Requirements for Disability

What is the criteria to get disability?

by Tim Moore. Free Case Evaluation for North Carolina Residents here.


How do I meet the requirements for disability?

To meet the requirements for disability you must prove your case to the Social Security Administration. This means showing, through a combination of your medical records and work history, that you have enough physical and/or mental limitations that you can no longer work, either at one of your past jobs, or at any other type of work. This can be hard to prove.

(Read if you live in North Carolina)

As a disability representative and a former examiner, I can state that the system is hard and complex but if your case is prepared properly, you will have a very good chance of satisfying the disability requirements for winning benefits, especially at a hearing, and especially with good, experienced representation. Now, I’ll explain how the system works.

How to meet the Requirements

To qualify for Social Security Disability or SSI benefits, you have to satisfy the Social Security definition of disability, as well as meet several other requirements. Note: This information is based on how the process actually works and my own experience as a former disability claims examiner.

The first requirement: Are you working?

Qualifying for disability is based on how much you are able to work. If you are working when you apply, you cannot earn more than the SGA, or substantial gainful activity, amount. For 2021, this means that earning $1310 or more per month will immediately disqualify you without your medical records even being looked at (called a technical denial).

Please note: Most individuals are NOT working when they file for disability. So if you are working, particularly if you have a mental impairment, this may affect how the disability examiner views your claim when they try to assess your functional capacity (ability to work). Translation: it’s usually better to not be working while you are applying for SSD or SSI.

The second requirement: Is your condition severe?

To qualify for disability, you must have a severe medical condition, which can be a physical or mental impairment, or several impairments; disability examiners look at your overall condition and how it affects your ability to work. What makes your condition severe for Social Security?

1. Your condition is severe if it prevents you from working completely, or prevents you from earning the SGA income level that we mentioned above.

2. Your condition is considered severe enough to meet the Social Security criteria if it already has, or will, keep you from working for at least a year.

How does Social Security decide you meet the disability requirements?

After you apply, your case is assigned to a disability examiner who will decide your case. The examiner will review your medical records and work history, based on the information on your application. At some point, they may contact you for additional information about your activities of daily living, your treatment sources, and your individual jobs. They may also schedule you for a medical consultative examination. If the examiner requests that you contact them, respond immediately.

The examiner has two ways they can potentially award you SSD or SSI disability benefits.

The 1st way: Getting approved through the impairment list

If you have a physical or mental condition that is in the Social Security list of impairments (also known as the blue book), you can be approved for disability if your medical records satisfy the listing criteria. There are two things to remember about listing approvals.

1. Most claims do not get approved this way because the approval criteria is very specific. Often, your medical records won’t provide the right information.

2. Not all conditions are in the listings. For example, carpal tunnel syndrome, which is common, is not in the listings. Nor is Lyme disease.

If you have a condition that is listed, such as depression or seizure disorder, and you meet the listing requirements, then your case ends there. But what if your case doesn’t fit this criteria?

The 2nd way: Being approved because you cannot return to work

If you aren’t approved on a listing, a disability examiner, or a judge at a Social Security hearing, will look at your work history. They will determine what you are still physically and mentally capable of doing (your RFC, or residual functional capacity), and they will compare that to what your past work required of you. They do this to answer two questions.

Can you go back to your past work?

If Social Security decides you can do your past work, which can include any job you did in the last 15 years, then your case will be denied. This is where the importance of listing all your treatment sources, conditions, and symptoms really comes to light. Because you will want show as many functional limitations as possible to prove that you can’t return to your past work.

If Social Security determines that you cannot go back to your past work, that is a positive development. However, it does not mean you are approved. At that point, a disability examiner or a judge will decide if you can do something else.

Can you do some type of other work?

What is other work? Other work is basically jobs that Social Security may claim you are capable of doing based on A) your age, B) your work skills, C) your level of education, and D) the physical and mental limitations you have.

This is where the information you provided about your work history becomes very important, because Social Security will try to determine if you have the ability to switch from your past work to something else.

For this reason, when you file your claim you need to be very specific about your past jobs. You need to give good descriptions of what you did on each job so the examiner can look up each job and the requirements it had. If your past jobs are not properly identified, that can play a role in having your case denied.

Getting a medical-vocational approval

If Social Security decides that you can’t do other work, in addition to not being able to do your past work, you will be approved on your disability claim.

If you are denied at this step, of course, you will want to file an appeal immediately. You should also consider getting a disability attorney, particularly if your appeal is for a hearing.

What about the non-medical requirements for disability?

So far, we have mainly discussed the medical requirements for disability. What are the non-medical requirements? One of them we have already discussed which is that your work earnings need to be under the SGA level.

Work Credits

Another issue, however, is work credits. To receive Social Security Disability, you must be insured for the program and have a certain number of work credits. This page discusses this: Work credits for Social Security Disability.

Assets

If you are not insured for SSD, you may be considered for SSI. However, SSI also has it’s own non-medical requirements. One is the same restriction on not going above the SGA earnings limit if you are working. The other, however, is the fact that SSI has a limit on how much a person can have in countable assets. That limit is set at $2000. To learn more about assets that count, go here: Countable assets for SSI.

Don’t worry about non-medical requirements

Non-medical requirements are not something you should worry about. These will be considered at your time of application, including whether you apply for SSD or SSI. Your only concern will be the medical qualification process because this will specifically involve you providing information about your work, your conditions, your doctors, and possibly going to one or more medical examinations.