Despite what you might hear, the Social Security Administration (SSA) uses an objective system to qualify individuals for Social Security disability benefits. The Social Security field office that receives your application first checks to make sure you're financially eligible for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) benefits and that you aren't doing a substantial amount of work.
If you meet these non-medical requirements, Social Security then forwards your application to Disability Determination Services (DDS), a state agency. DDS determines whether your medical condition is severe enough to qualify you for benefits.
DDS follows a step-by-step evaluation process to determine if you're medically eligible for benefits. The process has four parts. In this order, the DDS claims examiner will determine the following:
Social Security and DDS have a list of the approval criteria for certain impairments, nicknamed the "Blue Book." Most serious medical impairments are listed in the blue book along with the specific criteria, or qualifications, your condition must meet to be automatically approved for disability benefits.
For example, if you have congestive heart failure (CHF), the DDS disability examiner reviewing your case would check the manual of impairment listings against your medical evidence to see if your condition meets the listed requirements for heart failure (for example, systolic failure with an ejection fraction of 30% or diastolic failure with an enlarged left atrium). If your condition matches the listing, you will medically qualify for Social Security disability.
If your medical condition doesn't match exactly, you can argue that your symptoms are "equivalent" to the requirements of a disability listing and, as such, should qualify you for benefits.
Learn more about getting approved based on a disability listing.
Not every condition is listed in the blue book. Fibromyalgia, for example, isn't in the blue book. Nor is irritable bowel syndrome, adult diabetes, carpal tunnel syndrome, or a variety of other problems. This doesn't mean you can't get disability benefits for these conditions.
How can you medically qualify for Social Security disability if your particular problems aren't covered in the disability listings? That depends on whether the disability applicant is an adult or a child.
If you're an adult and your condition doesn't meet or equal the requirements of a listing, you can get what's called a medical-vocational allowance (or "med-voc allowance"). A med-voc allowance is how most people get approved for Social Security disability.
If a child's condition doesn't meet the requirements of a specific medical listing, the child could still be found disabled if their condition can be considered "functionally equivalent" to the listings. For more information, see our article on how a child can qualify for SSI disability based on functional equivalence.
This is how a medical-vocational allowance works. DDS looks at your medical records and prepares an RFC (residual functional capacity) assessment, which indicates how much you can do and includes your "exertional limits." Exertional limits include things like:
The RFC assessment will indicate whether you're capable of doing only sedentary work, light work, or medium work.
After DDS finishes the RFC assessment, the agency will gauge whether or not you can return to your past work, based on your RFC limitations. For example, if your RFC says you can't do more than light work, and your past work was at the medium exertion level (that is, the job required being able to lift 50 lbs occasionally and 25 lbs frequently), then Social Security can't reasonably expect you to return to your past work.
DDS finds that most people who apply for Social Security disability benefits can't return to their past work. In other words, not being able to do your past work isn't usually the reason an applicant is denied Social Security disability. (If you are denied on this basis, learn what you need to do to prove you can't do your past jobs.)
The final step in the process is determining whether you can do "other work." If you have a physical impairment, the DDS examiner first looks at the medical-vocational guidelines, called the "grids," or "grid rules." DDS uses these rules to determine if you're disabled based on the combination of:
If the grid rules say you're disabled. If you're over 50 and your situation matches the particular vocational factors of a grid rule, DDS could find that you're disabled right away. The claims examiner won't even evaluate whether your limitations actually prevent you from doing any type of job.
For instance, someone who's 59 years old, has a sedentary or light RFC, and who's only done unskilled work would automatically be found disabled. Read about the grid rules to find out whether there's one that applies to your age and work history.
If the grid rules are silent. If there's no grid rule for your particular situation, the DDS examiner will investigate whether there are other forms of less demanding work that you might be able to switch to. For the DDS to say you can do another type of work, it has to be work that you're physically capable of doing. And if it's skilled work, it must be work that your particular job skills will transfer to.
For example, if you used to do a skilled mechanic-type job that required medium exertion, but now, because of your medical condition, the examiner gives you an RFC for only light work, the examiner will try to find other light work you could do, like a mechanic job that involves less lifting and is classified as light exertion (such as "brake adjuster").
When the claims examiner looks for other jobs you can do, the examiner uses a huge volume called the Dictionary of Occupational Titles that lists thousands of jobs, including many that might not exist in your area. The claims examiner might also consult with a vocational expert (VE) for help.
DDS will usually find that there's some other type of job you can do that's within your limitations—it's called "sending you to other work," and it's the reason given when most people are denied Social Security disability benefits. (When DDS "sends you" to an "other work" job, that doesn't mean that DDS actually sends you anywhere. That's just the terminology used to describe the process DDS uses to turn you down for benefits by saying that you're capable of doing another job.)
To successfully appeal a denial on this basis, you'll need to prove that you can't do "other work." Learn more about how to prove to Social Security that you can't do other jobs.
If the grids say you're not disabled. If a grid rule says that you're not disabled, you'll need to show that the rule doesn't apply to your situation (and the reasons why they don't). For more information, see our section on the grid rules.
People in their fifties usually have an easier time getting approved for this reason: Social Security doesn't commonly expect individuals in their fifties to be able to learn a new job as easily as a younger person might. This is especially true for older people without much formal education.
So, for this kind of disability applicant, it's less likely that they'll be "sent" to other work. The grids have different rules that apply to those over age 60, age 55-59, age 50-54, and under age 50, and the grids direct a finding of disabled much more often in the rules for those over 55 and 60.
Learn more in general about how Social Security decides if you can work.
DDS goes through a similar process if you file for disability due to cognitive, emotional, psychiatric, or psychological impairment. First, the examiner looks to see if your condition meets or equals a listing, and then the examiner assesses whether you can function well enough to do your previous job or any other work. (Learn more about getting disability for mental, emotional, or psychological impairments.)
For someone with emotional or mental problems, such as depression, anxiety, or learning problems, the disability examiner will sometimes find that the applicant is incapable of performing SRRTs. These are "simple, routine, repetitive tasks."
If you're found to be incapable of SRRTs, Disability Determination Services will have trouble sending you to "other work." So, if you have depression, anxiety, or any other "mental" impairment in addition to your physical problems, get this condition documented: Be seen by a psychiatrist or a psychologist. In some cases, a mental condition in addition to physical impairments can help you get your disability claim approved. (Learn more about how moderate mental illness can help you get disability benefits.)
Return to our series of articles on the Medical Eligibility Rules for Social Security Disability.
Updated August 31, 2022