Being medically determinable through evidence of physical or mental impairment; and
- Lasting or being expected to last more than 12 consecutive months or result in death.
However, it may be a bit harder to prove to the SSA and the Florida Disability Determination Services (DDS) that you are disabled with a condition not listed in the blue book. In some cases, the DDS may try to see if there is a similar condition to yours that is listed in the book and use that as a comparison point.
Qualifying for Disability Benefits with a Condition Not in the Blue Book
There are no guarantees that your initial SSDI application will pass whether your condition is in the blue book or not. According to statistics from the SSA, “the percentage of applicants awarded benefits at the initial claims level averaged 28 percent” over the period of 2001-2010.
Denials fall into two broad categories:
- Medical Denials. In these cases, the disability is generally found to not be severe enough or long-term enough to qualify for SSDI benefits.
- Technical Denials. These denials include a broad variety of denials based on both nonmedical decisions and medical approvals that were later denied for technical reasons.
The best way to avoid a denial is to make sure that you have plenty of evidence and to cooperate with the SSA to the greatesst extent possible.
Work with your doctor/physician/psychiatrist closely to collect and organize your evidence for the DDS. The more evidence you have, the easier it is to prove your case.
What if I’m Denied Benefits?
If you’re denied benefits at first, don’t give up. There are many who get denied disability benefits at first that are later awarded them on appeal.
If you get denied, examine the reason why—was it a medical denial or a technical one? If the denial was because of a technical issue, learn more about it and how you can avoid that issue in the future.
A medical denial could be because of a lack of evidence, or a projection by the DDS that your condition might not meet the duration requirement—which you might be able to challenge with more evidence.
You may also want to consult with an experienced disability advocate who can help you by:
- Assessing your case;
- Helping you organize your evidence;
- Representing you in SSA hearings; and
- Providing advice and support to get you through the appeals process.
Dealing with disability can be unbearable enough as is. Getting access to the SSDI benefits you’re owed from your Social Security contributions shouldn’t be hard just because your specific condition isn’t codified in a government book.
Learn more about how Disability Experts of Florida can help you prepare to file your SSDI application today!