Qualification for Social Security Disability benefits (SSD benefits) is contingent on the kind of disabling condition you have. The guidelines for qualifying conditions can be confusing, especially for people who are just navigating the system for the first time. 

If you aren’t sure if your condition qualifies, or if you tried to file a claim and it was rejected, then an experienced Social Security Disability benefits lawyer can help you file an appeal and represent you in a hearing to argue for your claim.

More About Social Security Disability Qualifying Conditions

SSD benefits provide income for people who are unable to work due to an injury or the development of a debilitating medical condition, either physical or mental. However, you may need more than simply being hurt or being diagnosed with a specific illness to qualify for these benefits. 

The SSA guidelines are strict, and even people with severe impairments may find it challenging to get approved for their benefits.

The SSA catalogs different medical conditions and the conditions under which a benefits applicant would qualify in a “Blue Book” — the Disability Evaluation Under Social Security guidelines. It’s the first measurement of disability that the SSA uses when evaluating an individual’s claim.

The SSA Blue Book

Doctors and other healthcare professionals use the Blue Book to determine whether their patient meets the disability benefits threshold. The Blue Book is written for an audience of medical professionals, so many laypersons may need help determining their eligibility on their own. 

SSA representatives also use the Blue Book when evaluating claims and referencing the claims in communications with recipients.

The Blue Book covers benefits for recipients and eligibility criteria, including:

• The SSA’s definition of disability
• The process for a claim evaluation
• The standards for evidence deemed acceptable by the SSA
• A list of qualifying impairments (listed separately for adults and children)

The book is comprehensive and intended to serve as a guide for doctors and SSA administrators.

Criteria for an SSD Benefits Claim Approval

A diagnosis, even by a specialist medical professional, isn’t enough to qualify someone for an SSD benefits claim. The applicant must also demonstrate that they meet certain medical criteria and have appropriate functional limitations because of their injury or disease.

Medical Criteria

An applicant is considered physically or psychologically impaired only if they meet set medical standards. Objective evidence must indicate that there is a physical or psychological cause for the disability. Furthermore, the condition must also be anticipated to prevent the applicant from working for at least one year or to lead to death.

Short-term injuries or conditions are not eligible for SSDI coverage, no matter how badly you’re hurt or how debilitating the condition is.

Each medical condition or impairment that qualifies for SSD benefits is listed in the Blue Book, along with the related requirements to qualify. The requirements will vary by condition; what may be disabling for one condition may not be disabling for another condition.

Functional Limitations

Functional limitations refer to how your physical or mental condition affects your ability to perform “substantial gainful activity (SGA),” aka work. The guidelines for SGA and the income limitations for what is considered “substantial” change almost every year. 

For example, someone who is self-employed and able to work from home may be considered able to perform SGA, while someone who can’t work from home may not be considered able, even if they have the same condition as the work-from-home individual.

If the SSA determines you can perform substantial gainful activity, your claim for SSD benefits will be denied. If you aren’t currently working because of your injury or illness, the SSA may assess whether you’re capable of performing different work — a job other than the one you had prior to your injury. 

This determination is based on:

• Your age
• Your work experience
• The extent of your education
• Your functional restrictions
• Your job-related or practical skills

If you are considered able to perform the same level of work that you previously did, you won’t be considered disabled per the definition to qualify for SSD benefits. 

Although you may not be in the same physical shape as you were before, the evaluation of disability for a Social Security disability claim is based strictly on whether the agency determines you are capable of working.

Do You Need Help Navigating Your Social Security Disability Claim?

The standards for a qualifying disability can be confusing, and many people who are injured or have a chronic medical condition may not receive the SSD benefits they could be entitled to. If your claim was denied, you have the right to file an appeal. Fill out our contact form online to have an experienced Social Security disability lawyer contact you.