What Medical Conditions Qualify for Social Security Disability or SSI?
Here’s what you need to know about whether your medical condition will qualify for disability and how to apply for benefits.
The Social Security Administration’s impairment listing manual (called the blue book) lists a number of impairments, both physical and mental, that will automatically qualify an individual for Social Security disability benefits (SSDI) or Supplemental Security Income (SSI), provided the individual’s condition meets the specified criteria for a listing.
What Medical Conditions Are Listed?
The listing manual, which has been updated for 2020, includes:
- musculoskeletal problems, such as back injuries
- cardiovascular conditions, such as heart failure or coronary artery disease
- senses and speech issues, such as vision and hearing loss
- respiratory illnesses, such as COPD or asthma
- neurological disorders, such as MS, cerebral palsy, Parkinson’s disease, or epilepsy
- mental disorders, such as depression, anxiety, autism, or intellectual disorder
- immune system disorders, such as HIV/AIDS, lupus, and rheumatoid arthritis
- various syndromes, such as Sjogren’s Syndrome and Marfan Syndrome
- skin disorders, such as dermatitis
- digestive tract problems, such as liver disease or IBD
- kidney disease and genitourinary problems
- cancer, and
- hematological disorders, such as hemolytic anemias and disorders of bone marrow failure
For articles on getting disability for many common conditions, some of which are in the blue book and some of which aren’t, see our section on Medical Conditions, Impairments, and Problems.
How Do You Get Disability for Listed Medical Conditions?
If your disability is listed in Social Security’s Listing of Impairments, the first step is to get a diagnosis of the condition from your doctor. A mere diagnosis will get you an automatic disability approval for only a few conditions, however, like ALS, an organ transplant, or certain serious cancers, such as esophageal cancer, mucosal melanoma, anaplastic carcinoma of the thyroid gland, or small-cell carcinoma (of the prostate, ovaries, breast, lungs, pleura, intestines, or bladder). For all other conditions, the next step is to determine if your medical condition meets the specific criteria for that condition. The listing requirements are often quite complex; our illness-specific articles simplify the medical criteria in the listings so that you can understand whether your condition will qualify for disability.
If you haven’t had the clinical or laboratory tests required in the listing, you can ask your doctor to perform them. Or you can wait for the SSA to pay for a consultative exam, but this makes your claim take longer. It’s generally better if the test results are already in your medical record before you apply. Then you can check to see if your test results meet the requirements of the listing, and if they match the criteria or are close, you can apply for disability.
Does a Medical Condition Have to Match the Blue Book Listing?
An individual filing for Social Security disability benefits does not necessarily have to satisfy the exact listing requirements for a particular illness or condition to be awarded disability benefits based on the condition. You can be awarded disability benefits if Social Security considers aspects of your condition medically equivalent to the criteria in the listing or a related listing. This is called “equaling a disability listing.” (According to recent government statistics, 37% of all approved disability applications “met” a listing and only 6% “equaled” a listing.)
Alternatively, you can be eligible for disability benefits if you don’t meet or equal the criteria for the blue book listing, if your condition limits your functioning so much that you can’t work. The SSA will consider the effect of your condition on your capacity to perform routine daily activities and work and will then determine whether there is any kind of job you can safely be expected to do. For more information, see our section on how Social Security decides if your limitations make you disabled. (In a recent year, half of all approved disability applications were approved based on an assessment of applicants’ limitations.)
Does a Medical Condition Have to Be in the Blue Book?
A Social Security disability claimant doesn’t even have to have an impairment that is listed in the Social Security disability blue book to be awarded disability benefits. For instance, migraine headaches are not included in the blue book, but if a claimant’s migraines are severe enough and are well documented, the SSA may grant disability benefits if the migraines make it impossible for the disability applicant to work a full-time job. The keys here are that the condition be a medically determinable impairment and that it reduces someone’s RFC enough so that they can’t do their prior job or any job. In this case, an applicant could qualify for benefits under a medical-vocational allowance. Other common impairments that aren’t listed in Social Security’s blue book include carpal tunnel syndrome, fibromyalgia, chronic regional pain syndrome, reflex sympathetic dystrophy, celiac disease, and degenerative disc disease.
Which Medical Conditions Are Likely to Qualify for Disability?
While any of the above medical conditions are SSDI and SSI qualifying disabilities, some medical conditions are more likely to lead to an approval of benefits than others. We recently surveyed our readers about their experiences in applying for disability benefits and compared their answers to government statistics. For details, see our article on survey statistics on getting Social Security disability for common medical conditions.
How Do You Apply for Disability Benefits?
There are three ways to apply for Social Security benefits:
- file online at www.ssa.gov/applyfordisability (but note that online filing isn’t available to most SSI applicants)
- call the Social Security office at 800-772-1213 for an appointment to apply, or
- go to your local Social Security office without an appointment.
Before you apply, make sure you have the names and addresses of all doctors and clinics you’ve visited over the last five years. Applying for benefits involves much more than filling out the disability application. Your first step should be making sure that you have sufficient medical records for Social Security to make a decision on your claim. If you’ve been seeing a doctor regularly, have a conversation with your doctor about your limitations (such as not being able to lift 30 pounds or stand for three hours), and whether the doctor thinks they rule out full-time work for you. If your doctor agrees, it’s time to apply for disability benefits.
If you haven’t been seeing a doctor, it’s time to start. As mentioned above, you need to have medical records that support your claim, including your diagnoses, your limitations, your test results, and your treatment plans. Once you’ve had several doctors’ appointments, ask if your doctor thinks your limitations are disabling and about your long-term prospects for work. Only then should you apply for disability.
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