SSDI Requirements: Eligibility for Disability


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Determinations of Disability are made by Disability Determination Services Office in your state.  They apply a five-step process to determine disability.  You must meet each level or go to next.  The steps in the process are:

Are you working? - If you are working and your earnings average more than a certain amount each month, you will generally not be considered disabled.  This amount changes every year.

Is your medical condition “severe” - your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting, and remembering—for at least one year.

Is your medical condition on the List of Impairments:
  conditions on this list are considered so severe that they automatically mean that you are disabled as defined by law.  If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled.  If it does not, the state agency goes on to step four.

Can you do the work you did before?
  At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before.  If yes, you qualify, if not you go to the last step.

Can you do any other type of work?  The agency  evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work.  If you cannot do other work, the state agency will decide that you are disabled.

Listing of Medical Impairments

Social Security regulations include a listing of medical impairments organized by body system, that provide a basis for determinations that many individuals are disabled without further evidence of their inability to work or consideration of their age, education, and work experience.  The major categories with their subheadings are listed below:

Musculoskeletal

Major dysfunction of a joint(s) (due to any cause):

  • Reconstructive surgery or surgical arthrodesis of a major weight- bearing joint,
  • Disorders of the spine
  • Amputation (due to any cause).
  • Fracture of the femur, tibia, pelvis, or one or more of the tarsal bones.
  • Fracture of an upper extremity
  • Soft tissue injury (e.g., burns)

Special Senses and Speech

  • Loss of visual acuity.
  • Contraction of the visual field in the better eye,
  • Loss of visual efficiency.
  • Disturbance of labyrinthine vestibular function (including Meniere’s disease),
  • Hearing impairments (hearing not restorable by a hearing aid) manifested by:
  • Loss of speech

Respiratory System

  • Chronic pulmonary insufficiency
  • Asthma
  • Cystic fibrosis
  • Pneumoconiosis
  • Mycobacterial, mycotic, and other chronic persistent infections of the lung (
  • Cor pulmonale secondary to chronic pulmonary vascular hypertension.
  • Sleep-related breathing disorders.
  • Lung transplant

Cardiovascular System

  • Chronic heart failure
  • Ischemic heart disease,
  • Recurrent arrhythmias,
  • Symptomatic congenital heart disease
  • Heart transplant
  • Chronic venous insufficiency
  • Peripheral arterial disease

Digestive System

  • Gastrointestinal hemorrhaging from any cause, requiring blood transfusion
  • Chronic liver disease,
  • Inflammatory bowel disease (IBD)
  • Short bowel syndrome (SBS
  • Weight loss due to any digestive disorder
  • Liver transplantation

Genitourinary System

  • Impairment of renal function
  • Nephrotic syndrome

Hematological Disorders

  • Chronic anemia (hematocrit persisting
  • Sickle cell disease, or one of its variants.
  • Chronic thrombocytopenia (due to any cause),
  • Hereditary telangiectasia
  • Coagulation defects (hemophilia or a similar disorder) 7.09 Polycythemia vera (with erythrocytosis, splenomegaly, and leukocytosis or thrombocytosis).
  • Myelofibrosis (myeloproliferative syndrome).
  • Chronic granulocytopenia (due to any cause).
  • Aplastic anemias with bone marrow or stem cell transplantation

Skin Disorders

  • Ichthyosis
  • Bullous disease
  • Chronic infections of the skin or mucous membranes.
  • Dermatitis
  • Hidradenitis suppurativa
  • Genetic photosensitivity disorders
  • Burns

Endocrine System

  • Thyroid disorders
  • Hyperparathyroidism
  • Hypoparathyroidism
  • Neurohypophyseal insufficiency (diabetes insipidus
  • Hyperfunction of the adrenal cortex.
  • Diabetes mellitus

 

Impairments that affect Multiple Body Systems

  • Non-mosaic Down syndrome

Neurological System

  • Epilepsy - convulsive epilepsy, (grand mal or psychomotor), documented by detailed description of a typical seizure pattern, including all associated phenomena; occurring more frequently than once a month, in spite of at least 3 months of prescribed treatment
  • Epilepsy - nonconvulsive epilepsy (petit mal, psychomotor, or focal), documented by detailed description of a typical seizure pattern including all associated phenomena, occurring more frequently than once weekly in spite of at least 3 months of prescribed treatment.
  • Central nervous system vascular accident.
  • Benign brain tumors
  • Parkinsonian syndrome
  • Cerebral palsy
  • Spinal cord or nerve root lesions, due to any cause
  • Multiple sclerosis.
  • Amyotrophic lateral sclerosis.
  • Anterior poliomyelitis.
  • Myasthenia gravis.
  • Muscular dystrophy
  • Peripheral neuropathies
  • Subacute combined cord degeneration (pernicious anemia) with disorganization of motor function as described in 11.04B, not significantly improved by prescribed treatment.
  • Degenerative disease not listed elsewhere, such as Huntington's Chorea, Friedreich's ataxia, and spino-cerebellar degeneration. With:
  • Cerebral trauma.
  • Syringomyelia.

Mental Disorders

  • Organic mental disorders
  • Schizophrenic, paranoid and other psychotic disorders
  • Affective disordersMental retardation
  • Anxiety-related disorders
  • Somatoform disorders
  • Personality disorders
  • Substance addiction disorders
  • Autistic disorder and other pervasive developmental disorders

Summary

Social Security considers five issues when determining your disability: Are you working, is your medical condition severe, is you medical condition on the List of Impairments, can you do the work you did before and can you do any other kind of work.  Medical conditions have to be on the list of impairments or be equivalent to one of the listed impairments or combination of impairments to receive disability benefits.  Social Security uses the same criteria for determining disability for Supplemental Security Income applications.


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