Conditions That Automatically Qualify You for Disability Benefits

Every year in the United States, millions of people apply for Social Security Disability benefits. Unfortunately, only a fraction of these applications are successful. This article explores the conditions that automatically qualify you for disability benefits.

According to statistics from the Social Security Administration (SSA), in 2021, only 31.8 percent of social security disability applications were successful. The SSA sets the conditions that automatically qualify you for disability benefits. 

The SSA uses a set of objective standards to determine if a person applying for disability benefits is suffering from a qualifying impairment. The ultimate measure is whether the documents submitted with the claim show that the person has a condition that fits the SSA’s definition of a disability.

The Social Security Administration’s definition of a disability is:

A medically determinable physical or mental impairment that lasts or is expected to at least 12 months (or result in death) and prevents the claimant from performing substantial gainful activities.

No conditions or impairments “automatically” qualify for disability benefits, but there are many which are highly likely to be approved if the documents you submitted with the Social Security Disability (SSD) or Supplemental Security Income (SSI) claim package include the evidence that meets the “Blue Book” listed disabilities.

Blue Book Listed Disabilities

To provide a uniform set of standards to the public and to the SSA personnel who review all the claims, the Social Security Administration created a manual detailing many impairments that it will recognize as qualifying disabilities if they meet the specific criteria listed under each condition.

The manual of listed impairments is referred to as the “Blue Book.” Some impairments require test results to be within certain ranges. In this way, SSD and SSI benefits can be reserved for those whose impairments feature symptoms consistent with severe limitations.

The following parts contain medical conditions that apply to the evaluation of medical impairment in adults aged 18 and over and that may apply to the assessment of medical impairment in children under age 18 if the disease processes have a similar effect on adults and younger children.

Among the many illnesses, conditions, impairments, diseases, and injuries a human being can suffer, the Blue Book divides them into 14 categories and covers dysfunctions and illnesses in every one of the human body’s systems:

• Musculoskeletal
• 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 Disease)
• Immune System Disorders

Within each of those categories, individual illnesses and conditions are described along with the characteristics of the illness that must be present in the claimant’s case to meet the degree of severity the SSD and SSI will consider “disabling.”

What If Your Disabling Impairment Is Not In the Blue Book?

Not every person suffering from one or more physical or mental impairments fits into the prescribed criteria included in each of the conditions detailed in the 14 categories of the Blue Book.

Failing to perfectly fit into one of the “listed” disabilities is not at all disqualifying. Rather, fitting neatly into one of the “listed” impairment’s criteria virtually ensures that disability benefits will be granted to that claimant.

When an SSD or SSI benefits applicant does not meet one of the “listed” impairment criteria, the SSA’s case assessment reviewers still analyze every line of every medical record and report the claimant submitted that documents precisely what they are suffering from.

They attempt to identify when the impairment became disabling, whether the impairment has or is expected to last at least 12 months (or lead to death), and whether it’s severity so disrupts the claimant’s daily functioning or so interferes with the person’s ability to work that it qualifies as a disability under the SSA definition.

However, if your disability doesn’t fit into the Listing of Impairments, then you must present formal evidence of your medical condition to the SSA as you have the onus of proving a “medically determinable impairment” which prevents you from working at the maximum possible capacity. This implies that your medical condition must be such that you cannot perform your daily activities. This condition is also called “residual functional capability” (RFC).

Your Claim Can Be Based on a Combination of Impairments

Not every physical or mental impairment fits neatly into a pre-identified slot. In fact, many people who are receiving SSD or SSI benefit payments were granted benefits based on a disability that does not fit into one category. 

Someone may suffer from an illness or injury that one might expect would improve or resolve within a few months. But that person may have already been living with a mental illness that they were struggling to cope with, but which still allowed them to work.

A person could have several individual impairments with no single disorder qualifying as a disability under the SSA definition. But together, with a complex of impairments, the individual is unable to continue working.

Severity of Your Impairment Determining SSD or SSI Disability

The key to being approved for SSD or SSI benefits for both the Blue Book listed impairments and those not listed is the severity of the impairment.

In some cases, the severity of an illness or disease will be reflected in the results of lab or blood tests, x-rays, MRIs, or angiograms. In other cases, the notes and observations recorded by your treating physician or therapist will reveal the necessary information for your impairment’s severity to be gauged. 

Is your impairment “medically determinable,” has it or will it last for at least 12 months, and does it prevent you from engaging in enough employment to earn more than the SSA’s set maximum monthly income ($1,350 in 2022). 

Additional Factors involved in determining Disability Benefits Eligibility

There are two main requirements for determining benefits eligibility under the SSDI and SSI, as given below:

• You suffer from a condition that prevented you from working for 12 months.
• You are at least 18 years of age. 

Apart from these two conditions, there are some additional factors involved in determining your eligibility:

• The time at which you suffered the disability.
• The number of years during which you paid into Social Security either through a job or self-employment.
• Your marital status. 
• The number of your dependents, if any. 

Finally on Conditions That Automatically Qualify You for Disability Benefits

Whether or not you win disability benefits depends greatly on your condition and the documentation provided to the SSA to prove it. If you are injured in a car accident, industrial or domestic accident, this article can help you learn the conditions required to qualify for disability benefits.