What kind of cases win disability benefits?

Unfortunately, there are no specific kinds of cases that win disability benefits, as each person who files for Social Security Disability or SSI disability has unique conditions and limitations.

However, disability cases that involve paralysis of extremities, mental retardation (depending on severity), statutory blindness, total deafness, terminal disease processes such as cancer, ALS (also known as Lou Gehrig's disease), severe cardiovascular impairments, kidney failure requiring dialysis or transplant, and severe neurological impairments that cause significant disruption of function are likely candidates for approval of disability benefits at the initial disability claim level.

The reason that these types of conditions often win disability benefits at the initial disability claim level is that they often meet or equal the listing criteria of an impairment listing. Social Security has a disability handbook known as the blue book that contains a list of impairments of all of the body systems. Each of these impairment listings has the criteria needed to meet or equal the severity requirements of Social Security Disability and SSI (since both programs are evaluated in the same way).

People who have cases that involve these conditions listed above and other severe conditions are more likely to win their disability benefits on their initial claim (disability application).

However, this does not mean that people who file for disability with other conditions will not win their disability cases at some point in the Social Security Disability appeal process.

The Odds of Winning on the First Appeal

If an initial disability case does not win disability benefits, the disability applicant may still win benefits at one of the appeal levels. The first appeal level is a request for reconsideration appeal. Reconsideration appeals have the lowest chance of winning an applicant disability benefits (depending on one's state of residence, they may only have a 12-14 percent chance of being approved for disability at the reconsideration level).

Reconsiderations are just a review of the initial disability determination. If the disability examiner who made the initial disability decision was correct according to the criteria outlined in the blue book, there is very little chance of a disability case's medical decision being changed.

The Increased Odds of Winning at a Hearing

However, the reconsideration appeal is still a necessary step toward a disability case winning disability benefits. This is because if a disability applicant sticks with the process they will file a second appeal. The second appeal is a request for hearing before an administrative law judge. Statistically, the odds are in favor of claimants who pursue their claim to the hearing level, particularly if their case is well prepared and well presented.

Claimants with representation typically have a better than sixty percent chance of winning benefits at a disability hearing conducted by a federal administrative law judge. And disability cases involving the following conditions have a very good chance of winning disability benefits at a hearing: Having said this, though, any disability case that involves a severe physical or mental impairment, or combination of impairments that have caused a person to be unable to work at a substantial gainful activity level for at least one full year could represent a case that will win disability benefits.

Social Security does not decide disability cases on the basis of a diagnosis, no matter what that diagnosis is.

SSA will award disability benefits based on how limiting an impairment is to a person's functional ability. If a claimant's medical records support the contention that a person is unable to perform the duties of their past work and also any other kind of job that their vocational work skills might possibly qualify them for, their case may win disability benefits.

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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