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Understanding the Medical Requirements for Social Security Disability Benefits

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Navigating the medical requirements for Social Security Disability benefits is a crucial aspect of the application process. Disability claimants often seek clarity on what medical criteria they need to meet to qualify for these essential benefits. Let’s delve into the medical requirements necessary for SSDI eligibility.

Overview of Medical SSDI Eligibility Criteria

Meeting the Definition of Disability

SSA Definition: The Social Security Administration (SSA) defines disability as the inability to engage in substantial gainful activity (SGA) due to a medically determinable physical or mental impairment expected to last at least 12 months or result in death. The condition must significantly limit an individual’s ability to perform basic work-related activities required for most jobs, such as walking, sitting, lifting, or remembering instructions.

Establishing Medical Evidence

1. Medical Records and Documentation

Comprehensive Medical History: Providing detailed medical records documenting the impairment’s diagnosis, treatment history, and its impact on daily activities is essential. Within these records a decisionmaker will hopefully find objective medical evidence, including test results, physician reports, treatment plans, and statements from healthcare providers.

2. SSA-Ordered Medical Evaluations

Additional Medical Examinations: In some cases, the SSA may request a Consultative Examination (CE) to gather additional information when existing medical evidence is insufficient to make a disability determination. These examinations are conducted by healthcare providers designated by the SSA and aim to provide additional medical evidence to support or clarify the disability claim.

Medical requirements ssdi

Specific Medical Criteria – Listing of Impairments

SSA’s Listing of Impairments: The SSA’s Blue Book outlines specific impairments and medical criteria that automatically qualify for disability benefits if the condition meets or equals the severity outlined. If a claimant meets or equals a listing, then they are deemed disabled. If not, then a decisionmaker will proceed to the next step.

Residual Functional Capacity (RFC) – Assessment of Functional Abilities

RFC Evaluation: If the impairment does not meet the criteria in the Blue Book, the SSA assesses the individual’s Residual Functional Capacity (RFC). This evaluation determines the individual’s ability to perform work-related tasks despite the impairment. In this evaluation the decisionmaker will consider an individual’s physical and mental abilities, considering factors like lifting capacity, ability to concentrate, interact with others, and adapt to workplace demands. The more restrictive these limitations are, the less likely one will be able to successfully complete various jobs.

Final Considerations

Understanding the medical requirements for Social Security Disability benefits is crucial for a successful application. Providing comprehensive and detailed medical evidence that aligns with the SSA’s criteria significantly strengthens a disability claim.

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January 5, 2024

Written by TC Newlin

TC is a disability litigator and one of the managing partners in the Social Security Disability Department at Fleschner, Stark, Tanoos & Newlin. He has had the pleasure of helping thousands of people obtain the benefits they so desperately need.


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