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Health Education

What conditions qualify for disability benefits?

There are 14 categories that may entitle you to Social Security disability benefits as an adult
Leandra Beabout
By | Oct. 16, 2023 Medically reviewed by Scott Dershowitz, LMSW, CMC
Handicap symbol on purple background - What conditions qualify for disability benefits?

Key takeaways

  • The Social Security Administration (SSA) offers two types of benefits for qualifying disabilities: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), each with its own criteria.

  • Fourteen categories of conditions, including musculoskeletal, respiratory, cardiovascular, and neurological disorders, can qualify an adult for SSA disability benefits, with specific documentation required for each.

  • Conditions like certain cancers and severe mental health disorders may qualify for expedited claims under the Compassionate Allowance (CAL) and Terminal Illness (TERI) initiatives.

  • To be eligible for disability benefits, an individual must meet the SSA’s definition of disability, have sufficient work credits for SSDI, or meet age, income, and residency requirements for SSI.

In this article:

If you or a loved one have recently been injured or diagnosed with an illness that impedes your daily life, you might wonder: What medical conditions automatically qualify you for disability? What criteria do you need to meet to get federal disability benefits? Where do you go to start the process?

You can begin with the Social Security Administration (SSA). The SSA offers two types of Social Security disability benefits for those who meet the agency’s strict definition of “disabled.” This means you must develop a severe medical ailment on the list of disabling conditions and then meet other criteria for each type of benefit. 

  1. Social Security Disability Insurance (SSDI) is a benefit provided to people who meet the SSA’s criteria for disability, have worked in a job in which you paid Social Security taxes, and are unable to work due to a disabling condition that is expected to last at least one year or be fatal.
  2. Supplemental Security Income (SSI) is a benefit provided to people who have low income and resources alongside 
    1. blindness or a disabling condition, OR;
    2. are above 65 years old.

What conditions qualify for disability? 

Impairments that qualify are divided into two sections: Part A for adults and Part B for people younger than 18. (This is not to be confused with Medicare Part A and Part B.) Below, we detail the 14 categories of conditions that qualify for SSA disability in adults and what you may be expected to provide for documentation for each. The disability determination process can be quite lengthy, and appeals are not uncommon. For more information on Part B, consult the Social Security Blue Book.

1. Musculoskeletal or orthopedic conditions

Conditions that qualify as a musculoskeletal disability include:

  • Amputation
  • Spinal disorders such as lumbar spinal stenosis or degenerative disc disease
  • Bone disorders such as osteogenesis imperfecta or osteoporosis 
  • Other severe disorders of the bones, major joints, tendons, ligaments, or muscles 

Symptoms such as pain, decreased sensation, and muscle weakness may be helpful indicators of musculoskeletal disorders, but the SSA requires a thorough medical report that describes the severity, duration, and impact of your condition. Because the inability to move and perform daily tasks impedes the ability to work, musculoskeletal disorders are one of the most common disability types, accounting for more than one third of all disabilities. 

2. Sense and speech conditions

Special senses and speech disorders that qualify for disability benefits include:

To be eligible for disability benefits from a visual, hearing, or speech disorder, the SSA requires documentation from a medical professional. Sometimes, a description of how the condition impairs daily function is also required.

3. Respiratory conditions

Respiratory disorders that qualify for disability benefits include:

While the causes of these conditions may vary, most lead to symptoms such as chest pain, shortness of breath, coughing, and rapid or shallow breathing. To grant you disability benefits for respiratory conditions, the SSA requires medical evidence such as a pulmonary function test, chest X-rays, and healthcare provider notes on the severity and duration of your symptoms.

4. Cardiovascular conditions

Cardiovascular system conditions affect your heart and circulation. Circulatory conditions that qualify for disability benefits include:

Shortness of breath, ankle swelling, exhaustion, and an uneven heartbeat are common symptoms of cardiovascular conditions. However, experiencing these symptoms alone is insufficient to qualify you for disability benefits. The SSA requires detailed reports of at least three months of medical history, treatments you’ve tried, and how you responded to those treatments. 

5. Digestive system conditions

Digestive system disorders that qualify for disability benefits include:

  • Inflammatory bowel disease (IBD)
  • Short bowel syndrome (SBS)
  • Chronic liver disease
  • Gastrointestinal bleeding, in some cases

Severe gastrointestinal conditions can affect someone’s ability to work when symptoms include extreme weight loss from chronic malnutrition, GI tract bleeding, and painful abdominal obstructions. As with other disability claims, the SSA’s eligibility criteria for a disabling digestive system condition is strict. Medical evidence—such as records of your response to treatments and endoscopy, CT scan, and MRI results—determines eligibility.

6. Genitourinary conditions

Genitourinary disorders involve the reproductive and urinary body systems. Conditions that fall under this category for disability benefits include:

There are many possible signs of kidney dysfunction, and several symptoms could also point to problems with other body systems. Ankle swelling, fatigue, loss of appetite, and urinating more or less than usual can all be red flags for genitourinary conditions. Generally, the SSA requires laboratory evidence and treatment records covering at least 90 days to consider disability benefits for a genitourinary diagnosis. 

7. Hematological conditions 

Hematology refers to the study of blood and blood disorders. Disabling hematological disorders include:

  • Anemias such as sickle cell disease
  • Hemophilia
  • Bone marrow failure

Symptoms of blood disorders vary, but many hematological conditions cause weakness and easy bruising. Qualifying for disability benefits for a blood disorder requires blood work results to prove your diagnosis. 

8. Skin conditions

Skin disorders like eczema and psoriasis are very common. A Social Security disability evaluation will determine if these skin conditions are severe enough to impact your ability to function:

  • Dermatitis
  • Burns
  • Chronic skin infections
  • Genetic photosensitivity disorders

In most cases, you must have severe skin lesions for at least three months to be eligible for disability benefits in the skin condition category. The SSA also requires persuasive medical documentation from a healthcare provider.

