Social Security Disability Benefits Guide

Before you apply for Social Security Disability benefits, it is highly recommended that you hire a lawyer. A lawyer can help you file your application, walk you through the process, and keep you updated on the proceedings. Applying for disability benefits can be a complicated and cumbersome process. This can be extremely frustrating, especially because you are not able to work due to injury or illness. This page guides you through the process step-by-step and explains what the Social Security Administration SSA qualifies as a medical disability.

Social Security Disability Benefits: The Application Process

Applying for Social Security Disability benefits requires time and patience. With only thirty percent of people getting approved during the initial application process, it can be discouraging as well.  These are the four steps to your case that you should be aware of:

  1. Initial Application: At this step, you submit your application to the SSA, along with all supporting documentation.
  2. Reconsideration: If your claim is denied by the SSA, this is the first appeal.
  3. Administrative Hearing: If you are denied again, this is the second appeal.  In about a year, you appear before a Social Security judge to decide your Social Security case.
  4. Appeals Council: If the judge denies your case, you can appeal his or her decision.

Below is a more in-depth description of each step.

Step: 1 Initial Application

The initial application is the first step in the social security disability benefits claim process. During this stage you will submit your application to the SSA along with any and all medical evidence and supporting documentation to help support your claim. The SSA Blue Book lays out exactly which documents you need to provide. After submitting your application and documents, it can take anywhere between 90 to 120 days to receive a decision on your application. It is important to note that most claims are denied upon this initial review, however, you should not give up hope. As there are more steps in place to help get you the support you need.

Step: 2 Reconsideration

If your claim is denied during the first review, the SSA will send you a denial notice through the mail. This notice will outline exactly why you were denied benefits and how long you have to appeal this decision. The “appeal-by” date is extremely important. This is because if you miss this date you will have to start the process over again.

After you review why you were denied, you should provide additional documentation and evidence to help strengthen your claim. During this process, most claims are again denied during the second review. If you are denied benefits at this stage of the process you must request a hearing before a Social Security Administrative Law Judge (ALJ). You will have exactly 60 days from the date of your denied reconsideration request to ask the SSA for a physical hearing. Once you reach this level, your odds of being approved for benefits increase significantly.

Step: 2 Administrative Hearing

During your scheduled hearing you will be questioned about your past work and your current medical limitations. There will also be some sort of vocational expert present, who will provide un-biased testimony that may or may not sway the judge. At some hearings a medical expert will be called to testify and provide details about your specific medical condition and give their opinion on whether your disability keeps you from doing your job.

During this process, it is strongly recommended that you hire an experienced lawyer, if you have not already.  The hearing will require you to have extensive knowledge of social security laws. Your lawyer will also be able to prepare you for questioning and be able to cross-examine the expert witnesses testifying.

It is important to note that this appeal process may take up to two years to complete. However, 42% of cases are decided in favor of the applicant.

Step 4: Appeals Council

If the judge denies you benefits at the administrative hearing, you may appeal his or her decision with the Appeals Council. You must file a request to the Appeals Council within 60 days of the judge’s decision to deny you benefits. However, if you reach this stage you must understand that fewer than two percent of cases are won at this appeal stage. It is also another time commitment, as the Appeals Council can take anywhere between six months to a year to come to a decision.

The Appeals Council claims they review your entire case, along with any other documents you provide that could help your case. They will also review the judge’s conduct during your administrative hearing to see if any procedural or legal errors were made. After this the Appeals Council has three options:

  1. Deny the Request for Review – you will have 60 days after this decision to file an appeal with your federal district court
  2. Remand the Case to the Administrative Law Judge – the Council will send it back to the ALJ for another hearing
  3. Approve your Claim – the Council decided to award you benefits

If your claim is denied by the Appeals Council and you appeal again to the Federal District Court, then your claim may be approved, denied, or sent back to the SSA for further review.

What Medical Conditions Qualify for SDI or Social Security Disability?

The conditions and impairments that cover social security disability can be found in the Social Security Blue Book which is separated into two parts. Part A – Adult Listings & Part B – Childhood Listings.

Adult Medical Conditions & Impairments

Cardiovascular:

  • Heart arrhythmias
  • Heart disease
  • Heart failure

Congenital Disorders:

  • Down’s Syndrome

Digestive System:

  • Gastrointestinal hemorrhage
  • Hepatic (liver) dysfunction
  • Inflammatory bowel disease
  • Malnutrition
  • Short bowel syndrome

Endocrine Gland Disorders:

  • Adrenal gland disorders
  • Diabetes mellitus
  • Parathyroid gland disorders
  • Pituitary gland disorders
  • Other pancreatic gland disorders
  • Thyroid gland disorders

Genitourinary Disorders:

  • Chronic glomerulonephritis
  • Chronic obstructive uropathy
  • Diabetic nephropathy
  • Hypertensive nephropathy
  • Hereditary nephropathies

Hematological Disorders:

