What types of conditions are covered by Social Security Disability benefits?
In establishing eligibility for Social Security Disability (SSD) or Supplemental Security Income (SSI) benefits, the Social Security Act defines “disability” as a physical or mental impairment that prohibits substantial gainful activity (i.e., work) and has lasted or is expected to last for at least 12 months or result in death.
Disability evaluation for SSD or SSI benefits is a long, complicated process that involves multiple agencies and medical professionals, and sometimes an administrative law judge should a rejected claim be appealed. Disability lawyer Michael Hartup has an extensive record of success helping disabled workers from Tennessee and Kentucky recover the Social Security benefits they need.
If you need help filing a Social Security Disability claim or appealing a denied claim, please call The Law Offices of Michael Hartup in Jackson, Tennessee, at 731-513-5282 or in Paducah, Kentucky, at 270-366-0223 to arrange your free consultation. You can also contact us online to tell us your story now.
Disabilities Covered by Social Security Benefits
The disability evaluation process follows strict criteria to determine an applicant’s eligibility. If you live in the Paducah, Kentucky, or Jackson, Tennessee, areas and have questions about whether you qualify for SSD or SSI benefits, disability attorney Michael Hartup can discuss your individual situation with you and help you understand your options through a no-obligation consultation. While it is not necessary to retain a lawyer to file or appeal a disability benefits claim, working with a knowledgeable attorney can improve your chances for benefits approval upon your initial application or appeal.
Following is a list of impairment categories currently covered under SSD and SSI.
Musculoskeletal System Disorders
Musculoskeletal disorders affect muscles, bones, and joints. In order to qualify for benefits, the disorder must cause “major dysfunction,” although, the disorder itself may result from any cause (such as hereditary, congenital, developmental events, repetitive trauma, etc.).
Eligible disorders under this category include but are not limited to:
- Spine disorders (degenerative disc disease, osteoarthritis, vertebral fracture, etc.)
- Major fractures (such as to the femur, tibia, pelvis, or one or more of the tarsal bones)
- Soft tissue injury (such as burns)
Special Senses and Speech Disorders
This category covers vision, speech, and auditory impairments. Eligible disorders include:
- Loss of central visual acuity (the remaining vision in the better eye is 20/200 or less)
- Loss of speech (due to any cause)
- Hearing loss (with and without implantation devices)
Respiratory disorders are evaluated based on obstruction, restriction, or interference of air moving in or out of the lungs, or deficiencies in gas exchange. This category also covers respiratory failure; for example, lung transplantation resulting from a previous respiratory disorder.
Eligible respiratory disorders include:
- Chronic bronchitis or asthma
- Hereditary disorders (such as cystic fibrosis)
- Chronic pulmonary hypertension (due to any cause)
- Lung transplant
- Respiratory failure that requires invasive or noninvasive mechanical ventilation for an extended period of time
Cardiovascular System Disorders
This is a broad category covering heart function and the circulatory system, which includes arteries, veins, capillaries, and lymphatic drainage.
Eligible disorders include:
- Chronic heart failure (must include both systolic and diastolic failures to qualify)
- Ischemic heart disease (reduced blood flow to the heart)
- Coronary artery disease
- Recurrent arrhythmias (deviations from normal rhythm or beating of the heart)
- Heart transplant
Digestive System Disorders
This category includes gastrointestinal hemorrhage, liver dysfunction, inflammatory bowel disease (IBD), short bowel syndrome (SBS), and malnutrition. Documentation of these disorders requires specific medical evidence such as imaging studies or reports of endoscopy, operations, and/or pathology, depending on the condition.
Eligible digestive disorders include:
- Gastrointestinal hemorrhaging (from any cause, but must require blood transfusion)
- Chronic liver disease or liver transplant
- Inflammatory bowel disease
- Short bowel syndrome
- Weight loss due to any digestive disorder (BMI of less than 17.5 percent)
Genitourinary refers to the urinary and genital organs. Genitourinary system disorders range from those that are asymptomatic to those that manifest an array of signs and symptoms. Again, specific documentation or evidence is required to meet the criteria outlined by the Social Security Administration.
Eligible genitourinary disorders include:
- Chronic kidney disease
- Kidney transplant
- Nephrotic syndrome (kidney disorder)
These disorders disrupt the normal function of white blood cells, red blood cells, platelets, and the proteins involved in bleeding and clotting. Disability evaluations in this category include nonmalignant hematological disorders; cancers such as lymphoma and leukemia are recognized in the Cancer (Malignant Neoplastic Disease) category.
Eligible disorders in this category include:
- Hemolytic anemias (such as sickle cell disease and thalassemia)
- Thrombosis and hemostasis
- Bone marrow failure and/or transplant
- Stem cell transplant
- Complications resulting from hematological disorders
Skin disorders are evaluated based on extent of skin lesions, the frequency they occur, how symptoms limit a person’s ability, and available treatment. In most cases, the skin disorder must persist for at least three months despite treatment or medication.
Eligible skin disorders include:
- Ichthyosis (dry, scaly, or thickened skin)
- Bullous disease (large, fluid-filled blisters)
- Chronic infections of the skin or mucous membranes
- Dermatitis (skin inflammation)
- Genetic photosensitivity disorders (such as xeroderma pigmentosum, a disorder that prohibits a person from healing after exposure to the sun or ultraviolet light)
- Burns (burn-related skin lesions expected to last no less than 12 months)
The endocrine system includes the pituitary, thyroid, parathyroid, adrenal, and pancreas. This system is responsible for producing and managing hormonal levels in the body.
