Overview of Covered Conditions
In order to claim Social Security Disability Insurance benefits (“SSDI”), you must have a “severe” medical condition that “significantly” limits your ability to engage in basic work functions for at least one year. This includes your ability to stand, walk, sit, remember, or think critically whether due to pain or cognitive limitations. The Social Security Administration (“SSA”) maintains a list of medical conditions it considers sufficiently disabling to qualify for benefits. These conditions are generally organized by the bodily system they affect. Most of these conditions result or will result in permanent limitations of work-related functions or are fatal. There are some conditions, such as certain cancers, that are included on the list because they will likely result in at least a 12-month work limitation.
In addition to the listed conditions, there is an associated list of “compassionate allowances.” These conditions, once diagnosed, are serious enough to qualify otherwise eligible claimants for expedited SSDI benefits. Claimants with compassion allowance conditions seldom have to prove work limitations, as they are typically assumed based on the nature of the illness or injury.
Lastly, if you have a rare condition or a condition not listed with the SSA, you have the opportunity to prove that it’s substantially similar to one of the listed conditions and has resulted in the necessary long-term work limitations. As you review the most common disabling conditions covered by SSDI and the work limitations associated therewith, consider whether your condition is substantially similar to those listed.
Musculoskeletal Disabilities Covered by SSDI
Back pain, neck pain, and related musculoskeletal disabilities are the most common disabling conditions in the world. However, because SSDI claimants need to be totally disabled such that they can’t engage in any meaningful work, it’s difficult to claim SSDI benefits for neck and back pain alone. This is because they rarely disable claimants from all work. Nonetheless, there are certain serious musculoskeletal conditions that qualify claimants for SSDI benefits:
- Major Joint Dysfunction: This includes amputations, severe fractures, bone and joint deformities, and burns provided such conditions result in prolonged periods of immobility and/or convalescence.
- Surgery to a Major Weight-Bearing Joint: This typically includes knee and hip replacements resulting in an inability to walk expected to last more than 12 months.
- Spinal Disorders: These common disorders can include paralysis, herniated discs, spinal stenosis, osteoarthritis, spinal fractures, and late-stage degenerative disc disease resulting in the compression of the nerves in your spinal cord. Such conditions typically limit your ability to walk and function, while the pain takes a significant toll on your ability to focus.
The primary characteristic associated with qualifying musculoskeletal conditions is the inability to walk.
Cardiovascular & Hematological (Blood) Disorders
While these disabilities fall into separate categories, heart dysfunction often affects your body’s blood supply. Heart disease is the number one killer in America, and as such, many claimants may need SSDI benefits for a cardiovascular disorder. Covered heart and blood conditions include:
- Bone Marrow Failure due to Non-Cancerous Diseases: This can result in an inability to produce sufficient red and white blood cells, which are necessary for life.
- Sickle Cell Anemia and related blood and oxygen disorders that require monthly inpatient treatments and infusions.
- Chronic Heart Failure: This can result in multiple heart attacks and the need for a heart transplant. Some disorders are genetic or the result of childhood diseases, such as Scarlet Fever. These conditions prevent the heart from sufficiently pumping blood through your body.
- Recurrent Arrhythmias: These cannot be related to “reversible causes,” such as drugs. They must be disabling arrhythmias due to a type of electrolyte abnormality.
- Congenital Heart Disease: These are genetic disorders that cause serious heart dysfunction.
- Heart Transplant: Otherwise eligible transplant recipients automatically qualify for one year of SSDI benefits following surgery. Additional complications, such as heart failure, fall under the other categories as listed.
This list is not exhaustive, but notice that heart attacks are not included. While major aneurysms often qualify, if your cardiac disability was due to a “reversible cause” such as unhealthy habits, you may not qualify for benefits for a heart attack alone.
Cancers Covered by SSDI
Almost all metastasized and later-stage cancers qualify claimants for SSDI benefits. If your cancer can’t be effectively “cured” by surgery, such as removal of an early-stage tumor or superficial skin cancer, you likely qualify for SSDI. Many cancers are also listed on the compassionate allowance list. Cancer is the second leading cause of death in the United States, and the following cancers often qualify claimants for SSDI benefits:
- Breast cancer,
- Prostate cancer,
- Pancreatic cancer,
- Non-Hodgkin’s Lymphoma,
- Adrenal cancer,
- Ovarian cancer,
- Lung cancer,
- Kidney cancer, and
- Colon cancer.
Cancers that cannot be treated surgically, such as leukemia and lymphoma, or have metastasized into other areas of your body are often located on the compassion allowance list.
Immune System Disorders Covered by SSDI
Difficult to diagnose medical conditions that involve multiple body systems are often autoimmune disorders. These disorders are diagnosed when your immune system malfunctions and begins attacking the healthy cells in your body. The following most common autoimmune disorders may qualify claimants for SSDI benefits:
- Immune Deficiency Disorders: These disorders result in recurrent infections that are difficult to treat, which begin to affect other areas of your body.
- Sjögren’s Syndrome: This immune system disorder often results in severe fatigue, fever, and weight loss affecting activities of daily living.
- HIV/AIDS: While treatment for HIV/AIDS has come a long way, claimants with AIDS or who suffer from constant infections may qualify for SSDI.
- Rheumatoid Arthritis (“RA”): Unlike traditional osteoarthritis, RA is an autoimmune disorder characterized by an attack on your major joints.
- Multiple Sclerosis (“MS”): This is a disabling disease believed to be caused by immune system malfunction whereby your body attacks your central nervous system, interrupting the flow of information from the brain. MS is often characterized by flare-ups but tends to worsen over time.
Immune system disorders, even the same disorder, can range from mild to severe depending on the patient. Sometimes a disorder is disabling, while other times it responds to treatment.
Additional Conditions Covered by SSDI
The SSA’s list of conditions covered by SSDI also includes:
- Special Senses and Speech Disorders,
- Respiratory Disorders,
- Digestive System Disorders,
- Genitourinary Disorders (Chronic Kidney Failure),
- Skin Disorders,
- Endocrine (Hormone) Disorders,
- Multiple Body System Disorders such as ALS,
- Mental Disorders, and
- Neurological Disorders.
Your condition may qualify you under multiple areas of disability, but it helps to identify one or two underlying conditions. For example, cancer may be the underlying condition, but your disability may be caused by your body’s reaction to chemotherapy. Review the disabilities listed on the compassion allowance list first, and then look at the conditions and associated symptoms that qualify under the SSDI disability list. If all else fails, find the listed condition closest to your disability’s symptoms and work with an experienced SSDI attorney to make your case.