Social Security Disability Benefits
The Social Security Administration (SSA) administers two programs that provide benefits based on disability. The Social Security Disability Insurance (SSDI) program listed as Title II of the Social Security Act and the Supplemental Security Income (SSI) program listed as Title XVI of the Act.
The Act and SSA's implementing regulations prescribe rules for deciding if an individual is "disabled." SSA's criteria for deciding disability may differ from the criteria applied in other government and private disability programs.
Definition of Disability
To meet the Social Security Administration’s definition of disability, you must have a condition that significantly hinders your ability to work. SSA refers to this as engaging in any substantial gainful activity because of a medically determinable physical or mental impairment(s). The disability must be expected to result in death or has lasted or is expected to last for a continuous period of at least 12 months. SSA’s definition is stricter than many vocational or insurance-based definitions. This means you should not be surprised if you are approved for short or long term disability but denied Social Security Disability benefits.
Do You Have a Medically Determinable Impairment?
A medically determinable impairment is a condition, either physical or mental, that can be proven by verifiable medical facts, not just by what you feel or say. This is a fundamental first step in the SSA's sequential evaluation process for determining disability. Without a medically determinable impairment, your claim cannot move forward.
While symptoms like pain, fatigue, or shortness of breath are a crucial part of a disability claim, they are not enough to establish a medically determinable impairment on their own. SSA will consider your symptoms, but they must be consistent with objective medical evidence. For example, if you claim disabling back pain, SSA will look for evidence in your medical records including physical examinations that show muscle spasms and limited range of motion along with imaging such as an MRI showing severe findings.
Can You Perform Any Work in the National Economy?
To be considered disabled, your medical condition must be severe enough to prevent you from doing work you performed previously. It must also prevent you from adjusting to other types of work in the national economy. For example, if you previously performed work as a Registered Nurse but can no longer perform the physical demands of the job, SSA will consider whether you could perform unskilled sedentary work. Any work will be considered, not just the work you performed in the past.
Understanding SSDI/SSI Benefits
The Social Security and Supplemental Security Income disability programs are the largest of several federal programs that assist people with disabilities.
Social Security Disability Insurance (SSDI)
Social Security Disability Insurance (SSDI) pays benefits to you and certain members of your family if you worked long enough and paid Social Security taxes. The amount of a monthly disability benefit is based on your Social Security earnings record if you were an insured worker and qualify as disabled. Disability benefits are also paid to blind or disabled workers, widows, or adults disabled since childhood who are otherwise eligible.
Supplemental Security Income (SSI)
Supplemental Security Income (SSI) is a needs-based federal program designed to provide financial assistance to disabled adults and children with limited income and resources who are blind or disabled. The program is administered by the Social Security Administration (SSA). Individuals who receive SSI may also be eligible for other benefits such as Medicaid, food stamps, and housing assistance.
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How Does SSA Define Disability by Impairment?
The SSA Listing of Impairments, also referred to as the Blue Book, contains a listing of medical conditions and illnesses that the SSA considers serious enough to be disabling. It can be found on the Administration's website.
The Blue Book divides impairments into Listing of Impairments for Adults and Listing of Impairments for Children. The Blue Book is divided into sections for each major area of the body and outlines illnesses and medical conditions that may be disabling. Besides providing a rundown of health concerns, the Blue Book contains impairment overviews, general information, and evidentiary requirements. It is frequently updated by SSA.
The Listing of Impairments contains many medical conditions, illnesses, and injuries. It's frequently updated by the SSA. Sections include:
- Musculoskeletal Disorders
- Special Senses and Speech
- Respiratory Disorders
- Cardiovascular Disorders
- Digestive Disorders
- Genitourinary Disorders
- Hematological Disorders
- Skin Disorders
- Endocrine Disorders
- Congenital Disorders
- Neurological Disorders
- Mental Disorders
- Cancer Neoplastic Disorders
- Immune System Disorders
In addition to SSA’s Listing of Impairments, SSA has also established rules for conditions that might not be found in their impairment list. Conditions such as Fibromyalgia, Primary Headache Syndrome and other medical conditions have specific guidelines that, if met, can lead to favorable decisions.
Don't Meet a Listing? There's Still Hope!
If, after reviewing your medical records, the SSA determines your medical condition meets the requirements of a disability listing found in the Blue Book, then you could be deemed disabled. Requirements include symptoms associated with a specific medical condition along with proof of observable medical data such as x-rays, MRIs, chemical analysis, psychological tests, and exercise tests.
If you fail to meet all the medical criteria specified in a Blue Book listing, you can argue you are disabled based on “medical equivalence.” That is, your impairment has the same level of severity and lasts as long as a similar Blue Book listing.
If you have been forced to stop work or greatly reduce your hours due to a medical condition and your condition is expected to last 12 months, applying for one or both of Social Security’s disability programs is strongly recommended. Even if you have a goal of returning to work!
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