The SSA does not evaluate endocrine disorders directly; rather, most endocrine disorders are evaluated in other categories since they typically result in complications in other body systems. For example, gland disorders such as pituitary hypofunction impacts a body’s ability to manage water and electrolytes, which can cause complications to the kidneys. This endocrine disorder is evaluated in the Genitourinary Disorders category.
Congenital disorders are often inherited and occur at or before childbirth (examples include congenital heart disease, Down syndrome, and spina bifida); however, only congenital disorders that affect multiple body systems (like non-mosaic Down syndrome) are evaluated in this category.
Non-mosaic Down syndrome is a genetic disorder distinguished by three identical copies of chromosome number 21 in all body cells. Those with non-mosaic Down syndrome often suffer congenital heart disease, audio and vision impairments, as well as intellectual disabilities. Those with non-mosaic Down syndrome are considered disabled at birth.
Neurological disorders affect the nervous system, which is responsible for sending and receiving messages throughout the brain and body. In this category, the “limitations resulting from the neurological disease itself” are evaluated; both medical and non-medical evidence is used in the evaluation process.
In most cases, limitations caused by a neurological disorder must exist despite treatment and/or medication and result in a “disorganization of motor function” (the inability to stand, balance, or use the upper extremities like hands, fingers, or arms).
Eligible disorders in this category include:
- Benign brain tumors
- Parkinsonian syndrome
- Cerebral palsy
- Multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS)
- Muscular dystrophy
- Traumatic brain injury (TBI)
- Coma or persistent vegetative state
Mental disorders represent the largest population of beneficiaries collecting Social Security Disability benefits.
There are currently 11 categories for mental disorders:
- Psychotic disorders: characterized by delusions or hallucinations or catatonic behavior (such as schizophrenia)
- Depressive disorders: this includes clinical depression, bipolar disorder, and other mood-related disorders
- Intellectual disorders: significant deficit to intellectual functioning and historically known as “mental retardation”
- Anxiety or obsessive-compulsive disorder (OCD): includes social anxiety disorder (SAD), panic disorder, agoraphobia, etc.
- Somatic symptom disorder: extreme anxiety about physical symptoms like pain
- Personality and impulse-control disorders: characterized by repetitive, rigid and pervasive behavior patterns that interrupt daily life and activities (including paranoia, schizoid, dependency, etc.)
- Neurocognitive disorders: degenerative disorders that cause significant decline in cognitive functioning (e.g., dementia, Alzheimer’s disease, Huntington disease, etc.)
- Autism: the entire autism spectrum is considered in this category
- Neurodevelopmental disorders: these disorders generally appear during the developmental period and include abnormalities in cognitive processing, visual perception, or memory (e.g., tic disorders like Tourette syndrome)
- Eating disorders (including anorexia nervosa, bulimia nervosa, and binge-eating disorder)
- Stress- or trauma-related disorders: these disorders are caused by exposure to a significantly dramatic or stressful event and may result in disturbing memories, dreams, or flashbacks (such as post-traumatic stress disorder, or PTSD)
Cancer (Malignant Neoplastic Diseases)
Cancers are evaluated based on: the origin of the cancer; the extent of involvement; cancer treatments; and the effects of any post-therapeutic residuals. Evaluations are made on a case-by-case basis because therapies and conditions vary widely.
Eligible forms of cancer may include but are not limited to:
- Breast cancer
- Brain and spinal cord cancers
- Prostate cancer
Click here for a full list of cancers evaluated by the Social Security Administration.
Immune System Disorders
These disorders cause dysfunction in one or more components of the immune system. Immune disorders often result in recurrent infections, inflammation, and/or dysfunction in specific body organs.
There are three categories of immune system disorders: autoimmune disorders; immune deficiency disorders; and human immunodeficiency virus (HIV) infection.
Eligible disorders immune system disorders include:
- Systemic lupus erythematosus (inflammatory disease)
- Systemic sclerosis or scleroderma (hardening of skin and soft tissues)
- Meningitis (inflammation of the brain and spinal cord membranes)
- Inflammatory arthritis
- Sjögren’s syndrome (chronic dry eyes and mouth)
Children and Disability Benefits
Children are eligible to receive cash payments for disabilities under the SSI program. The eligibility criteria for children includes financial benchmarks based on the income of the parents or legal guardians, and medical standards regarding the child’s disability or impairment.
Click here for a complete list of child impairment listings covered by SSI.
Contact an Experienced Disability Lawyer
Again, you are not required to work with an attorney to apply for Social Security Disability benefits or appeal a denied claim. But many disabled individuals who otherwise qualify for benefits have their initial applications rejected due to improperly filled out documentation or incomplete medical records.
Disability lawyer Michael Hartup devotes his entire practice to helping disabled individuals from Tennessee and Kentucky. He can guide you through this complicated process to get the benefits you need.
If you need assistance applying for SSD or SSI benefits, or appealing a denied application, please call our Jackson, Tennessee, office at 731-513-5282 or our Paducah, Kentucky, office at 270-366-0223. You can also contact us online to get started now.