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How to file for disability, Filing for SSI
Disability Requirements, Disability Status
How long is the wait?, Disability Application
The Social Security List of Impairments
Qualifying for Disability, Mental Disability
Disability Lawyer Info, Disability Back Pay

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.








Essential Questions

What is the Social Security Disability SSI list of impairments?

Can you work while getting or applying for Disability?

How Often Does Social Security Approve Disability The First Time You Apply?

Tips for getting Social Security Disability or SSI benefits approved

What medical conditions will get you approved for disability?

What kind of Mental Problems Qualify for Disability?

Receiving a Disability Award Letter

Conditions Social Security will recognize as a disability

Previously answered questions regarding SSD and SSI

Applying for disability in your state



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Filing a Social Security Disability SSI application

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How to Prove you are disabled and Win your Disability Benefits

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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
If you apply for disability in Texas
Disability requirements in Texas
Qualifying For Disability in Texas



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

Can you get temporary Social Security Disability or SSI benefits?

Permanent Social Security Disability

What is the difference between Social Security Disability and SSI?

Who is eligible for SSI disability?

Can I Be Eligible For SSI And Social Security Disability At The Same Time?

What makes a person eligible to receive disability benefits?

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?









For the sake of clarity, SSDRC.com is not the Social Security Administration, nor is it associated or affiliated with SSA. This site is a personal, private website that is published, edited, and maintained by former caseworker and former disability claims examiner, Tim Moore, who was interviewed by the New York Times on the topic of Social Security Disability and SSI benefits in an article entitled "The Disability Mess" and also by the Los Angeles Times on the subject of political attempts to weaken the Social Security Disability system.

The goal of the site is to provide information about how Social Security Disability and SSI work, the idea being that qualified information may help claimants pursue their claims and appeals, potentially avoiding time-consuming mistakes. If you find the information on this site helpful and believe it would be helpful to others, feel free to share links to its homepage or other pages on website resource pages, blogs, or social media. Copying of this material, however, is prohibited.

To learn more about the author, please visit the SSDRC.com homepage and view the "about this site" link near the bottom of the page.