How to Get Approved: 14 Health Conditions That Qualify for Social Security Disability Benefits

When navigating the Social Security Disability Insurance (SSDI) process, understanding which health conditions qualify is critical to securing the benefits you deserve. Millions of Americans face debilitating medical conditions that prevent them from working and earning a living, leaving them in need of financial support.

However, the path to approval is often complex, and without the right information, many applications are denied. That’s why it’s essential to familiarize yourself with the specific health conditions recognized by the Social Security Administration (SSA).

These conditions vary widely, from severe physical impairments to chronic illnesses and mental health disorders. By knowing what qualifies and ensuring your application aligns with SSA guidelines, you can significantly improve your chances of approval.

If you or someone you know needs help filing a disability claim, contact our office today. Harris Disability Law has extensive experience in navigating the SSDI process and can provide the guidance you need to secure the benefits you deserve.

SSA’s Listing of Impairments

The Social Security Administration (SSA) maintains a comprehensive list of health conditions, known as the Listing of Impairments or the “Blue Book.” This resource outlines impairments that the SSA considers severe enough to prevent individuals from engaging in substantial gainful activity (SGA) and thus qualify for SSDI benefits.

It is important to note that meeting Blue Book criteria does not guarantee approval; rather, it serves as a guideline for determining eligibility. Additionally, even if your condition is not listed explicitly, you may still be eligible for benefits by proving your disability’s severity through medical evidence.

What Conditions Qualify for Disability Benefits?

The Blue Book is divided into two parts: Part A covers adult impairments, and Part B covers childhood impairments. Both sections are further categorized by body systems, such as musculoskeletal, respiratory, or mental disorders. Here are 14 health conditions that may qualify for disability benefits under the SSA’s Listing of Impairments:

1. Musculoskeletal System
2. Special Senses and Speech
3. Respiratory System
4. Cardiovascular System
5. Digestive System
6. Genitourinary Disorders
7. Hematological Disorders
8. Skin Disorders
9. Endocrine Disorders
10. Congenital Disorders that Affect Multiple Body Systems
11. Neurological Disorders
12. Mental Health Conditions
13. Cancer and Other Malignant Diseases
14. Immune System Disorders

Musculoskeletal Disorders

Musculoskeletal disorders are the most commonly recognized impairments by the SSA, affecting millions of Americans and accounting for the highest percentage of approved disability claims. These disorders involve problems with bones, joints, muscles, tendons, ligaments, and nerves.

Common Qualifying Musculoskeletal Conditions

• Spinal disorders with nerve root compression
• Major joint abnormalities
• Reconstructive surgery of weight-bearing joints
• Amputation of limbs

Required Medical Documentation for Musculoskeletal Claims

As with any disability claim, a proper medical diagnosis, treatment records, and evidence of functional limitations are essential. For musculoskeletal disorders, the SSA may require additional imaging or laboratory tests to confirm a diagnosis and assess the severity of your condition. Some examples include the following:

• Detailed physical examination reports with clinical findings
• Medical imaging results (X-rays, MRI, CT scans)
• Operative reports if you’ve undergone surgery
• Documentation of treatment effects and responses
• Records of assistive devices used

How Musculoskeletal Conditions Are Evaluated

The SSA carefully examines how your condition limits daily activities. Their evaluation focuses on:

Your ability to perform fine and gross movements. Medical experts assess your walking capacity and ability to complete routine tasks. The SSA pays special attention to upper body dexterity for work-related activities.

Your commitment to prescribed treatments matters. The SSA reviews treatment compliance and improvement. Remember, your condition must prevent substantial work for at least 12 months to qualify.

Special Senses and Speech Disorders

Special senses and speech impairments can limit your ability to work, interact with others, or engage in social activities. The SSA evaluates these disorders based on the severity of your symptoms, treatment plans, and functional limitations.

Common Qualifying Conditions Under This Category

• Loss of visual acuity
• Blindness (e.g. Vision cannot improve beyond 20/200 in your better eye, even with correction)
• Hearing loss
• Loss of speech

Required Medical Documentation for Special Senses and Speech Claims

To substantiate your claim, you may need to provide:

• Audiometry tests
• Visual field tests
• Speech-language evaluations

How These Disorders Are Evaluated

The SSA evaluates three critical aspects of speech function: audibility, intelligibility, and functional efficiency. They assess how your sensory impairment impacts your daily life and ability to work, carefully considering your communication abilities in both social and work environments.

Respiratory Disorders

Breathing difficulties from respiratory disorders often prevent people from maintaining steady employment. The Social Security Administration carefully evaluates how these conditions restrict air movement and limit oxygen exchange in your lungs.

Common Qualifying Respiratory Disorders

• Chronic obstructive pulmonary disease (COPD)
• Asthma
• Cystic fibrosis
• Bronchiectasis
• Pneumoconiosis and other occupational lung diseases

Note that your respiratory condition must prevent full-time work for at least 12 consecutive months to qualify for benefits. Simply having a diagnosis is not enough.

Required Medical Documentation for Respiratory Claims

To support your claim, you may need to provide:

• Complete medical history and examination records
• Chest X-rays and CT scan results
• Pulmonary function testing, especially spirometry
• Treatment records showing medication responses
• Documentation of oxygen therapy needs

How Respiratory Limitations Are Assessed

The SSA evaluates three critical aspects of lung function. Their medical experts examine breathing difficulties from:

• Airway obstruction preventing proper exhaling
• Restricted lung capacity limiting inhalation
• Problems with oxygen/carbon dioxide exchange

As with other disabilities, the SSA checks for not just the diagnosis but also how this prevents you from sustaining gainful employment for at least 12 months.

Cardiovascular Conditions

Cardiovascular disorders refer to heart and blood vessel problems. Because the heart is a vital organ, qualifying for benefits based on cardiovascular conditions can be tricky. The SSA may consider both objective medical evidence and how the condition limits your daily activities.

Common Qualifying Cardiovascular Conditions

• Chronic heart failure
• Ischemic heart disease (including coronary artery disease)
• Recurrent arrhythmias
• Symptomatic congenital heart disease

Required Tests and Documentation

To document your impairment, provide:

• Cardiac imaging results (e.g., EKG/ECG or cardiac catheterization reports)
• Blood markers of specific enzymes used as evidence of recent damage or severity of heart attacks
• Detailed physical examination reports
• Laboratory test results
• Complete medical history and examination records
• Treatment plans and responses to treatment

How Cardiovascular Conditions Are Assessed

Your heart condition must significantly limit daily activities for SSA approval. The SSA focuses on how it affects activities like walking, standing, sitting, lifting, carrying items, or moving around in general. Additionally, they also consider the frequency of emergency room visits and hospitalizations due to the condition.

Digestive System Disorders

Issues with digestion can arise from various medical conditions, including disorders of the stomach, liver, intestines, pancreas, and gallbladder. The SSA evaluates how your digestive system impairment affects your daily activities.

Common Qualifying Digestive System Disorders

• Inflammatory bowel disease (IBD)
• Chronic liver disease
• Gallbladder disorders
• Pancreatitis

Required Medical Documentation for Digestive System Claims

To support your claim, you may need to provide:

• Endoscopic examination results (e.g., colonoscopy or endoscopy)
• Laboratory test results like blood tests, stool samples, or biopsies
• Radiological imaging results
• Medical imaging (X-rays, ultrasound, MRI)

These lab results should show both the existence of your disability as well as its severity.

Assessment of Digestive Limitations

The SSA carefully evaluates your daily functioning limitations. The Listing of Impairments contain guidelines for what the SSA looks for when evaluation specific issues.

For example, when evaluating chronic liver diseases, the SSA check for jaundice, ascites, and other complications like changes in size of the liver and spleen. Additionally, they look for symptoms that cause diminished liver function for at least 12 consecutive months.

Genitourinary Disorders

Geniurinary disorders involve issues with the urinary tract, bladder, or kidneys. The SSA acknowledges that these conditions can cause significant limitations in daily functioning.

Common Qualifying Genitourinary Disorders

• Chronic kidney disease
• Nephrotic syndrome
• Kidney transplant outcomes

Required Medical Documentation for Genitourinary Claims

To support your claim, provide:

• Complete medical history and examination records
• Urine culture reports
• Imaging tests like ultrasound, MRI, or CT scans of the kidneys and bladder
• Biopsy results if you have had one done

The SSA demands extensive medical documentation covering at least 90 days.

How Genitourinary Disorders Are Evaluated

Detailed clinical reports showing symptoms and treatment outcomes. Your kidney function must be proven through laboratory findings (e.g. serum creatinine and albumin measurements).

The SSA considers dialysis as a key factor when evaluating disability claims for kidney disease. Your ongoing dialysis must have lasted or be expected to last for at least 12 continuous months. A report from an acceptable medical source must confirm your CKD diagnosis, describe your current dialysis treatment, and indicate that the dialysis will continue. This documentation is essential to satisfy the SSA’s requirements for claim approval.

Hematological Disorders

These disorders involve issues with the blood and bone marrow. The SSA acknowledges that these conditions can significantly limit a person’s daily functioning ability.

