The Disability Evaluation Under Social Security is a guide for health care professionals and physicians that explains the Social Security disability programs. The guide is more commonly referred to as the Social Security Disability Blue Book.
5 Ways the Social Security Administration Uses the Blue Book
- Overview and Guideline for SSA Office Employees, Applicants, and Health Care Providers
- General Information About Social Security Disability Programs
- Acceptable Evidentiary Requirements
- Listing of Impairments
- Does Not Guarantee Approval for Benefits
The Blue Book explains how the Social Security Administration (SSA) defines disability and medically determinable impairment. The guide also contains a Listing of Impairments that describes various impairments that are typically considered severe enough to prevent an individual from performing any gainful activity (work).
1. Overview and Guideline for SSA Office Employees, Applicants, and Health Care Providers
What is the Blue Book as it relates to Social Security Disability?
Social Security office employees use the Social Security Disability Blue Book as they process applications for Social Security disability benefits. The Blue Book is a reference guide for physicians and other healthcare professionals who need to evaluate a patient to determine if the patient’s condition is included in the Listing of Impairments. The Blue Book can be a great source of information if you are filing your Social Security disability application for the first time.
2. General Information About Social Security Disability Programs
The first section of the Social Security Disability Blue Book provides general information about the two disability programs administered by the SSA — Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The information is intended to help individuals, caretakers, physicians, and other parties understand the medical eligibility requirements for disability benefits and how to apply for Social Security disability.
Some of the information contained in this section of the Social Security Disability Blue Book that can assist individuals filing for disability include, but is not limited to:
- What qualifies as a disability? The Blue Book defines SSA disability, which is different from the definition used by other programs. The definition of disability is when a person cannot perform any substantial gainful activity (work) because of a medically determinable physical or mental impairment that has lasted or is expected to last for at least one year or result in death.
- What conditions qualify a child for disability?
- What is considered a medically determinable mental or physical impairment?
- How the disability determination process typically works, including the appeals process.
- The role of health care professionals in the disability determination process.
- The difference between consultative examiners (physicians used by SSA) and treating sources (an applicant’s personal doctor).
- Answers to frequently asked questions about the SSA disability process.
The Social Security disability requirements explained in this section of the Blue Book can be very helpful for people who are just beginning to research how to apply for disability benefits.
3. Acceptable Evidentiary Requirements
The second section of the Social Security Disability Blue Book discusses the acceptable medical evidence required to prove a person is disabled because of a medical condition. An applicant must be able to provide medical documentation that proves the applicant has a physical or mental impairment that meets or exceeds the requirements in the listing of impairments.
The information must come from “acceptable medical sources” identified by the SSA. The Blue Book reviews the acceptable medical sources that the SSA recognizes, including licensed physicians, psychologists, optometrists, podiatrists, and speech-language pathologists.
This section of the Blue Book also describes evidence that may be used by the SSA when evaluating an application for disability insurance benefits. Some of the evidence that may be used to prove disability include:
- Medical documentation from treating physicians
- Medical records from hospitals, clinics, and health care facilities
- Laboratory findings and test results
- Results of imaging tests (X-rays, CT scans, MRI)
- Clinical findings, impairment ratings, treatment plan, and prognosis
- The applicant’s ability to perform work-related activities
- Consultative Examinations (a health care professional used by the SSA to perform additional tests and a physical examination)
- Evidence relating to a person’s symptoms
The more information an applicant can provide regarding his or her medical condition, the better chance the applicant qualifies for disability benefits.
4. Listing of Impairments
What qualifies as a disability?
The Social Security Disability Blue Book also contains a comprehensive, detailed Adult Listing of Impairments and Childhood Listing of Impairments. As part of the Social Security disability requirements, an applicant must have a disabling impairment. The Listing of Impairments describes each major body system and the impairments affecting that body system that may result in a disabling impairment. For each condition, the Blue Book lists the medical criteria used when evaluating claims for disability benefits. The Listing of Impairments can help individuals answer questions such as “Does my mental disability qualify for Social Security?”
The Listing of Impairments contains two sections. Part A is the Adult Listing of Impairments, which applies to applicants 18 years of age and older. However, the criteria in Part A may be used to evaluate a patient under 18 years of age if the disease has a similar effect on adults and children. Part B is the Childhood Listing of Impairments that provides the medical criteria for disabling conditions and impairments for applicants under 18 years of age.
5. Does Not Guarantee Approval for Benefits
The criteria contained in the Social Security Disability Blue Book is only one step in the evaluation process for SSI or SSDI. You are not guaranteed disability benefits if your condition appears in the Listing of Impairments. The Blue Book is a guideline and provides general information about conditions that can typically result in a disability. The SSA considers other factors when evaluating a claim. However, understanding the criteria in the Blue Book can help an applicant and an applicant’s physician perform required tests and gather documentation and evidence to improve the chance that a Social Security disability claim is approved.
Adult Listings in the Social Security Disability Blue Book Listing of Impairments
The Listing of Impairments – Adult Listings (Part A) in the Social Security Disability Blue Book contain 14 sections.
What medical conditions qualify for Social Security Disability or SSI?
The examples taken from the following sections are not a complete list of all conditions found in the Listing of Impairments.
