Social Security Disability: Qualifying Conditions

Are there specific conditions that qualify a claimant for Social Security Disability benefits?

The short answer is no. The long answer is a slightly more nuanced no.

On some disability websites, potential claimants may come across lists of conditions like these. Many providers assemble these lists as examples of conditions that could be the basis of an SSDI or SSI claim. This can generally be somewhat misleading in that it can create the false impression that there are specific conditions that one must have in order to qualify for disability. However, this is simply not the case.

Social Security does have the Listing of Impairments. These Listings were created to streamline the disability process a bit by providing a list of common conditions that can lead to a finding of disability. However, what must be understood about the Listings in that they can be somewhat generic. This means that instead of identifying depression as a condition they identify “Affective Disorders,” which is a category of psychological conditions. This is the same for numerous other conditions. In fact, the listings only get specific where they need to be.

In some cases, the Listings will not only identify a specific condition, but also specific testing or test results that a claimant would need to have completed in order to meet the requirements of the Listing. For instance, with chronic heart failure, one would need to experience systolic failure, an ejection fraction of 30% or less, and inability to perform an exercise tolerance test at a workload of 5 METs or less due to a decrease of 10 mmHg in systolic blood pressure below their baseline systolic blood pressure in order to meet Listing 4.02 Chronic Heart Failure. So, in this example, a claimant would need to fail a cardiac stress test due to a drop in blood pressure, have an ejection fraction (which can be measured or estimated through a few different tests) that is approximately half of normal, and, though it is not mentioned, a poorly functioning left ventricle.

That seems pretty specific. But, most people do not realize that it is possible to “equal” a Listing. So, with the heart failure example, if a claimant had an ejection fraction of 40% and also had a knee problem limiting his ability to perform a stress test, he or she might be considered to have equaled the listing because, while they did not have exactly what the listing was looking for, they had conditions that combined to equal the severity that the Listing was looking for.

The equals argument can even be applied to conditions that have nothing to do with what the Listing is asking for, but demonstrate a similar level of severity. For instance, the asthma Listing is applicable to a number of different conditions including migraines. So, while you may not have ever had asthma, as long as you are taking a prescribed treatment and still have six migraines within a twelve-month period you would be able to argue that you equal the asthma listing.

The fact is that there are no specific conditions that one must have in order to medically qualify for disability. We have even seen claimants approved who did not have a firm diagnosis, but only confirmation by a doctor that they were experiencing severe symptoms of an unknown origin. In fact, all that is required to medically qualify is to have a severe, medically determinable impairment, that prevents a claimant from maintaining substantial gainful employment in their prior or other work, that is expected to last at least 12 months. If these basics are met, a claimant likely will have a good medical argument for disability.

If you would like further information on how your conditions could qualify you for disability or would like to speak with someone in the office about your claim please contact us!

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