What Conditions Qualify for Social Security Disability Benefits?

This category covers conditions affecting bones, joints, ligaments, and soft tissues that limit your ability to perform basic work activities like standing, walking, lifting, or manipulating objects.

Qualifying conditions include chronic arthritis (rheumatoid, osteoarthritis, psoriatic), degenerative disc disease of the spine, spinal stenosis requiring surgical intervention, joint dysfunction in major weight-bearing joints (hip, knee, ankle), and reconstructed joints with complications. The SSA requires imaging studies (X-rays, MRI, CT scans) showing anatomical abnormalities along with clinical findings demonstrating significant functional limitations.

For spinal disorders, you must show nerve root compression with motor loss, sensory changes, and reflex abnormalities. For arthritis, medical evidence must document joint inflammation, deformity, and persistent symptoms despite prescribed treatment for at least three months.

This category addresses sensory impairments affecting vision, hearing, and speech that prevent you from performing work requiring these senses. Visual disorders include legal blindness (central visual acuity of 20/200 or less in the better eye with correction, or visual field limitation to 20 degrees or less), retinal disease, and visual efficiency impairments.

Hearing loss qualifies when air conduction thresholds demonstrate a severe bilateral impairment. Specific audiometric criteria apply based on the frequency range tested. Speech disorders must significantly impact your ability to communicate effectively in a work setting despite treatment.

Medical documentation requires specialized testing: visual field testing by a perimetry, comprehensive ophthalmological examination, and pure-tone audiometry performed by qualified professionals.

Respiratory conditions qualify when they cause severe chronic breathing difficulties that persist despite prescribed treatment. Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis, represents the most common qualifying condition in this category.

Other qualifying conditions include chronic asthma requiring frequent hospitalizations, cystic fibrosis, pulmonary fibrosis and other restrictive lung diseases, bronchiectasis, and lung transplants. Sleep-related breathing disorders like severe sleep apnea may qualify when they result in daytime hypercapnia or cor pulmonale.

The SSA requires pulmonary function testing demonstrating reduced FEV1 values, arterial blood gas studies showing hypoxemia or hypercapnia, and documentation of exacerbations requiring physician interventions. For asthma, you must show at least six documented episodes annually requiring emergency department visits or hospitalizations.

Cardiovascular impairments include conditions affecting the heart and circulatory system. Chronic heart failure qualifies when you have persistent symptoms despite prescribed treatment, with imaging or other testing showing reduced ejection fraction, ventricular dysfunction, or significant cardiac enlargement.

Coronary artery disease may qualify with documented ischemia despite revascularization procedures, recurrent arrhythmias causing syncope or near-syncope despite prescribed treatment, or congenital heart disease with cyanosis or secondary polycythemia. Peripheral arterial disease qualifies with intermittent claudication and evidence of significant arterial obstruction.

Digestive system disorders may qualify when they cause significant nutritional deficiencies, require frequent hospitalizations, or result in complications preventing sustained work activity. Inflammatory bowel disease (Crohn’s disease and ulcerative colitis) qualifies with documented obstruction, abscess formation, perineal disease, or persistent symptoms despite prescribed treatment.

Chronic liver disease qualifies with cirrhosis documented by imaging or biopsy, portal hypertension with ascites or bleeding varices, hepatic encephalopathy, or end-stage liver disease scores meeting specified thresholds. Short bowel syndrome requires documentation of malabsorption resulting in significant weight loss despite nutritional support.

Other qualifying conditions include weight loss due to any digestive disorder with BMI below specific thresholds despite treatment. Medical documentation must include endoscopy reports, imaging studies, liver function tests, and nutrition assessments showing the severity and persistence of symptoms.

This category primarily addresses chronic kidney disease requiring ongoing dialysis or a kidney transplant. Chronic kidney disease qualifies when you require chronic hemodialysis or peritoneal dialysis due to irreversible renal failure.

Nephrotic syndrome may qualify with laboratory findings showing serum albumin below 3.0 g/dL and proteinuria with persistent edema despite treatment for at least three months. Chronic glomerulonephritis, chronic obstructive uropathy, and other renal impairments may qualify when they result in chronic renal failure meeting specific laboratory thresholds.

Medical evidence must include laboratory studies showing elevated creatinine and blood urea nitrogen levels, decreased glomerular filtration rate, and documentation of dialysis treatment or transplantation. For nephrotic syndrome, serial laboratory studies over time are required.

