What Medical Conditions Qualify for Social Security Disability or SSI

Published on: November 19, 2019


Knowing which Social Security disability benefits you qualify for can sometimes be complicated to sort out when you’re also struggling with a serious medical condition. The Social Security Administration (SSA) relies upon medical evidence when evaluating your disability claim, which makes it important for you to know what kinds of medical tests and other records you may need when applying for benefits.

What Medical Conditions Qualify?

The SSA and state-level Disability Determination Services (DDS) reference a list of approved medical criteria compiled in a document known as the “Blue Book.” Medical impairments are grouped into 14 broad categories and accompanied with detailed information about how the government assesses the severity of an applicant’s impairment.

1. Musculoskeletal System

Includes any disorders of the musculoskeletal system that result in a loss of function. These conditions may be hereditary, congenital, or acquired pathologic processes. Loss of function is typically defined as an inability to move effectively or perform fine motor movements effectively for prolonged periods for any reason. Examples include joint dysfunction, amputation, and disorders of the spine.

2. Special Senses and Speech

Primarily divided into visual disorders that cause a loss or severe diminishment of visual acuity, hearing loss, and the loss of speech due to any cause. There are a variety of tests utilized to measure what level of visual, hearing, and speech loss qualifies as an impairment.

3. Respiratory Disorders

This section covers conditions that prevent air from entering or leaving the lungs. It also applies to cancers that impact the respiratory system as well as the pulmonary effects of neuromuscular and autoimmune disorders. Some examples include asthma, cystic fibrosis, and bronchiectasis.

4. Cardiovascular System

A cardiovascular impairment refers to any disorder that interferes with the heart and the circulatory system’s regular functions. The condition can be congenital or acquired. Cardiovascular impairment typically results from one of four symptoms of heart disease: chronic heart failure, myocardial ischemia, syncope, or central cyanosis. Disorders of the veins or arteries may also result in cardiovascular impairment.

5. Digestive System

Digestive disorders cover conditions that impact the digestive system itself, along with complications that may manifest in other body systems. The primary disorders include gastrointestinal hemorrhage, hepatic dysfunction, inflammatory bowel disease, short bowel syndrome, and malnutrition.

6. Genitourinary Disorders

This section covers a variety of conditions related to chronic kidney disease (CKD). Any evaluation of genitourinary disorders takes treatments such as dialysis and kidney transplants into consideration. Some examples of conditions include chronic glomerulonephritis, hypertensive nephropathy, and chronic obstructive uropathy.

7. Hematological Disorders

Blood conditions can come in non-malignant (non-cancerous) and malignant (cancerous) forms. Both are evaluated under this category. Some non-malignant disorders include hemolytic anemias, disorders of thrombosis and hemostasis, and bone marrow failure. Malignant disorders include cancers such as lymphoma, leukemia, and multiple myeloma. There is a notable exception here pertaining to HIV-related lymphomas, which are categorized under immune system disorders.

8. Skin Disorders

This section covers hereditary, congenital, and acquired skin conditions. The severity of these conditions based upon the extent of skin lesions, the frequency of flare ups, and how much they limit regular activity. Some examples of skin conditions include ichthyosis, dermatitis, hidradenitis suppurativa, and genetic photosensitivity disorders.

9. Endocrine Disorders

These conditions cause hormonal imbalances, usually as a result of abnormal function of an endocrine gland that produces too much or too little of a specific hormone. A hormonal imbalance can cause a variety of complications in other parts of the body. The most common endocrine disorders affect the thyroid, pituitary, adrenal, and parathyroid glands.

10. Congenital Disorders that Affect Multiple Body Systems

This section primarily covers non-mosaic Down syndrome, which typically causes delayed physical development and intellectual disability. It is also frequently accompanied by congenital heart disease, impaired vision and hearing, and other disorders. People with non-mosaic Down syndrome are considered disabled from birth. The mosaic form of Down syndrome is less common and more difficult to detect clinically, which is why it is not covered under this category.

11. Neurological Disorders

Any neurological condition that results in impaired or disorganized motor function or communication function falls under this section. Neurological disorders that cause only mental impairment are treated as a separate category. Some examples include epilepsy, amyotrophic lateral sclerosis, early-onset Alzheimer’s disease, and persistent vegetative state (PVS).

12. Mental Disorders

A rather complicated section, there are eleven categories of mental disorders that cover a wide variety of conditions. Generally speaking, any mental impairment that is not accompanied by a specific physical impairment falls under this section. Each category is further broken down into a variety of specific conditions.

The eleven categories include:

  1. Neurocognitive disorders

  2. Schizophrenia spectrum and other psychotic disorders

  3. Depressive, bipolar, and related disorders

  4. Intellectual disorder

  5. Anxiety and obsessive-compulsive disorders

  6. Somatic symptom and related disorders

  7. Personality and impulse-control disorders

  8. Autism spectrum disorder

  9. Neurodevelopmental disorders

  10. Eating disorders

  11. Trauma/stressor-related disorders

13. Cancer (Malignant Neoplastic Diseases)

This section includes all cancers except those related to HIV infection. The impact of this cancer or the effects of its associated treatment must be severe enough to prevent a person from performing any gainful activity in order to meet the impairment criteria.

14. Immune System Disorders

Symptoms of immune system dysfunctions can include recurrent and unusual infections, inflammation, tissue dysfunction, and, in serious cases, organ failure. They can also cause severe fatigue or malaise, fever, musculoskeletal pain, and involuntary weight loss. These symptoms are typically a result of poor antibody production, impaired cell immunity, cellular deficiency, or impaired phagocytosis. A variety of autoimmune and immune deficiency disorders, as well as HIV, fall under this section.

Assessing Your Condition

The Blue Book provides a general set of guidelines that are meant to be interpreted on a case by case basis. Every case is unique, and any attempt to create a truly exhaustive list of conditions that qualify for assistance would be impossible. If your specific condition does not appear there, it doesn’t necessarily mean you don’t qualify for benefits. When you apply for disability, DDS representatives will review your medical history and may even require that you undergo additional tests to gather more information about your condition.

Having an experienced disability advocate at your side throughout this process can greatly improve your likelihood of avoiding common mistakes people make when applying for disability. Should your application be denied (and many of them are the first time they’re submitted), an advocate can assist you as you move on to the appeals process or make your case before a judge.

Contact the seasoned advocates at Disability Experts of Florida today for a thorough consultation that will help you better understand what options are available to you.

Contact Us

New Call-to-action