Common Qualifying Hematological Disorders

• Chronic anemia, especially sickle cell disease
• Coagulation defects like hemophilia
• Blood clotting and bleeding disorders
• Bone marrow failure syndromes

Required Medical Documentation for Hematological Disorder Claims

Medical proof makes winning your case possible. The SSA demands a physician-signed laboratory report confirming your diagnosis. To support your claim, you need to provide:

• Detailed medical history and examination records
• Laboratory test results including complete blood count (CBC), bone marrow biopsy reports, and genetic testing if applicable
• Treatment plans and responses to treatment

As with others, the specifics will depend on your personal situation.

For instance, bone marrow and stem cell transplant recipients qualify automatically for 12 months post-procedure. The SSA then reviews complications like graft-versus-host disease and recurring infections to be considered disabled for a longer period.

Skin Disorders

Skin disorders can range from mild rashes to severe skin conditions like psoriasis or eczema. The SSA acknowledges that these conditions can cause significant limitations in daily functioning.

Common Qualifying Skin Disorders

• Genetic photosensitivity disorders (e.g., xeroderma pigmentosum)
• Burns
• Chronic skin conditions

Some of these include, but not limited to ichthyosis, bullous disease, dermatitis, psoriasis, and hidradenitis suppurativa.

Required Medical Documentation for Skin Disorder Claims

For your claim to be approved, you must provide:

• A detailed medical history and examination records
• Biopsy results if done
• Laboratory tests like allergy testing or patch

Evaluation Criteria

The SSA measures how skin problems limit your daily activities. Their medical experts review lesion severity, flare-up patterns, and treatment results. Your condition must show three months of persistence despite following doctor’s orders/treatments.

Endocrine Disorders

These disorders involve issues with the endocrine system, which produces hormones that regulate various bodily functions. The SSA takes into consideration how these conditions affect a person’s daily functioning.

Common Qualifying Endocrine Disorders

Five major gland disorders fall under Social Security Administration review. These are:

• Pituitary glands
• Thyroid glands
• Parathyroid glands
• Adrenal glands
• Diabetes mellitus and other pancreatic glands

Required Medical Documentation for Endocrine Disorder Claims

Medical evidence proves crucial for endocrine disability claims. The SSA demands clear documentation showing how hormone problems affect multiple body systems. You need to provide:

• Detailed medical history and examination records including symptoms and treatment plans
• Laboratory test results such as blood sugar levels or thyroid function tests
• Imaging tests like ultrasounds or CT scans if applicable
• Applicable biopsy results

How Endocrine Disorders Are Evaluated

The SSA considers multiple factors when evaluating endocrine disorder claims. These include:

• Objective medical evidence from acceptable medical sources
• Current treatment and response to treatment
• Severity and frequency of symptoms affecting daily functioning

Endocrine disorders impact multiple body systems. Thyroid conditions may trigger heart problems, weight changes, or mental difficulties. Pituitary disorders often disturb water balance and other gland functions.

Congenital Disorders

Congenital (or birth) disorders affecting multiple body systems qualify for Social Security disability benefits. The Social Security Administration applies strict medical standards when evaluating these complex genetic conditions.

Qualifying Congenital Conditions

According to the SSA, they only evaluation non-mosaic Down syndrome under this condition/category. It is a genetic disorder where individuals have an extra copy of chromosome 21 in all their cells. It causes characteristic physical features, delayed development, and intellectual disability.

Required Medical Evidence

Down syndrome claims demand specific proof. The SSA requires physician-signed laboratory reports showing karyotype analysis, which is the definitive test to establish non-mosaic Down syndrome.

According to the SSA Blue Book, they will not accept a fluorescence in situ hybridization (FISH) test because it does not distinguish between the mosaic and non-mosaic forms of Down syndrome

Evaluation Process

As stated above, mosaic down syndrome aren’t covered in this condition. Instead, if “profound and disabling, and affecting various body systems,” they are evaluated under the appropriate affected body system such as musculoskeletal, etc.

As with other conditions, the SSA will look at physician’s notes, medical history, lab results, treatment plans and responses, and any other relevant medical information to determine the severity of the disability and how it impacts daily functioning.

Neurological Disorders

Neurological disorders affect the nervous system, which controls bodily functions and movements. The SSA takes into account how these conditions impact daily functioning.

Common Qualifying Neurological Disorders

• Epilepsy
• Amyotrophic lateral sclerosis (ALS)
• Multiple Sclerosis (MS)
• Parkinson’s disease

Required Medical Documentation for Neurological Disorder Claims

For your claim to be approved, you need to provide both medical and non-medical evidence.

Medical evidence can include:

• Detailed medical history and examination records including symptoms and their severity
• Laboratory test results such as MRI, CT scans, or EEG if done
• Treatment plans and responses to treatment

For non-medical evidence, the SSA looks at statements you or other people say about your impairments, restrictions, etc.

