Disabilities Covered by Social Security Disability Benefits
How Social Security defines and determines disability.
Many injuries and illnesses are obviously disabling, such as late stage kidney disease, congestive heart failure, and advanced cancers. There are others, however, such as chronic illnesses that become acute with age, or residual conditions that deteriorate over time, that eventually become disabling even though they were not initially too severe. For example, a worker may have had a previous back injury that is aggravated through the years to the point where work is extremely difficult or impossible. That person may become eligible for disability benefits even though the original illness or injury was not disabling.
Because Social Security disability is a government program, its features include a good number of qualifying rules and regulations. To receive Social Security disability benefits, all three of the following must be true:
- You must have a physical or mental impairment.
- The impairment must prevent you from doing any substantial gainful work.
- The disability must be expected to last, or have lasted, at least 12 months, or it must be expected to result in death.
Of course, these terms are subject to different interpretations. There are guidelines developed by Social Security and the courts regarding qualifications for disability. The bottom line is that proving a disability is often a difficult task. In preparing your claim for a disability, examine these guidelines carefully, discuss the matter with your doctor or doctors, and plan your claim accordingly.
Physical or Mental Impairment
The basic rule regarding disability is that the condition preventing you from working must be a medical one, meaning that it can be discovered and described by doctors (Social Security calls this "medically determinable.") To prove you have a medically determinable condition, when you file your disability claim, you should bring records and statements from doctors, or from hospitals or clinics where you have been treated, describing the medical condition that prevents you from working, and exactly how your limitations affect you. The letters should also state that your disability is expected to last for 12 months or to result in your death.
Substantial Gainful Work
Social Security will first consider whether your condition prevents you from doing the job you had at the time you became disabled, or the last job you had before becoming disabled. If your disability prevents you from performing your usual job, Social Security will next decide whether you are able to do any other kind of substantial gainful work, which is currently defined as any job that pays $1,130 per month or more.
Your age, education, training, and work experience will be considered in making this determination, as will the practicality of learning new job skills for another work position. Social Security will evaluate whether you are able to perform any kind of work for pay, whether or not there are actually any such jobs available in the area in which you live.
EXAMPLE: Arnold has been a longshoreman for 40 of his 58 years. Weakened by an early injury, Arnold’s back has grown slowly but steadily worse over the past decade, causing him to miss several months of work in the past two years. His doctor has told him that his back will not get better, and Arnold decides to apply for disability benefits.
As Arnold’s back prevents him from standing for long periods of time and restricts the movement of his arms, Social Security determines he is unable to do any physical labor. The next question would be whether he is able to do any other kind of work. It is possible that his back would be too bad for him to do even a job which required him to sit at a desk; if so, and if Arnold proved this to Social Security through his doctor, or Social Security found that because of his age, education, and job skills there were no desk jobs he could learn to do, he would probably get his disability payments.
Disability Must Be Lasting
No matter how serious or completely disabling your illness or injury is, you will not qualify for disability benefits unless your condition has lasted, or is expected to last, for 12 months—during which time you are unable to perform substantial gainful work. The disability will also qualify if it is expected to result in your death. Even though the disability must be expected to last 12 months, you do not have to wait 12 months to apply.
As soon as the condition is disabling and a doctor can predict that it is expected to last a year, you may qualify for disability benefits. And if, after you begin receiving benefits, it turns out that your disability does not last 12 months, Social Security cannot ask for its money back. You are not penalized for recovering sooner than expected, as long as the original expectation that the illness would last 12 months was a legitimate one. Social Security does do continuing disability reviews, however, and can terminate your benefits at a later date.
The amount of your ultimate retirement benefits and your disability benefits is determined by your average income over the years. If, after your disability, you are earning considerably less than you were before, the years of those earnings could pull your average income lower, which could result in a lower ultimate Social Security payment. However, if you had a disability that caused you to work for significantly lower wages, the Social Security Administration may put a disability freeze on your earnings record. The disability freeze permits you to work and collect your lower income without having it figured into your lifetime average earnings. To learn more, see our article on Social Security's disability freeze.
Do You Have a Disability? How the Social Security Administration Decides
To decide whether you are disabled and able to receive benefits based on that condition, the Social Security Administration uses a step-by-step process involving five questions.
Step 1: Are you working?
If you are working and your earnings average more than $1,130 a month—the base amount set by Social Security for 2016—you generally cannot be considered disabled.
Step 2: Is your condition severe?
Your condition must be severe enough that it significantly interferes with basic work-related activities for your claim to be considered. If it only has a minimal effect on your ability to do work-related activities, the Social Security Administration will find that you are not disabled.
Step 3: Is your disability found in the list of disabling conditions?
The Social Security Administration maintains a list of medical conditions that are so severe they automatically mean that you are disabled (if you match the requirements for the condition). If your condition is not on the list, the Social Security Administration will have to decide if it is of equal severity to a medical condition that is listed. (See www.ssa.gov/disability/professionals/bluebook/AdultListings.htm.) If it is, the Social Security Administration will find that you are disabled.
Step 4: Can you do the work you did previously?
If your condition is severe but not as severe as a medical condition on the list, then the Social Security Administration must determine if your condition interferes with your ability to do the work you did previously. If it does not, your claim will be denied.
Step 5: Can you do any other type of work?
If you cannot do the work you did in the past, the Social Security Administration will see if you are able to do a less physically and/or mentally demanding job. The Social Security Administration considers your medical conditions and your age, education, and past work experience and any transferable skills you may have. If you cannot adjust to other work because of your age or other factors, your claim will be approved. If your limitations prevent you from even doing a simple sit-down job, you will be approved. But if you can adjust to other work, and there is other work that fits within your restrictions and limitations, your claim will be denied.
To find out how Social Security evaluates specific illnesses and injuries, see Nolo's section on disability benefits for certain medical conditions.