To qualify for Social Security Disability or SSI, how severe must a condition be?

Social Security Disability is determined by an individual's mental or physical functional limitations, which prevent them from being able to perform work activity (including past work and other forms of work). Therefore, any condition that prevents an individual from working, or limits the degree to which they can work, may be considered a severe condition by the social security administration.

How does the Social Security Administration determine that a condition is severe enough to qualify a person for disability benefits? If the claim is at the disability application or request for reconsideration level, a disability examiner who works in a state-level DDS agency (disability determination services, the agency that makes decisions on disability claims for the social security administation) will consider all the information contained in the claimant's medical records.

This, of course, may include supporting statements from the claimant's treating physician(s). Using this information, the examiner will determine to what extent, and in what ways, the claimant is functionally limited.

For example, does the individual have neurological deficits, or deficits with regard to hearing or seeing, or being able to ambulate (move about)? Do they have range of motion problems? Do they have trouble using their hands, or standing or sitting longer than a certain period? In the case of mental impairments, do they have difficulty with concentration, or remembering.

The functional limitations that are indicated by the medical evidence will allow the disability examiner to decide how to rate the claimant (for physical conditions, for example, ratings can include the ability to do medium level work, light duty work, sedentary work, and less than sedentary work).

This rating--or ratings if the claimant has both physical and mental conditions--will be compared to the types of work that were performed by the claimant within the prior fifteen year period. And this comparison will allow the disability examiner to determine if the disability claim will be approved or denied.

If the disability case has moved beyond the first two levels (application and reconsideration), and is now at the level of a Social Security Disability or SSI hearing, the same evaluation process will be used, only this time it will be conducted by a federal administrative law judge. And at this hearing, the claimant and their attorney will be allowed to present new evidence and challenge the basis of the prior decisions (i.e. the denials of the claim) in the attempt to A) win ongoing monthly disability benefits, and B) obtain as much back pay as possible for the claimant.

Often, individual have multiple impairments that, taken by themselves, may not be severe enough to qualify for Social Security Disability. However, when taken together along with an individual's age and education, they may result in a Social Security Disability allowance. In other words, an approval for SSD benefits or SSI disability benefits.

If your condition or conditions have been preventing you from engaging in work activity that enables you to earn a substantial and gainful income, you should contact your local Social Security office or call the toll free number to file a disability application.

You may also seek representation from a disability representative at any time to assist you with your claim. Representation is not required, but for individuals who will eventually have their case decided at the hearing level (before a federal judge), it can provide a significant advantage in terms of case preparation.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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