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Why You Must Understand Social Security’s Definition of Disability Before You Apply for Benefits

If you are struggling with chronic medical problems, you may be thinking about applying for Social Security disability benefits. Like retirement Social Security, the disability programs pays you monthly and also qualifies you for Medicare (although not immediately).

Unlike retirement Social Security, which you can qualify for automatically based on your age, the disability program requires you to prove that you meet SSA’s qualifications for disability benefits.  You can qualify for Social Security disability regardless of your age as long as you have enough earnings credits and if you meet the qualifications for benefits.

How Does Social Security Define “Disability”

Social Security defines disability in terms of how your medical problems impact your capacity for work.  Specifically, SSA asks if you have a medically determinable condition or conditions that prevents you from performing substantial gainful activity and has lasted or is expected to last twelve consecutive months or result in death.

Let’s break down this definition.

First, you have to have a medically determinable condition.  This means that SSA decision makers will be looking for a diagnosis. Generally speaking the more specific your diagnosis the better and the more objectively determinable the better.

If your condition can be imaged using an MRI, CT, ultrasound or other diagnostic test, your chances of approval will be greatly increased.  Chronic pain conditions like fibromyalgia or CRPS can result in approvals but these cases are much more difficult.

Similarly, mental health conditions like depression, PTSD and anxiety disorder can support a finding of disability but disability adjudicators and judges expect to see long and consistent mental health treatment, evidence of severity in the form of suicide attempts, in-patient hospitalizations and multiple medication trials

Second, your condition has to be a long term problem that has lasted or is expected to last twelve consecutive months or longer.  SSA does not offer short term disability payments so a broken arm or broken leg will not qualify you absent unusual complications.

Here, too, your medical provider needs to note in your record that you have been or are likely to be impaired for at least a year or longer.

Finally, your condition has to be serious enough to preclude any work activity, which SSA calls “substantial gainful activity.”  Not being able to perform the duties of you past work is not enough – you have to show that you would not be reliable or capable at any type of job, even a simple, sit-down, entry-level job.

It does not matter, by the way, that a simple, entry-level job would only pay minimum wage, or that no such jobs exist near where you live. The only relevant question is whether you could perform one of these simple jobs, if one actually existed.

As the lawyers at Ginsberg Law Offices can explain, many disability applicants mistakenly focus on their medical issues instead of how those medical problems impact their work capacity.  If you understand what you have to prove, your chances of success with your disability application will increase dramatically.