SSDI Definitions and Legal Terms

What is the SSA's Definition of "Disabled"?

Question: What is the SSA’s definition of “disabled”?

Answer: You are considered disabled by the SSA when you are no longer able to perform substantially gainful actives at work as the result of a physical or mental impairment that is expected to last at least 12 months or result in death.

Social Security Disability programs can provide financial assistance to those who are unable to work due to severe impairments.

Contact TruLaw using the chat on this page and receive an instant case evaluation to determine if you qualify for Social Security Disability programs today.

Eligibility Criteria to Qualify for SSDI Benefits

In order to satisfy eligibility criteria for social security disability benefits, applicants must provide sufficient evidence that their disability began while they were covered under the Social Security system.

This involves providing detailed medical records that substantiate the onset and severity of the condition, ensuring it aligns with SSA’s disability criteria of Social Security Disability Insurance (SSDI).

Social Security List of Impairments

The SSA looks for certain criteria in your medical records to see whether you can work a substantial amount—if you can’t, you’ll meet Social Security’s disability definition.

The Social Security Act along with the Listing of Impairments outlines specific conditions and impairments that qualify for benefits, helping ensure that those who are truly unable to work receive support.

Medical conditions that may qualify for SSDI benefits include, but are not limited to:

• Cancer and Blood Disorders
• Cardiovascular Conditions
• Endocrine Metabolic Disorders
• Mental Health Conditions
• Musculoskeletal Disorders
• Neurological Conditions
• Respiratory Conditions
• Vision Hearing Problems
• Other Medical Conditions

Social Security’s Listing of Impairments includes listings for both adults and children appearing in the Code of Federal Regulations (CFR) in appendix 1 to subpart P of part 404.

This resource describes impairments considered severe enough to prevent an individual from doing any substantially gainful activity for each major body system (or in the case of children under age 18 applying for SSI, severe enough to cause marked and severe functional limitations).

Demonstrating Limitations of Substantial Work

To determine whether you’re able to perform substantial gainful activity (SGA), the Social Security Administration (SSA) will first assess if you’re capable of performing your most recent job or any past jobs you’ve held within the last 15 years.

The SSA will carefully review your medical records, including treatment notes and medical source statements from your healthcare providers to evaluate the extent of your physical or mental limitations.

This process, known as developing medical evidence, is critical in establishing the legitimacy of a disability claim and determining eligibility for benefits.

If the SSA concludes that your limitations prevent you from carrying out your past work, they will then evaluate your ability to perform “other work.”

This decision is made by considering several factors relating to:

• Nature of your limitations
• Severity of your limitations
• Age
• Educational background
• Transferability of job skills from previous employment

Consider a 58-year-old former construction worker with a high school education who can no longer perform his past work due to chronic back pain and arthritis.

In this case, the SSA would likely not expect him to learn entirely new skills or transition to a sedentary office job that requires computer proficiency, as it would be beyond his existing qualifications and experience.

For individuals with severe sensory impairments such as profound hearing loss or legal blindness, the SSA would not typically expect them to perform work that heavily relies on the affected sense, as their condition would significantly impact their ability to meet these job requirements.

The SSA aims to make a fair and accurate assessment of your capacity to engage in substantial gainful activity by carefully examining your unique circumstances.

This ensures that you receive the appropriate level of support and benefits based on your individual needs and limitations.

Medical Factors Determining SSDI Eligibility

Analyzing Objective Test Results

The criteria often include certain objective test results that include, but are not limited to blood tests, x-rays, MRIs, breathing tests, or exercise tests) in order to evaluate the severity of your health condition.

These tests provide important data that aids in determining eligibility for monthly benefits under SSDI.

Diagnosis of Qualifying Condition

A thorough diagnosis is essential for proving the extent of your impairment.

If the medical evidence supports a finding of a severe disability, the SSA will consider this when determining eligibility for benefits, including the possibility of receiving partial disability benefits if the impairment does not completely prevent work but does significantly limit one’s capacity to perform substantial gainful activity.

Non-Medical Factors for SSDI and SSI Benefits

Social Security runs two programs: SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income).

These programs cater to different needs and have varying eligibility requirements, including work history and income levels.

Work Credit Requirements: SSDI Disability Benefits

To qualify for social security benefits, individuals must have contributed to the Social Security system through payroll taxes or self-employment taxes for a sufficient period.

This ensures that the social security trust fund remains adequately funded to support those who are genuinely in need.

The number of years required to pay into the system varies based on the applicant’s age:

• SSDI applicants 50 years old must have worked and paid taxes for at least 7 years.
• SSDI applicants 62 years or older must have worked and paid taxes for at least 10 years.

SSDI applicants who meet these requirements are considered “insured” or “covered” for SSDI purposes.

It’s important to note that if a worker stops working and paying Social Security taxes, their SSDI insurance coverage will lapse after five years (this period is shorter for those age 30 and under).

