What Social Security Disability and SSI Cases Win?

Here’s what it takes to build a winning Social Security disability case.

By , Attorney
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Generally, it's not the name of your particular medical condition that matters in a Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability case, but whether or not your condition is severe enough to keep you from working. Social Security provides three ways to win your disability case:

  • meet or equal the requirements of an impairment listing
  • demonstrate that your condition significantly affects your ability to function, or
  • prove that you qualify under Social Security's grid rules (see below).

Almost half of all disability applicants who are eventually approved for benefits don't meet an impairment listing (48% of SSDI cases and 45% of SSI cases). Instead, they won their disability cases because Social Security considered their limitations and work histories, and sometimes their age and education, to determine that they could no longer work.

Here's what it takes to build the kind of Social Security disability case that can win.

Is Your Impairment a Listed Medical Condition?

Social Security's listing of impairments (called the Blue Book) sets out over 200 medical conditions and illnesses with criteria for automatically qualifying for disability benefits. Social Security uses the listings to fast-track some disability cases.

If you meet the specific requirements in an impairment listing, the determination process ends—your SSDI or SSI disability case is approved on the spot. For SSDI, in a recent year (2020), 46% of applicants who were approved for benefits met the requirements of a listed impairment directly. And in winning SSI disability cases, in a recent year (2021), 50% of applicants met the requirements of a listing.

But not every serious impairment is listed in the Blue Book. And the listing criteria can be tough to meet.

When Serious Conditions Might Not Meet a Listing

It's possible to have a serious health condition that's listed in the Blue Book and still not win your SSI or SSDI case because your condition doesn't meet the strict requirements of the listing.

Here's an example: Myocardial infarctions, commonly referred to as heart attacks, are covered in Social Security's cardiovascular impairment listings. One of the most common causes of heart attacks is coronary artery disease, which is listed in the Blue Book (listing 4.04).

Let's suppose you have coronary artery disease (plaque buildup in the wall of the arteries that limits the supply of blood to your heart). Even if you've had a heart attack and one or two coronary artery bypasses, your condition might not meet the requirements of the listing. That's because the listing for coronary artery disease requires that after surgery, you continue to have:

  • specific abnormal stress test results
  • ischemic episodes, or
  • abnormal imaging results.

But just because your condition doesn't meet the requirements of a listing—or isn't on the list—it doesn't mean you can't win your disability case.

Does Your Condition Equal a Listing?

If your condition is listed in the Blue Book but doesn't meet the requirements of the listing, or it's similar to a listing but not exactly the same, you still could win your disability case by "equaling a listing." There are three ways your condition could equal a listing under Social Security rules. You can equal a listing if:

  • your impairment doesn't meet the listing requirements, but you have related medical issues of equal "medical value" to the requirements in the listing
  • your condition isn't listed, but your limitations are as severe as those found in a similar condition that is listed, or
  • you have multiple impairments that don't meet a listing individually, but their combined effect medically equals impairments found in a similar listing. (Learn more about Social Security disability cases based on multiple impairments.)

To win a disability case by equaling a listing, you'll need to tell Social Security exactly how your impairments equal a listing in both duration and severity. And you'll need to back up your arguments with convincing medical evidence, like a written statement from your doctor explaining in detail why your condition equals a specific listing and the medical basis for that opinion. It's not an easy thing to do on your own; only about 5% of approvals are based on equaling a listing.

Can You Win Your Case If Your Condition Doesn't Meet or Equal a Listing?

If you don't meet or equal a listing, Social Security will consider the effect your medical condition has on your ability to perform daily tasks and to work—called your "functional limitations." To win your disability case based on functional limitations, you'll need to show that your impairment significantly limits your ability to perform the physical and/or mental tasks needed to work full-time.

How Your Functional Capacity Affects Your Disability Case

Social Security will look at the level of exertion you're capable of and any physical restrictions you have. The agency will use that information to determine your "residual functional capacity" (RFC). Your RFC is a rating for the kind of work you're still able to do (medium, light, or sedentary) despite the limitations caused by your medical condition.