Blood disorders may qualify when they result in significant complications affecting your ability to work. Sickle cell disease qualifies with documented painful crises requiring emergency department visits or hospitalizations at least six times in a 12-month period, or with chronic severe anemia or other complications.

Hemophilia and other coagulation defects may qualify with spontaneous hemorrhage requiring transfusions at least three times within a consecutive five-month period. Chronic thrombocytopenia qualifies with platelet counts persistently below specified thresholds and bleeding requiring transfusions.

Bone marrow failure syndromes, including aplastic anemia and myelodysplastic syndromes requiring ongoing transfusions, may also qualify. Medical documentation must include complete blood count studies showing persistent abnormalities, coagulation studies, bone marrow biopsy results, and emergency department or hospital records documenting complications.

Skin conditions rarely qualify alone but may when they result in extensive lesions interfering with joint movement or causing repeated infections. Ichthyosis qualifies when extensive lesions on hands, feet, or other areas interfere with movement or require frequent medical interventions.

Bullous disease (pemphigus, epidermolysis bullosa) qualifies with extensive skin lesions persisting for at least three months despite prescribed treatments. Chronic skin infections secondary to other conditions may contribute to qualify for social security disability benefits when combined with the underlying impairment.

Severe burns and their residual effects may qualify when they result in contractures limiting motion in major joints or requiring repeated surgical interventions. Medical evidence must include photographs, dermatologist treatment notes, and documentation of functional limitations caused by the skin condition.

Diabetes mellitus qualifies not based on the diagnosis alone but through its complications affecting other body systems. Diabetic neuropathy causing significant loss of function in two extremities may qualify under neurological listings. Diabetic retinopathy qualifies if it meets vision loss criteria under special senses listings.

Diabetic nephropathy may qualify if it results in chronic kidney disease meeting renal failure criteria. Diabetic peripheral vascular disease may qualify under cardiovascular listings with documented arterial insufficiency and complications. Hypoglycemia or hyperglycemia requiring frequent emergency interventions despite prescribed treatment may also qualify.

Thyroid disorders, pituitary gland disorders, and parathyroid gland disorders may qualify when they cause complications evaluated under other body system categories. Medical evidence must include endocrinologist treatment records, laboratory studies (HbA1c, blood glucose logs, hormone levels), and documentation of end-organ damage.

This category addresses birth defects and genetic conditions that significantly affect functions. Down syndrome qualifies based on clinical findings and chromosomal analysis. Other genetic disorders may qualify based on their specific manifestations evaluated under relevant body system listings.

Non-mosaic Down syndrome qualifies with confirmation by karyotype or other accepted genetic testing showing trisomy 21. Congenital conditions are evaluated based on resulting functional limitations under appropriate body system categories.

Medical documentation requires genetic testing results, specialist evaluations, imaging studies showing anatomical abnormalities, and assessments of functional limitations caused by the congenital condition.

Neurological conditions include disorders affecting the central and peripheral nervous system. Epilepsy qualifies with dyscognitive or convulsive seizures occurring despite adherence to prescribed treatment at specified frequencies. Tonic-clonic seizures occurring at least once a month for three consecutive months may qualify, as do dyscognitive seizures occurring at least once a week for three consecutive months.

Multiple sclerosis qualifies with disorganization of motor function in two extremities despite prescribed treatment for at least three months, significant visual or mental impairment, or marked physical limitations combined with mental impairment. Parkinson’s disease qualifies with disorganization of motor function in two extremities despite prescribed treatment.

Amyotrophic lateral sclerosis (ALS), Huntington’s disease, and other progressive neurological conditions may qualify based on their specific manifestations. Traumatic brain injury may qualify based on resulting motor dysfunction, cognitive impairments, or communication deficits persisting beyond expected recovery periods.

Medical evidence must include neurologist treatment notes, EEG reports for seizure disorders, MRI or CT scans showing neurological abnormalities, and detailed descriptions of seizure frequency, type, and post-ictal manifestations.

Depression, anxiety disorders, bipolar disorder, schizophrenia spectrum disorders, autism spectrum disorder, and other mental impairments may qualify when they result in marked limitations in:

• Understanding, remembering, or applying information
• Interacting with others
• Concentrating, persisting, or maintaining pace
• Adapting or managing oneself

For mental disorders, the SSA requires comprehensive documentation from mental health professionals showing diagnosis, prescribed treatment (including medications and therapy), response to treatment, and specific functional limitations. “Marked” limitation means functioning is seriously limited but not precluded. “Extreme” limitation means you are unable to function independently in that area.