To maintain eligibility for retirement benefits benefits, workers who stop working due to a disability must demonstrate that their disability onset occurred before their insured status expired.

The SSA has established these work credit requirements to ensure that SSDI benefits are provided to individuals who have contributed to the Social Security system and have a sufficient work history.

By meeting these criteria, applicants demonstrate their attachment to the workforce and their eligibility for SSDI support in the event of a disabling condition that prevents them from engaging in substantial gainful activity.

Financial & Residency Requirements: SSI Disability Benefits

Applicants must also meet specific income, asset, and residency criteria to qualify for Supplemental Security Income (SSI) disability benefits.

SSI is a means-tested program, meaning that applicants’ income and assets must fall below certain thresholds to be eligible for benefits.

These limits are adjusted annually and vary based on factors such as marital status and living arrangements.

In addition to meeting the financial criteria, SSI applicants must also satisfy one of the following citizenship or residency requirements:

• Be a U.S. citizen
• Be a U.S. national
• Meets additional conditions for qualified aliens

Qualified aliens include lawful permanent residents (green card holders), refugees, asylees, and certain other categories of non-citizens who are legally residing in the United States.

It’s important to note that some non-citizens, such as students with temporary visas or individuals without legal immigration status, are not eligible for SSI benefits.

Who Determines Your Eligibility for SSDI & SSI?

When you submit your disability application to the Social Security Administration (SSA), it is forwarded to a state agency called Disability Determination Services (DDS) for a comprehensive evaluation.

At DDS, your application is assigned to a disability claims examiner, a specialist responsible for making the initial decision on your Social Security disability claim.

These examiners also handle decisions at the reconsideration level, which is the first stage of the appeals process and involves a thorough review of your paperwork.

What are Activities of Daily Living (ADL)?

Activities of Daily Living (ADLs) are the basic tasks a person has to do on their own to live independently, such as bathing, showering, dressing, eating, and using the toilet.

ADLs are activities related to personal care and are performed on a daily basis, usually without assistance.

The disability claims examiner will ask questions about your ability to perform these routine tasks and daily activities during the ADL calls.

This information helps the examiner understand the practical impact of your medical condition on your functioning.

Here are a few examples of questions the disability claims examiner may ask:

• Can you independently perform self-care tasks such as bathing, dressing, and grooming?
• Are you able to prepare meals, do housework, and manage your medications?
• Can you drive, use public transportation, or navigate your community independently?
• How do your symptoms affect your ability to socialize, maintain relationships, and participate in hobbies or leisure activities?

Your responses to these questions, along with the medical evidence and any consultative examination results, provide valuable insights into the extent of your limitations and help the examiner determine whether you meet the SSA’s disability criteria.

Other essential activities necessary for independent living are sometimes referred to as Instrumental Activities of Daily Living (IADLs).

These include doing household chores, taking care of pets, caring for children, and looking after others.

ADLs are used as an important measure to determine an individual’s functional status, especially for older adults or those with disabilities.

The DDS works diligently to gather and evaluate all relevant information to ensure that your claim receives a fair and accurate assessment throughout the eligibility determination process.

Their goal is to make a well-informed decision based on your medical condition and its impact on your ability to perform daily activities.

Disability Determination Services (DDS)

The Disability Determination Services (DDS) is a state agency that works with the Social Security Administration (SSA) to determine whether SSDI and SSI applicants meet the medical requirements for disability benefits.

They’re also responsible for developing medical evidence and making the initial determination on whether or not a claimant is disabled under the law.

A disability claim examiners are trained to evaluate your eligibility by thoroughly reviewing your medical and work history by working with a licensed physician or psychologist, to assess the available medical evidence.

They may request additional information or clarification from your healthcare providers to ensure a comprehensive assessment.

The disability claims examiner at DDS will take one or more of the following steps to assess your eligibility:

• Request your medical records by contacting your healthcare providers, including doctors, hospitals, and clinics.
• Gather additional information about your condition by conducting Activities of Daily Living (ADL) calls with you or your close friends and family members.
• Consult with medical specialists, such as physicians, psychiatrists, or psychologists employed by DDS, to determine if you meet the SSA’s definition of disability.
• Schedule a consultative examination (CE) paid for by DDS if your medical records does not contain the information required to make a determination.

Once DDS has gathered all the necessary medical evidence, the disability examiner and medical consultant review the information and make a determination on whether you are disabled under Social Security’s rules.

If DDS finds that you are disabled, your case is returned to the SSA for payment processing.

If DDS finds that you are not disabled, your case is returned to the SSA, and you will receive a denial notice.

If you or someone you love has received a denial notice from the SSA, you still have the right to appeal the decision and pursue compensation.

Contact TruLaw using the chat on this page and receive an instant case evaluation to join others in appealing their denial for disability benefits today.