9. Endocrine conditions

An endocrine disorder is a medical condition that results in hormonal imbalance. Examples of these conditions include:

  • Thyroid and parathyroid disorders
  • Pituitary gland disorders
  • Adrenal gland disorders
  • Diabetes
  • Hyperglycemia and hypoglycemia

Most endocrine conditions cause problems in another body system, per the SSA. However, some people qualify for disability benefits under this category if their symptoms don’t match another category and still impede them from engaging in normal daily activities. As always, the SSA requires medical evidence of the condition from a healthcare professional.

10. Congenital conditions

The category titled “congenital disorders that affect multiple body systems” refers to inherited medical conditions that are not isolated to one part of the body, including:

Symptoms vary, but people with congenital disorders still require a clear medical diagnosis and clinical evidence to be considered for Social Security benefits.

11. Neurological conditions

Neurological disorders affect the brain, leading to both mental and physical dysfunction, per the SSA. Examples of neurological conditions that may qualify for SSA benefits include:

Neurological conditions can affect several body systems even more so than immune system disorders. This can make them hard to prove quickly. Symptoms vary depending on the diagnosis, but most neurological disorders interfere with movement, communication, and mental functioning. The criteria vary depending on the condition, but the SSA typically requires documentation based on the generally accepted medical methods of diagnosis. 

12. Cognitive and mental health conditions

Qualifying mental disorders include conditions such as:

The SSA requires medical evidence of your mental disorder from a qualified healthcare professional, such as a doctor, psychologist, or licensed clinical social worker. Along with medical documentation, the SSA considers evidence of your mental disorder and daily functioning that comes from you and people who know you.

To qualify for disability benefits, the SSA needs proof that your mental illness is severe enough to keep you from performing in the workplace. Just because your mental health condition does not qualify for disability benefits does not mean it isn’t a legitimate condition that requires treatment. 

13. Cancers 

This disability category includes all cancers except cancer linked to HIV. This might include:

To qualify for cancer-related disability benefits, the SSA requires medical evidence of the:

  • Type of cancer
  • Extent or stage of the cancer
  • Body system or body part where the cancer originated
  • Metastasis (spread) of cancer

Only those who can prove the condition is severe enough to keep them from employment qualify for disability benefits. 

14. Immune conditions

Immune system diseases cause a problem with the body’s ability to recognize and fight infection properly. The SSA recognizes several conditions under the immune system disorders category, including:

These medical conditions affect multiple body systems, so symptoms vary. For instance, lupus causes muscle and joint pain, hair loss, kidney problems, and more. Sjögren’s syndrome, on the other hand, is marked by dry mouth and dry eyes. 

To confirm a disabling immune system disorder diagnosis, the SSA requires healthcare reports on your medical history, laboratory results, and, when applicable, imaging or tissue biopsy results. 

What conditions automatically qualify you for disability?

Typically, the Social Security Administration considers you to have a disability only if your condition has lasted for one year—or if there is medical evidence that it will be expected to last for at least one year or cause death. However, there are a few situations in which disability claims are expedited, without the lengthy application process. 

The Compassionate Allowance (CAL) initiative is designed to quickly identify the most serious disabilities. A full list of CAL conditions can be found on the Social Security website. “These conditions primarily include certain cancers and adult brain disorders,” says Casey Walker, an occupational therapist at Tilton’s Therapy in Nevada..

Terminal illness (TERI) cases also automatically qualify for disability. In the world of SSI disability benefits, a terminal illness is defined as “untreatable, irreversible, and expected to end in death.” Conditions that qualify for TERI include inoperable cancers or ALS.

Criteria to qualify for disability benefits

To qualify for SSDI, you must meet two criteria:

  • You have one of the medical conditions that meets the SSA’s strict definition of disability and prevents you from working
  • You have enough work experience in a job in which you paid Social Security taxes (40 credits, 20 of which were earned in the past 10 years)

To qualify for SSI disability benefits, you must:

  • Be over 65; or
    • Have one of the medical conditions that meets the SSA’s strict definition of disability
    • Have limited income and resources
  • Be a U.S. citizen and resident of the U.S.
  • Meet other residential and financial criteria described on the SSA website

Social Security disability benefits are not the only financial help available to people with disabilities. If you do not qualify for SSI or SSDI, you may still be able to receive workers’ compensation or short-term disability benefits through your insurance company. 

Which conditions are more likely to qualify for disability?

Thirty-four percent of approved disabilities fall under the musculoskeletal category, per the Social Security Disability Program. Back problems, neck problems, and arthritis are the top three reasons workers seek disability benefits, according to the Centers for Disease Control and Prevention (CDC).

What to do before you apply for disability benefits

First, ensure you or the person you are helping is eligible for disability benefits from Social Security. The most common non-medical reason the SSA denies a disability claim is that the applicant did not have enough work credits. In other words, the person needed to work longer or pay more Social Security taxes to be eligible.

If you have enough work credits and have a severe medical condition that falls into one of the categories described above, you can consider applying for disability benefits. Here is the information you will need, according to the SSA:

  • Your Social Security number
  • Proof of your age
  • Names and contact information for healthcare professionals who provided care for the disabling condition
  • Dates of your visits to healthcare providers for the disabling condition
  • List of the names and doses of your medications
  • Medical records and test results related to your condition
  • Information about your place and nature of work
  • Your most recent W-2 form or a copy of your recent tax return if you are self-employed

Remember that if you start receiving disability benefits, you must notify the SSA anytime you start or stop working. If you have a disability and receive SSI but want to work, the SSA can still help you financially. Don’t avoid employment simply because you’re receiving SSI.

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