Exertional restrictions. Social Security will use an RFC form to rate your ability to perform normal daily activities such as:

  • sitting
  • standing and walking
  • pushing and pulling, and
  • lifting and carrying objects.

Social Security will rate your abilities in these areas based on how long you can stand or walk or how much weight you can lift or carry. For instance, if you suffer from a back condition like degenerative disc disease or spondylolisthesis, your doctor might say you can't work on your feet for more than an hour at a time, and you can't lift or carry more than 10 pounds. You might even have restrictions on how long you could sit at a desk—say, your doctor says you can only be expected to sit in one place for a half hour or less.

With these restrictions, Social Security should give you an RFC of "less than sedentary" (meaning you can't be expected to do even sedentary work). If you can't do even sedentary work, you would qualify for disability benefits.

But if you can stand for a couple of hours a day, sit at a desk without issues, and lift and carry 10 pounds most of the time and 20 pounds occasionally, you'd get an RFC of light work. You're not likely to win your disability case if you can do light work (unless you are over 50 or 55—more on this below).

Non-exertional restrictions. Social Security will also look at any other physical restrictions that affect your ability to work, like the following:

  • manipulative limitations (using your hands and fingers to reach, grasp, or move objects)
  • postural limitations (bending, stooping, or crouching)
  • sensory limitations (seeing, speaking, or hearing), and
  • environmental limitations (things that would aggravate some conditions by exposure to them, like dust, fumes, or extreme temperatures).

Social Security must consider the combined impact of all of your functional limitations—both exertional and non-exertional limitations—to determine if there are any jobs that exist in the U.S. that you can do. For instance, if you have an RFC for light work, but you can't use your fingers to grasp objects, you might still qualify for SSI or SSDI benefits.

Disability Cases Based on Mental or Cognitive RFC

For SSI and SSDI cases based on mental or cognitive impairments, Social Security must consider how your symptoms limit what you can do and assign you a mental RFC. Your mental RFC will focus on your ability to perform the mental, psychological, emotional, and cognitive activities needed to do your past jobs or any other kind of work.

Social Security will examine the medical evidence, including any consultative exams or cognitive (IQ) tests you've had, and rate your mental capacity in several areas needed for intellectual and social functioning. Social Security will consider your ability to:

  • understand and remember instructions
  • function socially
  • concentrate, persist in a task, and work at a reasonable pace, and
  • respond to and deal with normal work pressures and stresses ("adaptation").

Based on these capabilities, your RFC will include the type of work Social Security believes you can do (skilled, semi-skilled, or unskilled), if any, as well as limitations you have in handling stress or dealing with the public.

If you're under age 50, Social Security will only find you disabled based on a mental RFC if you can't do low-stress, unskilled work with little contact with the public.

Other Factors That Affect Your Ability to Work

If you're over age 50, Social Security will consider additional factors when determining if there's any kind of work you can still do, including:

  • your age
  • your education
  • the kind of work you've done in the past, and
  • whether you have any transferable job skills.

Social Security uses guidelines called the "medical-vocational grid rules" to determine if, given all these factors, there's any kind of work you can be expected to do.

Because of the grid rules, it's often easier for older applicants to win their disability cases based on their functional limitations, age, and job history rather than by meeting or equaling a disability listing. For instance, if Social Security says you can do sedentary work, but you're over 55, have an 11th-grade education, and have only worked heavy jobs (like a longshoreman or miner), you'll likely win your SSI or SSDI case. But if you're 45 years old, have a college education, and work history as a computer programmer, a sedentary RFC won't qualify you for disability benefits.

What Factors Win Social Security Disability Cases?

There are several factors that go into a winning disability case. First and foremost, you must be able to demonstrate that you have a medical condition that makes you unable to work. You'll need a medical diagnosis (of a recognized condition) from a qualified doctor or psychologist, preferably a specialist, who can explain how your symptoms make you unable to work.

1. Good Medical Records Are the Backbone of Strong Disability Cases

The disability cases that win are the ones that are better documented—meaning they have recent and detailed medical records that prove a serious medical condition using accepted tests and diagnostic techniques. For instance, if you have cancer, Social Security will want to see:

  • diagnostic evidence (blood tests, biopsies, imaging tests)
  • any treatment you've had (chemotherapy, surgery, radiation therapy), and
  • how the cancer (or any side effect of cancer treatment) has limited your ability to function.

It's harder to win your case if you haven't been to a doctor recently. For many conditions, Social Security will require medical records from the last six months, and sometimes the last three or four months.

2. Having Your Doctor's Support Helps Your Disability Claim

It's extremely helpful to your disability case if your doctor supports your claim. If your doctor has been treating you for a long time or is a specialist in the field of medicine covering your impairment (like an oncologist treating a cancer patient), the doctor's opinion will carry more weight. And Social Security will take the opinion of your doctor more seriously if that opinion is backed up by medical evidence (more on this below).

Having a doctor fill out an RFC form for you—or something similar that sets out your limitations—is probably the single most important document you have at your disposal to win your disability case.

(Learn about what it takes to win disability when you don't have your doctor's support.)

3. Social Security Requires Functional Medical Evidence

Social Security bases disability decisions on "functional" medical evidence. Examples of good functional evidence would include:

  • results of a straight-leg test (for back problems)
  • results of an exercise stress test (for heart problems)
  • evidence that you can't stand up from a seated position or balance while standing
  • results of laboratory tests or x-rays
  • results of intelligence or memory tests, or
  • clinical psychiatric notes.

In most cases, statements from employers, relatives, and friends, have limited value. But detailed, supporting statements from your doctor(s) about your limitations are considered functional medical evidence.

Social Security will give your doctor's statements a lot of weight as long as the statements point out exactly why you're disabled—what your symptoms are and how they cause your limitations. Your doctor should point out which medical evidence is tied to which limitations on your RFC form.

4. A History of Frequent Hospitalizations Strengthens Your Case

Hospital records are another form of functional medical evidence. You can strengthen your disability case if you can show you have a history of frequent trips to the hospital for conditions like:

Be sure to include records of hospitalizations or any procedures or surgeries you had to treat your disabling condition. The more often you had to spend time in the hospital and the longer your hospitalizations lasted, the more likely you are to win your disability case.

5. A Consultative Exam Report Can Confirm Your Limitations

While considering your disability claim, Social Security might require you to have a consultative exam (CE) with a Social Security doctor. Social Security will often require a CE if you haven't seen a doctor in more than six months, or if the agency wants you to have a medical test you haven't had recently.

Often, consultative exam reports aren't very supportive of disability claims. But if the doctor or psychologist who performs the CE confirms your medical condition and the limitations it causes, that can only help your disability case.

6. Older Age and a Lack of Job Skills Will Help Your Disability Case

Although you can qualify for SSDI or SSI disability benefits at any age, the older you are, the more likely you are to win your disability case. Social Security's medical-vocational grid rules favor disability applicants between 50 years old and full retirement age.

If you're over 50 and your condition doesn't meet a listing, the agency will consider what job skills you have. Social Security assumes that the older you are, the less likely you are to be able to adjust to doing a new kind of work or learn new job skills—making winning your disability case more likely.

7. The Longer Your Impairment Has Lasted, the More Likely You'll Be Approved

Can you meet Social Security's durational requirement? To get SSDI or SSI disability benefits, your impairment must have lasted (or be expected to last) at least a year, or until your death. Although you can file your disability case at any time (including right after you first became disabled), Social Security must expect that your disability will last at least 12 months or your claim will be denied. If your disability started over nine months ago, you're more likely to get approved for benefits.

Survey Results on Which Disability Cases Win

Martindale-Nolo surveyed readers who had won and lost their disability cases and analyzed the factors that helped them win or lose cases. The results supported the idea that going to the doctor was key to winning disability. The survey also found other factors that indicated better odds of winning an SSDI or SSI case, including:

The survey also analyzed how age, gender, and type of benefit (SSDI or SSI) affected the success of a disability case. Learn more about what the survey statistics indicate are the types of cases most likely to be approved for disability benefits.

Updated October 13, 2022

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