We surveyed readers across the U.S. who recently went through the process of applying for SSDI or SSI. Here's what we learned about how the nature of their medical problems affected the outcome of their claims.
Our survey shows that it's more difficult to receive benefits for some kinds of medical problems (known as "impairments") than others. There are several reasons for these differences, including how serious the diagnosis is, what doctors predict about its future course (its prognosis), and how hard it may be to prove that the impairment keeps you from working.
Obviously, there's a wide range of medical conditions that can make someone disabled. But relatively few impairments account for a significant portion of disability applications. The most common are back problems (22% of readers in our survey), followed by depression and other mood and anxiety disorders (16% of our readers). Survey results showed that these common impairments have lower-than-average approval rates.
About a third (34%) of readers with back and other spinal problems were approved (see our disability survey results on back conditions). Less than four in ten (37%) were approved for mood and anxiety disorders (note that other impairments in the category of mental disorders had higher approval rates; see our survey results on mental or emotional conditions).
For other common impairments, our survey showed that the likelihood of receiving benefits can vary widely depending on the nature of your medical problem—from a low of 40% for osteoarthritis and other joint diseases to highs of 68% for multiple sclerosis and 64% for all types of cancer. Less than half (47%) of readers with various types of respiratory problems were approved for benefits, but the rate was somewhat higher (50%) for those with serious disorders like chronic obstructive pulmonary disease (COPD) and emphysema.
When looking at these results, it's important to keep a few things in mind:
It's not surprising that some impairments are more likely to result in disability awards than others. Obviously, you can't do much to change your medical diagnosis in order to improve the outcome of your SSDI or SSI case. Still, there are steps you can take to tilt the odds in your favor, including requesting a hearing if your application is denied at first. Our survey showed that the average approval rate for readers with all types of impairments jumped from 23% at the initial stage to 46% at the hearing stage.
Government statistics (from 2007-2015) also show significantly higher approval rates after a hearing for the most common impairments, including MS (80%), chronic respiratory disorders (66%), osteoarthritis/osteoarthrosis and related disorders (64%), back disorders (63%), mood and anxiety disorders (59%), and non-arthritic joint disease (58%, which the government lists separately from osteoarthritis). A word of caution when considering this data: Approval rates at hearings may be somewhat lower in current cases. Because approvals in general declined over several years up to 2015, the rates from the end of that period would've been lower than the average over the entire nine years.
One reason for this increase in approval rates at the hearing stage is that by the time the hearing is scheduled, the applicant's condition has often gotten worse. This is especially true for progressive diseases like MS and in regions where it takes close to two years to get a hearing.
Another reason for the improved outcomes after a hearing may be that more people hire a lawyer at this point. In our survey, 71% of readers who went to a hearing were represented by an attorney. (Social Security statistics show a similar pattern of legal representation at the hearing stage.) Their lawyers would have made sure that the applicants visited the doctor within 60 days of the hearing date and underwent key tests to strengthen the medical evidence on file. Our survey supports this point: For all types of medical problems, 60% of readers who were represented by an attorney were approved for benefits, compared to 34% of those who didn't hire a lawyer. Experienced disability attorneys know the system, the rules, and even the tendencies of local judges. Their assistance can be critical. (For more details, see our survey statistics on the role of a disability attorney.)
Here are some additional approval statistics from Social Security (covering 2007-2015) on the approval rates after hearing for common primary impairments.
To Social Security claims examiners, medical consultants, and judges, a disability applicant's diagnosis is usually far less important than the severity of the functional limitations that the applicant's condition causes. (Examples of limitations are: not being able to stand for more than two hours, not being able to lift more than 20 pounds frequently, or not being able to interact with the public.)
According to Social Security data, in half of all approved disability claims, applicants received benefits only after the Social Security Administration performed a medical-vocational analysis, looking at the applicant's physical or mental limitations as well as age, work history, and education. In contrast, only 43% of applicants were approved for benefits because their diagnosis and medical condition met (or "equaled") the requirements of one of Social Security's impairment listings. (The impairment listings lay out the exact criteria and test results an applicant must have to be considered disabled automatically.)
Further, most of Social Security's listings now require the applicant to have specific limitations. For instance, for multiple sclerosis, an applicant has to prove he or she has a severe physical limitation such as the inability to stand up, balance, or use the arms effectively. Similarly, a psychiatric diagnosis alone is not enough to get disability for any mental, emotional, or cognitive disorder, even for a serious illness such as schizophrenia; functional limitations are required to prove disability.
So while some diagnoses are more likely to be approved for benefits than others, it's usually because the limitations associated with those impairments are severe. There are a few exceptions to this rule: several medical conditions can qualify for benefits based on a simple diagnosis alone; these include ALS, metastatic cancer, and recent organ transplants.