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Disability Criteria - Eligibility For Social Security and SSI Disability




 
Social Security administers two disability programs that have different non-disability criteria but use the same disability medical evaluation process.

Title II benefits, otherwise known as SSD, or Social Security disability, is based upon an insured status that is earned through work activity. A person essentially becomes insured for SSD through work credits earned by years of working.

This insured status can lapse, however, particularly if a person has been not been able to work for a considerable length of time due to a disabling condition.

For individuals who have never become insured for SSD (such as children and stay-at-home spouses), or who have lost their insured status for SSD, there is the title 16 SSI program.

SSI, otherwise referred to as Supplemental Security Income is based upon need, in addition to being disabled. This means that eligibility for SSI hinges upon meeting certain resource limits.

Translation: you cannot have more than $2000 in countable assets to receive SSI. This is true even if you are found to be medically disabled following a review of your claim.

The medical criteria for SSI and Social Security Disability

Just as ALJs (administrative law judges) do so at the disability hearing level, Social Security Administration disability examiners use medical criteria outlined in the Social Security disability guide book,” Disability Evaluation Under Social Security”. The guidebook, also known as the listings, or the blue book (because, in printed form, the cover is blue) focuses on a number of medical condition for which SSA lists very specific approval criteria.

The disability handbook contains medical impairment listings that cover several body systems (such as the endocrine system for which diabetes would be evaluated and the neurological system for which epilepsy would be evaluated). It also contains the medical criteria needed to meet or equal the severity of an impairment listing, which can then result in an approval of benefits.

Getting approved on the basis of a listing in the Social Security list of impairments is fairly difficult. To complicate matters, most medical conditions--physical or mental--are not given a separate listing. Perhaps only 15-20 percent of cases that are awarded benefits are approved on the basis of a listing.

What if I cannot win disability by satisfying a listing?

Although all medical decisions are based upon the medical criteria set forth in the disability impairment listings, some disability applicants will be approved for disability even if they do not meet or equal the impairment listings. This happens when a review of the claimant's medical treatment history and work history allows the Social Ssecurity Administration to conclude that a claimant is not capable of doing their past work or doing some type of other work.

This type of decision makes use of several things:

1. A review of the claimant's medical records.

2. An analysis of the claimant's work history (the types of jobs that were performed, the physical and mental requirements of each job, and the skill levels involved.

3. The application of a set of medical-vocational rules known as the vocational grid. Grid rules allow a disability examiner or judge to "plug in" a claimant's age, skills, education level, and current RFC, or residual functional capacity, and then arrive at a specific rule that finds the claimant "disabled" or "not disabled".

Note: to use an example of RFC, a claimant's medical condition may be examined and it may be determined that they have an RFC of light. This would mean they cannot do more than light exertional work which would limit them to lifting 20 lbs at the most, and only occasionally. The result would be that if their past work required more than light exertion, they could not be expected to return to that past work, or do any other type of work that was rated more than light (e.g. medium or heavy). This is a very simply example, of course, and is only used to illustrate the meaning of RFC, or residual functional capacity.

Will I qualify for SSD or SSI disability?

All individuals who file for disability with Social Security will be evaluated for both programs. If they are eligible for both, their disability claim will be sent to the state disability agency as a concurrent disability claim. If not, their claim may be for Social Security disability or SSI disability benefits only.

It really does not matter which program an individual is eligible for. In either case, their disability claim will be sent to the state disability agency (disability determination services) for a medical determination. Once there, the disability examiner will gather medical information for a decision and make their decision based upon the information contained in the claimant's medical records.

As stated earlier, some disability applicants will be approved for disability even if they do not meet or equal the listing criteria for a specific impairment, such as depression or degenerative disc disease. These individuals may receive their approvals based upon residual functional capacity (what a person is capable of doing despite the limitations of their disabling condition), age, education, past work, and their ability to perform or be trained for other types of work.

If an individual’s residual function capacity makes it impossible to do all substantial work activity including jobs they have done before as well as other types of work, they may be approved for disability on the basis of a medical vocational approval. Basically, all Social Security disability decisions involve medical criteria whether the disability claims are for SSI disability or Social Security disability.















Return to:  Social Security Disability Resource Center, or read answers to Questions





























Related pages:

When does social security consider you eligible for disability benefits?
Who is eligible for SSI Disability?
Disability Criteria - Eligibility For Social Security and SSI Disability
Can I Be Eligible For SSI And Social Security Disability At The Same Time?
Social Security Disability and SSI Mental Claims and Criteria
Can you apply for disability on the basis of multiple health problems?
What makes a person eligible to receive disability benefits?
Inability to Work and Eligibility for Social Security Disability and SSI Benefits
What makes you eligible for Social Security Disability or SSI?
If You Are Currently Working Are You Eligible To Receive Social Security Disability Benefits?
Will Being A Veteran Affect Your Eligibility And Chances For Social Security Disability?
Are SSD and SSI disability cases decided the same way in terms of Eligibility?
Is the Medical Criteria to Get Social Security Disability or SSI Benefits hard?
Criteria for how Social Security Disability is Awarded
Social Security Disability SSI Criteria and the Evaluation Process



Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI


These pages answer some of the most basic questions for individuals who are considering filing a claim.

Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria