What Is Considered Disability for Social Security?

Disability is a federal program that provides money for seriously ill or impaired individuals who are no longer able to work. The Social Security Administration operates the disability program and makes determinations of disability based on the duration of a medical condition and its effect on an individual's ability to work gainfully.

Definition

• The Social Security definition of disability includes two components. First, you must have a severe medical condition that makes it impossible for you to engage in substantial gainful activity (SGA). The definition of SGA is subject to adjustment, but is generally employment that earns roughly $900 per month. Second, the medical condition must be expected to result in death or last for at least 12 months.

Evidentiary Requirements

• The primary source of evidence about a claim of disability is medical records. The burden of proving a disability lies with you, the applicant, and your doctor is your best source of support. The reports of licensed physicians and psychologists, including reports on medical history, clinical findings, diagnosis and treatments, are essential to proving disability for Social Security.

Impairments

• The Social Security Administration maintains a list of 15 categories of impairments that are recognized medical impairments meeting the definition of disability. The categories are based on organ systems, such as cardiovascular, musculoskeletal and digestive, but also includes mental, neurological and sense and speech disorders. Each category is subdivided into specific conditions and the criteria that must be established by appropriate medical evidence. There is a separate set of criteria for adults and for children.

Determination Process

• Most of the Social Security disability determination process occurs in the dozens of field offices located across the country. Applications can be submitted in person, by phone, by mail and even online. The field offices are responsible for evaluating disability claims according to the categories of impairments. Doctors themselves are usually familiar with the disability criteria, also known as the bluebook, and can be helpful in providing the necessary documentation to prove a disability claim.

Appeals

• The most common reason for a disability claim rejection is failure to prove inability to meet SGA levels or the duration of a condition. Presence of a disabling condition is not sufficient, nor is being unable to work in previously held jobs. Medical evidence must substantiate both elements of the disability definition. An initial appeal of a rejection allows for the opportunity of additional medical evidence, and is conducted at the field office level. Additional appeals before an administrative law judge are available. Also available but very rare are appeals to a U.S. District Court.