Is the Medical Criteria to Get Social Security Disability or SSI Benefits hard?

The partial disability benefit or temporary disability benefit programs. By contrast, both are total disability programs. This essentially means that the benefits provided by each program is not meant for individuals who have impairments or conditions that are likely to improve to the extent that they are able to return to work in less than twelve months (for example, simple fractures).

Additionally, unlike other disability programs such as workers compensation or VA benefits, the Social Security Administration does not allow percentage disability benefits (that are payable based on a percentage of infirmity and which may be payable even if a person is working a full time job).

Under SSA guidelines and regulations, a person's case must conform to a relatively high standard; they must prove that their disabling condition precludes the performance of not only their past job or jobs, but also any other type of job in the general economy for which their age, job skills, and education might otherwise qualify them.

Social Security sets rigorous disability medical criteria to address the severity of a person's disabling condition. SSA disability examiners make their disability medical determinations with a disability guidebook (the blue book, titled "Disability Evaluation Under Social Security") that contains impairment listings for all body systems. If a disability applicant meets or equals the severity listing criteria of an impairment listing and they are not performing substantial work activity, they may be approved for disability benefits.

Unfortunately, most individuals are not able to meet or even medically equal an impairment listing. If they do not satisfy the listing criteria of a condition in the blue book (the social security list of impairments), they have to undergo a sequential evaluation process that begins with a medically determinable impairment, but also includes:

A) Documentation as to the severity of the impairment,

B) An evaluation of the limitations imposed by the impairment,

C) A determination of residual functional capacity (what the applicant is able to do in spite of their disability)


D) An evaluation of their ability to perform any of their past work when their residual functional capacity is considered.

If the applicant cannot meet the requirements of any of their past work, the disability examiner must determine if they are able to do any other suitable type of job ("suitable" meaning when their residual functional capacity, age, education, and job skills are considered). Social Security Disability or SSI disability applicants are only approved for disability benefits if they are found unable to do any of their past work or any other work for which they might be qualified.

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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