To be eligible for Social Security Disability Insurance (SSDI), you will have to meet the Social Security Administration’s (SSA) standards for disability for your particular condition. The SSA has an extensive list of conditions that may qualify you for disability benefits if your condition is severe enough to prevent you from working. Here, we give an overview of what you will have to prove in order to qualify for SSDI.
What Is the Listing of Impairments?
Commonly referred to as the Blue Book, the SSA’s Listing of Impairments is a detailed list of all of the various medical conditions that could result in disability. The impairments are divided into the following categories:
- Musculoskeletal System
- Special Senses and Speech
- Respiratory Disorders
- Cardiovascular System
- Digestive System
- Genitourinary Disorders
- Hematological Disorders
- Skin Disorders
- Endocrine Disorders
- Congenital Disorders That Affect Multiple Body Systems
- Neurological Disorders
- Mental Disorders
- Cancer (Malignant Neoplastic Diseases)
- Immune System Disorders
Within each of these listings is a description of the general category as well as the specific conditions that fall under the category. Also included is a list of the types of documentation required as evidence of the condition such as biopsy results, medical exam reports, and other lab reports. The Blue Book is used as a guide to help determine if particular medical conditions are eligible for SSDI. However, just because your condition is listed in the Blue Book does not mean that you will automatically be approved. Likewise, if your specific impairment is not listed, that does not mean that you will not qualify. The Blue Book is simply a starting point.
Requirements for Qualification
Along with having an identifiable medical condition, you must also show one of the following:
- The condition is expected to result in death.
- The condition has persisted for at least 12 months.
- The condition is expected to persist for a minimum of 12 months.
All applicants must also show that the condition prevents you from engaging in substantial gainful employment. In other words, the condition must be terminal or long-term and must be severe enough to prevent you from working. You will have to provide evidence of both of these factors. The SSA uses the following Five-Step Sequential Evaluation to determine if you have a valid application:
- Can the claimant engage in substantial gainful employment? If the answer is yes, the claimant will not qualify. If the answer is no, the evaluator will move on to the next question.
- Will the impairment last 12 months or result in death? Being medically unable to work for less than 12 months does not qualify you for SSDI. However, if the answer is yes, the severity of the condition is considered.
- Does the impairment meet the severity of a defined medical listing? If the answer is “yes” based on a medical listing in the Blue Book, the claimant will qualify based on medical standards. If the claimant does not meet the requirements of the medical listing, however, the evaluator will determine if he qualifies based on vocational standards.
- Can the claimant perform past relevant work? If the claimant is capable of performing the job he had before the illness or injury, he will not qualify. If he cannot perform the same job he once did, the evaluator will ask if there is other work he can do.
- Can the claimant perform other available work? If there is alternative work the claimant can do to support himself, he will not qualify. However, if there is no other work the claimant can perform, he will be considered disabled according to vocational standards.
Evidence Required to Prove Your Eligibility
At each step of this evaluation, evidence will be needed to support the claim. A doctor’s diagnosis with lab tests and scans to back it up is the minimum evidence you will need. However, your claim has a higher chance of success if your evidence includes the following:
- Recent medical tests. Doctor’s reports and test results should be no older than six months. If your condition is rapidly changing, you will want even more recent reports.
- Accurate records. The SSA will only consider records from acceptable medical sources. If you present records from a chiropractor or other alternative-medicine source that contradict the diagnosis of a doctor, it could call into question the accuracy of your whole claim.
- Complete records. Do you have lab tests or scans to back up every claim you are making? When the Listing of Impairments lists specific documents that are required for your illness, you must provide all of those documents.
- Detailed reports. In order to prove eligibility based on vocational standards, you will need to present a detailed list of the tasks required by the jobs for which you are qualified and a complete list of your limitations—supported with medical evidence—that prevent you from performing those tasks.
The majority of SSDI claims are denied the first time. When you work with a New Mexico SSDI attorney, however, your odds are greatly approved. Call Keller & Keller to find out how we can help you submit a complete and accurate application the first time.