Assessment Criteria

The SSA demands proof of motor function problems in two extremities. Medical experts evaluate your ability to:

• Rise from sitting position
• Walk with proper balance
• Use arms and hands effectively
• Control fine and gross movements

Mental Health Disorders

Mental disorders can significantly impact daily function and quality of life, which is why the SSA outlines specific criteria for these conditions.

Meeting the criteria in any of these categories requires specific medical evidence and consistent documentation of how the condition limits basic functioning.

Qualifying Mental Health Conditions

The SSA recognizes eleven categories of mental disorders:

1. Neurocognitive disorders
2. Schizophrenia spectrum and psychotic disorders
3. Depressive, bipolar and related disorders
4. Intellectual disorders
5. Anxiety and obsessive-compulsive disorders
6. Somatic symptom disorders
7. Personality and impulse-control disorders
8. Autism spectrum disorder
9. Neurodevelopmental disorders
10. Eating disorders
11. Trauma and stressor-related disorders

Required Documentation

As with other disabilities, medical evidence by licensed health professionals proves crucial for mental health claims. The SSA looks at clinical records showing specific behavior patterns, thought disturbances, or memory problems. Psychological testing and structured interviews strengthen your diagnosis. Treatment records must detail medication effects, therapy outcomes, and side effects limiting daily function.

Evaluation Standards

The SSA measures mental health disability across four areas:

• Understanding and using information
• Social interactions
• Focus and task completion
• Self-management skills

Your mental disorder must cause “extreme” limitation in one area or “marked” limitation in two areas for benefit approval. The SSA reviews cases regularly, checking treatment compliance and functional changes.

Another common standard requires evidence of “serious and persistent” symptoms over the past two years.

Cancer

All types of cancer are covered by the SSA if they meet specific criteria. Some, like cancers associated with human immunodeficiency virus (HIV) can be evaluated under this condition or under the immune system disorders.

Qualifying Cancers

The SSA evaluates cancers based on their type, location, and progression. As mentioned, all cancers are considered; however, having a cancer diagnosis does not automatically qualify you for disability benefits.

Required Evidence

To be eligible for disability benefits due to cancer, you must provide:

1. A confirmed diagnosis with medical evidence such as pathology reports or imaging scans like MRI or CT scans
2. Detailed information about primary tumor size and extent of metastasis (if present)
3. Treatment plans with responses to treatment and side effects impacting daily function
4. Lab results showing ongoing treatment such as

Cancer disability claims deserve immediate attention. Our attorneys secure fast-tracked approvals through the Social Security Administration’s Compassionate Allowances program for qualifying diagnoses.

Medical Evidence Requirements

To support cancer disability claims, comprehensive medical evidence is essential, including details of the cancer type, extent, and location. Primary documentation like operative notes and pathology reports is preferred, but hospitalization summaries or other medical records may be accepted if necessary.

Evidence of cancer recurrence, progression, therapy response, and residual effects is also critical for evaluating the claim.

Evaluation Process

The SSA reviews several key factors like the cancer’s origin and spread, treatment frequency and duration, etc. More importantly, the SSA evaluates how this condition prevents you from doing any gainful work.

Immune System Disorders

Immune system disorders are conditions that affect the body’s natural ability to fight off diseases and infections. These conditions destroy single organs or gradually damage multiple body systems.

The SSA evaluates these disorders by considering their impact on daily function.

Qualifying Immune Conditions

The SSA evaluates three distinct types of immune disorders:

• Autoimmune diseases – lupus and systemic sclerosis
• Immune deficiency disorders (except HIV)
• HIV infection and related conditions

Documentation Standards

The SSA requires medical history, report(s) of physical examination, lab findings, or other medically acceptable imaging or tissue biopsy that indicate you have an immune system disorder.

Assessment Criteria

The SSA measures how immune disorders limit daily activities. Their medical experts look for:

• Severe Fatigue: Preventing basic self-care tasks
• Frequent Infections: Pattern and treatment success
• Body-wide Symptoms: Fever, weakness, weight loss

Apart from the disorder, your condition must prevent you from doing any substantial work for 12 months minimum to qualify for benefits.

Comparison Table: Qualifying Health Conditions for Social Security Benefits

The following table details medical requirements, documentation needs, and key factors the SSA considers for disability approvals.

Our disability attorneys understand these complex medical criteria. We help gather required documentation and prove how your condition meets SSA standards.

Need Help with a Disability Claim?

Qualifying health conditions for Social Security disability benefits demand specific medical proof. The Social Security Administration applies strict standards when evaluating disability claims.

Simply having the illness or condition is not enough. You must show how it limits your ability to work and support yourself.

Our experienced disability attorneys can help you navigate this process. We understand the medical criteria and the SSA’s evaluation methods. Our team will guide you through every step of the application and appeal process, giving you the best chance at receiving the benefits you deserve.

Contact our firm for help filing your disability claim or appealing a denial.

Frequently Asked Questions