What Conditions Qualify for Social Security Disability Benefits?
SSDI benefits are paid based on medical records review. This blog discusses the conditions that qualify for SSDI. Social security disability insurance provides valuable financial assistance to millions of Americans living with disabilities. Disability determination is made based on the claimant’s medical records, which makes the service of a medical chart review company useful to disability attorneys handling such cases. The Social Security Administration (SSA) follows the Blue Book, which is a listing manual that lists physical and mental impairments that would qualify a person for social security disability benefits or SSDI, or Supplemental Security Income (SSI), if the person’s condition meets the criteria specified for a listing. According to the SSA, a person is considered disabled if he or she is no longer able to do
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“substantial” work because of a physical or mental disability that is expected to last 12 months or possibly result in death. Substantial gainful activity, as the SSA defines it, is earning $1,260 or more per month before taxes (or $2,110 per month for people who are blind) for the year 2020. The disability determination process involves considering whether the applicant is capable of doing his/her last job, or any past jobs they have performed in the past 15 years. If they are unable to do it, the SSA will see whether the applicant can do other work, taking into consideration the applicant’s limitations, age, type of skills learned in the past, and level of education. The medical conditions updated in the Blue Book for 2020 include the following. •
Musculoskeletal injuries
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Respiratory illnesses
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Cardiovascular diseases
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Neurological disorders
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Senses and speech issues
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Immune system disorders
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Mental disorders
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Cancer
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Kidney disease and genitourinary problems
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Digestive tract problems
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Skin disorders
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Hematological disorders
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Syndromes such as Marfan Syndrome and Sjogren’s Syndrome
Since medical records review is an important part of the disability determination process, it is vital that claimants obtain a diagnosis of their particular condition from their doctor. A few serious conditions such as certain terminal cancers, ALS, and organ transplant can qualify the applicant for automatic disability approval based on a mere diagnosis. For other conditions, the next step would be to find out if the medical condition meets the criteria the SSA has set for it. It is best to have all clinical and lab tests required in the listing so that these will be included in the medical record before the application is made. This helps check whether the test
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results meet the requirements of SSA’s listing. If they match the requirements, the disability claim can be made. A common question that disability applicants have is whether he or she has to meet the exact listing requirements for a specific illness or medical condition. In fact, if the SSA believes that certain aspects of your condition are medically equivalent to the listing criteria or a related listing, the benefits may be awarded. Also, if an applicant’s condition restrains his/her functioning so much that they cannot work at all, the SSA will consider the impact of your condition on your capacity to perform routine activities and work. They will then determine if there is any kind of job the applicant can perform safely. Another thing to note is that sometimes a claimant may qualify for disability benefits even if his or her condition is not listed in the Blue Book. If the condition is severe or serious enough so that the person cannot work a full-time job, benefits may be granted. The condition must be one that can be medically determined, and one that reduces the person’s capacity to function so much that he/she can’t do their previous job or any job. Conditions in this category include severe migraine headaches, fibromyalgia, carpal tunnel syndrome, celiac disease, chronic regional pain syndrome, degenerative disc disease, and reflex sympathetic dystrophy. Given the importance of medical information in disability determination, the applicant must include all details of his/her impairments, symptoms, conditions and also details regarding all the healthcare providers involved in the treatment. SSA gives great importance to the treating doctors’ opinion. So, the claimant must clearly explain to the treating doctor how the impairment limits their daily activities. This will enable the doctor to include all such relevant information in the medical record. Apart from medical requirements, the SSA also has some non-medical requirements to grant SSDI benefits. The applicant must have paid social security payroll taxes over a period of time. This period would vary by the age of the applicant. If he/she stops working and contributing to social security, they must be able to show that their disability began before they stopped working and paying taxes. To be eligible for SSI disability benefits, the applicant must have income and assets within the SSI program’s strict limits. This information is available at the SSA website.
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Disability applicants have a better chance of winning an approval if they consult a social security disability attorney. An experienced attorney would review the person’s medical records with the assistance of a medical chart review company and determine whether the claim is feasible. The attorney would also help with the entire claim processing and submission. In case the claim is denied, the attorney can provide the required support for the appeals process.
www.mosmedicalrecordreview.com
918-221-7791