Conditions must persist despite compliance with prescribed treatment. Mental health disorders evaluated include depressive disorders, anxiety and obsessive-compulsive disorders, somatic symptom disorders, personality disorders, intellectual disorders, autism spectrum disorders, neurocognitive disorders, schizophrenia spectrum disorders, and eating disorders.

Medical documentation requires treatment records from psychiatrists and psychologists, psychiatric evaluation reports with mental status examinations, psychological testing results when performed, medication lists with dosages and side effects, hospitalization records when applicable, and third-party statements describing functional limitations.

Cancer qualifies based on site, histology, extent of disease, and treatment response. Many aggressive cancers automatically meet listings at diagnosis. Others may qualify if they persist, recur, or metastasize despite treatment.

Specific cancers with criteria include head and neck cancers with distant metastases or recurrence after treatment, breast cancer with distant metastases or recurrence, skin cancers including melanoma with certain characteristics, soft tissue cancers with certain features, lymphoma with specified staging, leukemia of certain types, and multiple myeloma with specified complications.

Many cancer diagnoses qualify for compassionate allowances, providing expedited processing. Cancers not meeting specific listing criteria may still qualify based on complications from the disease or treatment.

Medical evidence must include pathology reports confirming diagnosis and histology, operative reports, imaging studies showing extent of disease, oncologist treatment notes documenting treatment provided and response, and documentation of complications or residual effects.

Immune system disorders include autoimmune conditions and immunodeficiency disorders. Systemic lupus erythematosus qualifies with involvement of two or more organs or body systems with at least one involved to a moderate level of severity and constitutional symptoms or signs of severe fatigue, fever, or weight loss.

Rheumatoid arthritis qualifies with deformity or inflammation in one or more major peripheral joints and involvement of two or more organs/body systems with at least one involved to a moderate level of severity. HIV infection qualifies with specified complications including certain opportunistic infections, cancers, or CD4 counts below threshold values despite treatment.

Inflammatory arthritis qualifies with persistent inflammation or deformity in major joints and marked limitation in physical functioning despite prescribed treatment for at least three months. Sjögren’s syndrome, systemic sclerosis (scleroderma), polymyositis, dermatomyositis, undifferentiated and mixed connective tissue disease, and immune deficiency disorders may qualify based on specific manifestations.

Medical evidence requires laboratory studies showing diagnostic markers (ANA, RF, anti-dsDNA, complement levels), treating rheumatologist notes documenting clinical findings and functional limitations, imaging showing joint damage or organ involvement, and documentation of treatment including immunosuppressive medications.

No, legal representation is not required to apply. However, individuals who work with a social security disability lawyer have significantly higher approval rates, particularly at the hearing stage. An attorney can identify which medical evidence the SSA needs for your specific condition, obtain proper documentation from your physicians, and present your case effectively if you’re denied initially—which occurs in approximately two-thirds of claims.

Residual functional capacity (RFC) is the SSA’s assessment of what you can still do despite your limitations. Physical RFC evaluates strength demands (lifting, carrying), postural limitations (stooping, crouching, kneeling), manipulative limitations (reaching, handling, fingering), and environmental restrictions (heights, hazards, temperature extremes). Mental RFC assesses your ability to understand and remember instructions, sustain concentration, interact with others, and adapt to changes. RFC determines whether you can return to past work or adjust to other work.

Approximately two-thirds of initial claims are denied. You have the right to appeal through four levels: reconsideration (complete review by different examiner), Administrative Law Judge hearing (in-person hearing where you present testimony and evidence), Appeals Council review (reviews ALJ decision for errors), and Federal Court review (judicial review of administrative record). You must file appeals within 60 days of each denial. Working with a social security disability lawyer increases your chances of being approved during the appeals process.

The SSA must consider all medically determinable impairments in combination, even those that individually wouldn’t be disabling. Combined effects of multiple moderate impairments may prevent substantial gainful activity even when no single condition meets listing severity. Medical evidence should document all diagnosed conditions and describe how they collectively limit your functioning. The RFC assessment considers cumulative effects of all impairments on your ability to work.

Initial claim decisions typically take 3 to 6 months. If denied, the reconsideration stage adds an additional 3 to 5 months. Administrative Law Judge hearings are scheduled 12 to 18 months after the hearing request. Compassionate allowance claims may be approved within weeks. Processing times vary by state and office workload.

No medical condition qualifies automatically. All claims require medical evidence demonstrating that your impairment meets listing criteria or prevents substantial gainful activity. However, conditions on the compassionate allowances list receive expedited processing, often reaching a decision within weeks rather than months.