The Social Security Administration (SSA) maintains a strict standard for determining disability.
The SSA Disability criteria is a multi-step procedure created to carefully assess each case. It also ensures that benefits are granted only to those who demonstrate that their condition significantly limits their ability to perform basic work activities.
Understanding how the Social Security Administration (SSA) defines disabilities is crucial for individuals applying for benefits and for family members or caregivers assisting with applications.
This article provides a comprehensive guide on how SSA defines disabilities, an intro to SSA’s disability criteria and the evaluation process. Here you will find:
- Definition and Purpose of SSDI
- A Brief History of SSDI
- How SSA Defines Disabilities
- The Five-Step Evaluation Process
- Types of Disabilities Recognized by SSA
- How SSA Reviews Disability Status
- Frequently Asked Questions (FAQ):
Definition and Purpose of SSDI
Social Security Disability Insurance (SSDI) is a federal program funded by payroll taxes. It provides benefits to disabled individuals who have paid into the Social Security system through their employment.
The primary goal of SSDI is to offer financial support to those who can no longer engage in Substantial Gainful Activity (SGA) (work that involves significant physical or mental activities or a combination of both) due to a severe disability.
A Brief History of SSDI
The idea of SSDI emerged in the 1930s and 1940, but its implementation took time due to concerns about differentiating it from unemployment benefits and defining strict disability criteria, as well as a lack of attention to domestic policy during the years of World War II.
President Eisenhower signed the 1956 Amendments to the Social Security Act, which established the Social Security Disability Insurance (SSDI) program.
Initially, the program aimed to benefit disabled workers aged 50-65 who met specific insured status requirements. At first, the SSDI did not include benefits for the dependents of disabled workers or for individuals dealing with mental health issues.
The SSDI has since expanded to cover younger workers and a wider range of disabilities.
How SSA Defines Disabilities
Overview of the SSA’s Criteria for Disability
The SSA uses a specific definition of disability. Applicants must demonstrate that their condition significantly limits their ability to perform basic work activities. The evaluation process is thorough and involves multiple stages to ensure that only those who genuinely cannot work receive benefits.
The Five-Step Evaluation Process
- Substantial Gainful Activity (SGA): If you work and your earnings average more than a certain amount each month, you generally will not be considered disabled.
- Severity of Condition: Your condition must significantly limit your ability to do basic work activities.
- Listed Impairments: Your condition must meet or equal one of the SSA’s listed impairments.
- Past Work: The SSA evaluates if you can perform work you did in the past.
- Other Work: If you cannot perform past work, the SSA considers whether you can do any other type of work.
Read through our in-depth guide to the five-step evaluation process for a more detailed breakdown of each step.
Types of Disabilities Recognized by SSA
The SSA recognizes a wide range of impairments that can significantly diminish one’s ability to work. The disabilities encompass physical, mental, sensory, and chronic conditions.
Understanding the types of disabilities that qualify for SSDI benefits can help you determine your eligibility and prepare your application accordingly.
- Physical Disabilities: Musculoskeletal disorders (e.g., back injuries, arthritis), cardiovascular conditions (e.g., heart disease, chronic heart failure), respiratory disorders (e.g., asthma, COPD), neurological disorders (e.g., epilepsy, multiple sclerosis).
- Mental Disorders: Mood disorders (e.g., depression, bipolar disorder), anxiety disorders (e.g., PTSD, OCD), intellectual disabilities (e.g., Down syndrome), psychotic disorders (e.g., schizophrenia).
- Sensory and Speech Disorders: Vision impairments (e.g., blindness), hearing impairments (e.g., deafness), speech and language disorders.
- Chronic Illnesses: Autoimmune diseases (e.g., lupus, rheumatoid arthritis), cancer, diabetes.
Special Considerations on SSA Disability Criteria
Certain groups, such as children and veterans, have unique considerations when applying for SSDI. These special considerations address their distinct needs and circumstances and make sure they receive the proper evaluations and benefits.
Children with Disabilities
Children under 18 can qualify for Supplemental Security Income (SSI) benefits if they meet the SSA’s definition of disability for children, which involves separate criteria focusing on the child’s functional limitations compared to their peers.
Veterans with Disabilities
Veterans may qualify for SSDI based on their military service and the severity of their disability. The SSA collaborates with the Department of Veterans Affairs (VA) to expedite claims for veterans with a 100% permanent and total disability rating.
Temporary vs. Permanent Disabilities
Disabilities can be temporary or permanent, each with different implications for SSDI eligibility.
- Temporary Disabilities: Expected to improve over time and treatment (e.g., fractures, post-surgical recovery).
- Permanent Disabilities: Long-lasting or lifelong conditions that severely limit one’s ability to work (e.g., chronic pain, severe mental illness, progressive diseases like Parkinson’s disease).
How SSA Reviews Disability Status
The SSA conducts regular reviews to assess whether SSDI beneficiaries continue to meet the disability criteria. This process ensures that only those who remain unable to work due to their disability receive benefits. Understanding how and when these reviews occur can help beneficiaries maintain their eligibility and be prepared for reassessments.
Periodic Disability Reviews
The SSA conducts periodic reviews to determine if beneficiaries still meet the disability criteria. The frequency of these reviews depends on the likelihood of improvement in the condition.
Factors That Trigger a Review
- Scheduled Reviews: Based on the expected improvement timeline.
- Work Activity: If the SSA receives information that the beneficiary has returned to work.
- Medical Improvement: If there is evidence of significant improvement in the medical condition.
Process and Outcomes of a Review
The review process involves updating medical information, evaluating current work activity, and reassessing the severity of the condition. Outcomes can include continuation of benefits, termination of benefits, or a determination that the individual can work with certain limitations.
Understanding how the SSA defines disabilities is essential for a successful SSDI application. By familiarizing yourself with the SSA’s criteria and evaluation process, you can better prepare your application and increase your chances of approval.
Learn More about the SSDI Application Process
For more information and help from a professional team, reach out to Trajector Disability, or read “The Beginner’s Guide to Disability Benefits”. Our exclusive guide includes information on different programs, eligibility, how to apply, and more.
Frequently Asked Questions (FAQ):
Mental and Cognitive Impairments
How does the SSA evaluate mental health conditions for disability? The SSA considers the symptoms, limitations, and functional impairments caused by mental health conditions. Psychological assessments and medical records are crucial for evaluation.
What if my cognitive impairments affect my ability to understand the application process? You may qualify for additional assistance if you need help understanding the application process. Contact your local Social Security office to inquire about available support services.
Children with Disabilities:
How does the SSA determine disability for children? The SSA uses different criteria for children under 18. The focus is on functional limitations compared to children of the same age.
What evidence is needed to establish a child’s disability? Medical records, school reports, and statements from parents, teachers, and healthcare providers are essential for evaluating a child’s disability.
Additional Questions
Can I get disability benefits if I have a combination of impairments?
Yes, the SSA considers the combined effect of all your impairments when making a disability determination.
How often are disability benefits reviewed?
The frequency of reviews depends on the type of impairment. Some conditions require more frequent reviews than others.