  • Hemolytic anemias
  • Disorders of bone marrow failure
  • Disorders of thrombosis and hemostasis

Immune system:

  • Inflammatory arthritis
  • Lupus

Mental Disorders:

  • Anxiety disorder
  • Bipolar disorder
  • Depression
  • Schizophrenic, Delusional (Paranoid), Schizoaffective, and Other Psychotic Disorders
  • Personality disorder
  • Post-traumatic stress disorder (PTSD)

Musculoskeletal:

  • Arthritis
  • Back pain
  • Carpal tunnel syndrome (CTS)
  • Degenerative disc disease
  • Joint pain
  • Neck pain

Neurological:

  • Autism spectrum disorder
  • Epilepsy
  • Multiple sclerosis
  • Seizure disorders

Respiratory System:

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)

Skin Disorders:

  • Bullous diseases
  • Burns
  • Chronic infections of the skin or mucous membranes
  • Dermatitis
  • Genetic photosensitivity disorders
  • Hidradenitis suppurativa
  • Ichthyosis

Special Senses and Speech:

  • Hearing loss
  • Ménière’s disease
  • Statutory blindness
  • Visual disorders
  • Vertigo

Child Medical Conditions & Imparements

Special Sense and Speech:

  • Loss of Visual Acuity
  • Contraction of the visual field in the better eye
  • Loss of visual efficiency
  • Hearing loss not treated with cochlear implantation
  • Hearing loss treated with cochlear implantation

Digestive System:

  • Gastrointestinal hemorrhaging
  • Chronic liver disease
  • Inflammatory bowel disease (IBD)
  • Short bowel syndrome (SBS)
  • Growth Failure
  • Liver transplantation
  • Need for supplemental daily enteral feeding

Digestive System:

  • Gastrointestinal hemorrhaging
  • Chronic liver disease
  • Inflammatory bowel disease (IBD)
  • Short bowel syndrome (SBS)
  • Growth Failure
  • Liver transplantation
  • Need for supplemental daily enteral feeding

Cancer (malignant neoplastic diseases):

  • Malignant solid tumors
  • Lymphoma
  • Leukemia
  • Thyroid gland
  • Retinoblastoma
  • Nervous system
  • Neuroblastoma
  • Malignant melanoma

Endocrine Disorders:

  • Any type of diabetes mellitus in a child who requires daily insulin

Genitourinary Disorders:

  • Chronic kidney disease, with chronic hemodialysis or peritoneal dialysis
  • Chronic kidney disease, with kidney transplant
  • Chronic kidney disease, with impairment of kidney function
  • Nephrotic Syndrome
  • Congenital Genitourinary Disorder
  • Growth failure due to any chronic renal disease
  • Congenital Complications of chronic kidney disease

Growth Impairment:

  • Low Birth Weight
  • Failure to Thrive

Hematological Disorders:

  • Hemolytic anemias
  • Disorders of thrombosis and hemostasis
  • Disorders of bone marrow failure
  • Hematological disorders

Immune System Disorders:

  • Systemic lupus erythematosus
  • Systemic vasculitis
  • Systemic sclerosis (scleroderma)
  • Polymyositis or dermatomyositis
  • Undifferentiated and mixed connective tissue disease
  • Immune deficiency disorders
  • Human immunodeficiency virus (HIV) infection
  • Inflammatory arthritis
  • Sjögren’s syndrome

Neurological:

  • Major motor seizure disorder
  • Nonconvulsive Epilepsy
  • Brain tumors
  • Motor dysfunction
  • Cerebral Palsy
  • Meningomyelocele
  • Autism Spectrum Disorder and Other Pervasive Developmental Disorders
  • Communication impairment

Mental Disorders:

  • Schizophrenic, Delusional (Paranoid), Schizoaffective, and Other Psychotic
  • Disorders
  • Mood Disorders
  • Intellectual disability
  • Anxiety Disorders
  • Somatoform, Eating, and Tic Disorders
  • Personality Disorders
  • Psychoactive Substance Dependence Disorders
  • Attention Deficit Hyperactivity Disorder
  • Developmental and Emotional Disorders

Musculoskeletal:

  • Major dysfunction of a joint(s) (due to any cause)
  • Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint
  • Disorders of the spine
  • Amputation (due to any cause)
  • Fracture of the femur, tibia, pelvis,or one or more of the tarsal bones
  • Fracture of an upper extremity
  • Soft tissue injury (e.g., burns)

Respiratory System:

  • Chronic pulmonary insufficiency
  • Asthma
  • Cystic Fibrosis
  • Lung Transplant
  • Growth failure due to any respiratory disorder

Skin Disorders:

  • Ichthyosis
  • Bullous disease
  • Chronic infections of the skin or mucous membranes
  • Dermatitis
  • Hidradenitis suppurativa
  • Genetic photosensitivity disorders
  • Burns

Hoglund Law Social Security Glossary

If you see some terms which are hard to understand. Feel free to visit our social security disability glossary.