1.00 Musculoskeletal System
- Disorders of the Spine
- Soft Tissue Injury
- Major Dysfunction of a Joint
- Fracture of the femur, tibia, pelvis, or one or more of the tarsal bones
- Fracture of an Upper Extremity
2.00 Special Senses and Speech
- Loss of Central Visual Acuity
- Loss of Visual Efficiency
- Loss of Speech
- Hearing Loss Not Treated with Cochlear Implantation
- Hearing Loss Treated with Cochlear Implantation
- Disturbance of Labyrinthine-Vestibular Function
3.00 Respiratory Disorders
- Cystic Fibrosis
- Chronic Pulmonary Hypertension
- Lung Transplant
- Respiratory Failure
4.00 Cardiovascular System
- Chronic Heart Failure
- Ischemic Heart Disease
- Symptomatic Congenital Heart Disease
- Aneurysm of Aorta
- Recurrent Arrhythmias
- Chronic Venous Insufficiency
5.00 Digestive System
- Short Bowel Syndrome
- Chronic Liver Disease
- Liver Transplant
- Gastrointestinal Hemorrhaging
- Inflammatory Bowel Disease
6.00 Genitourinary Disorders
- Chronic Kidney Disease
- Nephrotic Syndrome
- Kidney Transplant
7.00 Hematological Disorders
- Hemolytic Anemias
- Disorders of Bone Marrow Failure
- Hematological Disorders Treated by Stem Cell Transplantation
- Disorders of Thrombosis and Hemostasis
8.00 Skin Disorders
- Bullous Disease
- Genetic Photosensitivity Disorders
9.00 Endocrine Disorders
- Pituitary Gland Disorders
- Thyroid Gland Disorders
- Adrenal Gland Disorders
- Diabetes Mellitus
- Diabetic Ketoacidosis
10.00 Congenital Disorders that Affect Multiple Body Systems
- Non-Mosaic Down Syndrome
- Mosaic Down Syndrome
- Congenital Anomalies
- Chromosomal Disorders
11.00 Neurological Disorders
- Benign Brain Tumors
- Cerebral Palsy
- Spinal Cord Disorders
- Multiple Sclerosis
- Peripheral Neuropathy
- Myasthenia Gravis
- Parkinsonian Syndrome
12.00 Mental Disorders
- Intellectual Disorder
- Personality Disorder
- Bipolar Disorders
- Neurodevelopmental Disorders
- Eating Disorders
- Other Mental Health Disorders
13.00 Cancer (Malignant Neoplastic Diseases)
- Multiple Myeloma
- Breast Cancer
- Lung Cancer
- Pancreatic Cancer
- Bone Cancer
- Cancer of Other Organs or Systems
14.00 Immune System Disorders
- Systemic Vasculitis
- Immune Deficiency Disorders
- Systemic Sclerosis
- Inflammatory Arthritis
- Sjögren’s syndrome
- Human Immunodeficiency Virus (HIV)
What if My Condition Doesn’t Meet Listing Criteria?
Does a medical condition have to match the blue book listing?
In some cases, an applicant does not meet all criteria listed in the Blue Book. However, they may still qualify for disability benefits. If your condition does not meet or exceed the listing criteria, you can submit a Residual Functional Capacity (RFC) statement. An RFC statement evaluates your ability or inability to perform certain tasks that would be necessary to perform a job. Your physician or a doctor the SSA assigns to examine you will complete the RFC statement. If the RFC assessment concludes that you are unable to perform tasks necessary to work because of your condition, you may qualify for Social Security disability benefits.
What if your condition does not appear in the SSA Blue Book?
If your condition is not listed in the Social Security Disability Blue Book Listing of Impairments, you may still be eligible for Social Security disability benefits. Impairments that are similar to the disabling conditions listed in the Blue Book may qualify for SSDI or SSI benefits. You must prove that your condition is “equal” to a listing in the Blue Book in duration and severity to another condition already listed in the Blue Book. You must be unable to work because of the medical condition to qualify for disability benefits.
Proving that your condition results in impairments that prevent you from working or you have a condition that is “equal” to a listed condition can be challenging. You can improve the quality of your case and your chance of being approved for disability benefits by working with an experienced Social Security disability attorney. A disability attorney understands the evidence the SSA wants to see to prove that your condition is a disabling impairment.
What Is Considered A Disabling Condition by Social Security?
If you are unsure whether your condition meets the definition of disabled for disability benefits, contact Acadia Law Group to discuss your situation with a Social Security disability attorney.
Many applications for SSI and SSDI are denied because applicants do not understand the requirements and criteria contained in the Social Security Disability Blue Book. SSDI eligibility and SSI eligibility requirements can be confusing. It is understandable why many people find the process of applying for disability benefits overwhelming.
An attorney experienced in filing Social Security disability applications can help you avoid some of the common mistakes that result in a denial of disability benefits. At Acadia Law Group, our disability attorneys have a thorough understanding of the Blue Book and how the Social Security Administration uses the book to evaluate a disability application. Let our legal team help you put together a strong, compelling case that meets all requirements to receive Social Security disability benefits.
In addition, our attorneys can help you ensure you meet the Medicare disability eligibility requirements after you receive SSDI so that you can receive help to pay for necessary medical expenses.
Do You Have Medical Conditions That Qualify for Disability Claims?
Call 1-800-653-4600 now for a free case review with Acadia Law Group.