What Social Security Disability and SSI Cases Win?

It's hard to say which cases (or impairments) generally win disability benefits, but here are the factors that matter.

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It isn't possible to say that a particular medical condition is more likely to win disability benefits than another (except for maybe a heart, liver, or kidney transplant--they're shoe-ins). But generally, it's not the name of your condition that matters, but what functional limitations the condition causes you.

Does My Condition Have to Be in the Blue Book?

Many people think that medical conditions listed in the "blue book" are the ones that win people disability benefits most often. But that's not true.

Listed Conditions

The Social Security Administration (SSA) has a list of impairments with criteria for automatically qualifying for disability benefits. But not every medical condition is listed in the manual and, of the ones that are, the requirements are fairly tough to meet. Here's an example. Myocardial infarctions, commonly referred to as heart attacks, are discussed in the SSA's manual of impairment listings. But if you've had one heart attack and one "cabbage" (CABG - coronary artery bypass graft), you probably won't be approved for disability benefits based on this listing. In fact, if you've suffered a heart attack and had to have a CABG X 2 (that is, two main arteries bypassed and grafted), the odds are still good that you won't be approved. That's because the listing for coronary artery disease requires that you continue to have specific abnormal stress test results, ischemic episodes, or abnormal imaging results post-surgery.

What the Listings Are For

Not having a condition that's on the list -- or not having a condition that meets the required severity of a condition on the list -- doesn't mean you won't get disability benefits. In fact, most people who receive SSDI and SSI don't have a condition that matches the requirements of an impairment on the SSA's listing. The impairments in the blue book, as specified, represent only the most severe disabilities, and is simply a way for the SSA to fast-track some obvious disability determinations: If someone meets the specific two or three requirements in an impairment listing, the claims examiner at the SSA doesn't even have to consider how the impairment affects the applicant's ability to work--the applicant is simply approved on the spot. But as I said, most applicants don't win benefits by matching an impairment listing.

What Factors Win a Disability Case?

The truth is, potentially any disability case can win, because the SSA is mainly concerned with the effect a claimant's medical condition has on a claimant's ability to work. 

Good Medical Records

Cases that win tend to be the cases that are better documented. I'm talking, of course, about good medical records. It's almost unfathomable, but I saw it all the time in my job as claims examiner: claimants are anxious to win Social Security Disability benefits, but they haven't been to a doctor in months, or don't go to their doctor but once every four months. It is almost impossible to win a disability case with medical treatment so infrequent. How can you have good medical records with sufficient documentation of your symptoms and limitations if you don't go to the doctor?

Functional Medical Evidence

What disability claimants need to know and realize is thisthe SSA bases its decisions on functional medical evidence. In most cases, statements from employers, relatives, and so on, are practically worthless. Supporting statements from physicians do count as functional medical evidence, as long as the statements point out to the disability claims examiner (or the judge in the case) exactly why the claimant is disabled. For this reason, a doctor's statement must be detailed, preferably in the form of an RFC form. The RFC (residual functional capacity) form is probably the single most important document you have at your disposal to win your disability case.

Learn more about the importance of your residual functional capacity.

Written by: Tim Moore, former Social Security disability claims examiner

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