Can Certain Medical Conditions Get You Approved for Disability Automatically?

How do I find out if I'll automatically be eligible for disability? Are there certain illnesses and diseases that are guaranteed to be approved?

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Are certain medical conditions automatically approved for disability? The answer to this question is yes and no. Even for medical conditions that automatically qualify for disability (and there are only a few), there are financial or legal requirements that need to be met before someone gets approved for disability.

Are There Automatic Qualifications for Social Security Disability?

The Social Security Administration (SSA) maintains a list of medical conditions that they consider severe enough to prevent a person from working. If you have one of these conditions, the SSA will automatically approve you (medically) for benefits without looking at your actual limitations. You can get automatically disability by having a condition on the Compassionate Allowances List or on Social Security's Blue Book list.

Compassionate Allowances List

For very severe illnesses or injuries, such as Stage IV breast cancer, Social Security keeps a list of over 200 conditions called the "Compassionate Allowances List." Some of these conditions are so serious that a simple diagnosis of the condition from a doctor automatically qualifies the applicant for disability benefits.

The conditions on the Compassionate Allowances list that only require proof of diagnosis include:

  • Lou Gehrig's disease (ALS)
  • acute leukemia
  • early-onset Alzheimer's disease
  • gallbladder cancer
  • pancreatic cancer
  • small cell lung cancer
  • hepatocellular carcinoma (a type of liver cancer)
  • anaplastic thyroid carcinoma (a type of thyroid cancer), and
  • inflammatory breast cancer (IBC).

Social Security will expedite an application that claims one of these conditions so that a decision is possible within a month—the closest to automatic as Social Security gets.

Claims with other conditions on the Compassionate Allowances list will also be expedited, but they may require more medical evidence than a diagnosis. For instance, for any late-stage cancers not on the above list, Social Security will want to see pathology reports, operative notes, or summaries of hospitalization and medical reports showing that the cancer could not be completely removed or isn't a candidate for surgery.

For more information on the other conditions included on the list, see our article on Social Security's Compassionate Allowances.

The Blue Book's Listing of Impairments

Several medical conditions listed in Social Security's Blue Book can qualify as disabilities just with proof of their occurrence or existence. These include a recent:

  • liver transplant
  • kidney transplant
  • heart transplant
  • lung transplant, or
  • cochlear implant.

But for these "automatic disabilities," Social Security will reassess the patient's condition at the end of one year (three years for a lung transplant) to see if the patient still has disabling impairments.

Most of the other listed impairments in the Listing of Impairments, however, lay out certain criteria the applicant needs to meet before the condition will qualify as a disability. For instance, for chronic kidney disease to qualify as a disability, the patient needs to be undergoing chronic hemodialysis or peritoneal dialysis (or have reduced glomerular filtration), and for central blindness to qualify as a disability, the applicant needs to have 20/200 vision or worse in the better eye—with contacts or glasses on.

In addition, all mental disabilities in the Listing of Impairments require the applicant to have certain severe limitations to qualify as disabilities. (You can read more about the Listing of Impairments in our article on the "listed" disabilities).

What Are the Legal or Financial Requirements for Social Security Disability?

Before deciding whether you are medically disabled, the Social Security field office checks to see if you fulfill the non-medical requirements for the SSDI or SSI program. SSDI requires a number of years of work and SSI requires low enough income and assets, as well as citizenship or legal residency requirements. In addition, you can't be currently doing what Social Security considers a substantial amount of work (the field office will check to see if you are working above the SGA level). If your claim passes these tests, it will be sent to a claims examiner at Disability Determination Services (DDS).

If the claims examiner finds your medical record contains sufficient medical evidence to qualify you automatically for benefits, your file will be sent back to the field office to make sure that you're still eligible for SSDI or SSI and that you still aren't working above the SGA level. If this final check goes well, your file will be sent to a Social Security payment center and you'll be sent an award notice with an estimated date of when your payments will start (for SSDI, this will be after the five-month waiting period).

What Medical Records Are Required for Automatic Disability?

Just because some conditions are automatically approved doesn't mean that you don't need to submit comprehensive medical records laying out your diagnosis and prognosis.

If the claims examiner assigned to your claim at DDS doesn't receive all of the necessary medical records showing evidence of the diagnosis and any required supporting information (or if the doctor left out important information), the applicant may be denied benefits even though his or her condition is medically eligible for Social Security benefits. (In this case, Social Security's denial letter will include a rationale for why benefits were denied, and the applicant can appeal and submit the missing information.)

For more information, see our article on what conditions qualify for disability.

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