What is a Disabling Condition?

Social Security considers any medical condition disabling if it keeps your form working. However, your conditions also must keep you from working for 12 months or longer. Social Security has a list of specific conditions that will automatically qualify you for benefits, known as the “Blue Book.”

Disabling conditions under the “Blue Book”

The Blue Book lists different medical conditions that qualify for disability benefits. However, you must meet certain conditions. Generally, the requirements under the Blue Book describe the most severe cases of any condition. The Blue Book generally categorizes conditions by body system or function. Social Security has separate disability listings for adults and children under the age of 18. The children’s listings are almost identical to the adult listings. Above all they also include a listing for growth impairments.

Listing of Medical Impairments

For adults, medical conditions that qualify for disability benefits include:

Musculoskeletal system, special senses and speech, respiratory disorders , cardiovascular disorders
Digestive system disorders, genitourinary disorders, hematological disorders, skin disorders
Endocrine disorders, congenital disorders affecting multiple body systems, neurological disorders, mental disorders, cancer and immune system disorders

Getting disability on a diagnosis alone

Social Security has very few conditions that qualify you for benefits on a diagnosis alone. These include ALS, an organ transplant and certain cancers. Not all cancers will automatically qualify your for benefits.

How do you meet a listing level impairment?

The Listings of Impairments set out the requirements for how severe the symptoms must be to qualify you for disability benefits.First, your doctor must diagnose you with a disability found under the listings. Second, Social Security needs to review your medical records. They look at your doctors’ treatment notes and test results. If you haven’t had the clinical or laboratory tests required in the listing, you should ask your doctor to perform them.

Example 1: when your disabling condition meets a listing

For example, Donna has degenerative disc disease and herniated discs in her lower back. Donna requires a walker for standing and walking. She has an MRI documenting both the degenerative disc disease and herniated discs. Her treatment records show that she has limited motion in her lower back. She also has muscle weakness, decreased sensation and positive straight-leg raise testing. Her doctors have continued to document these problems in her records. Donna meets the listing under 1.04 for disorders of the spine.

Disabling conditions and medical equivalence

If you do not meet the specific requirements under the Listings, you can medically equal them. Social Security understands that there are many ways to diagnose and document the same illness. Your disability may “equal’ a listing if it does not quite meet all of the requirements under the listing. For example, the listing may require a specific result on a specific lab test. However, you were given a different test that showed the same results. SSA may find that your disability equals the listing. Medical equivalence can be found if:

Your medical impairment is at least equal in severity and duration
But does not quite match the requirements under the listing.

What if your disabling condition isn’t in the listings?

You can still be found disabled if your disability isn’t found in the listings. The listings don’t cover all medical conditions that could cause disability. Social Security can still find you disabled if you can show that your conditions keep you from working. Some examples of other disabling conditions include:

Carpal Tunnel Syndrome
Fibromyalgia
Chronic Regional Pain Syndrome
Reflex sympathetic dystrophy
Celiac Disease

What if your disabling condition doesn’t meet or equal the listings?

If your disabling condition doesn’t meet the listings, Social Security considers your residual functional capacity or RFC. Your RFC is what you can do despite your medical conditions. An RFC includes both physical and mental limitations. Social Security looks at your medical evidence to determine your RFC. They will also consider the opinions of your doctors. Typically, these opinions can be provided in RFC forms.

What medical evidence is considered?

Your medical evidence should include records only for the period of time that you became disabled and unable to work. Your treatment should also be continuous and ongoing. Medical evidence can include:

Treatment notes and physical examinations
Imaging such as MRIs, x-rays, CT scans or nerve testing
Blood work or biopsy results
Pulmonary tests
Mental health records

Disabling conditions and your age

Social Security has special disability rules the older you are. They look at a chart known as the Medical-Vocational guidelines to evaluate your claim called the “grid rules.” The grid rules make it easier for older people to win their case. Social Security considers your age, education and work background. The older you are, the easier it can be to win your case.

Example 2: applying the grid rules

For example, Justin, a 57 year old man previously worked as a painter. He needs a cane, applied for disability because he injured his knee, trouble in standing and walking. His medical records include MRIs and x-rays of his knee documenting his injury. His doctors have also documented that he has pain and limited motion of his knee. Social Security found that he could not return to work as a painter. Since he is over the age of 55, the grid rules allow Social Security to approve his claim.

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