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What medical conditions are required to meet SSI disability qualifications and to get an SSI approval?

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Find out how disability is defined for SSI and what SSI disability qualifications adults and children must meet to get SSI.

ssi-disability-qualifications

The SSI Definition of Disability for Adults

Any medical or psychiatric condition can be the basis for meeting the SSI disability qualifications if you are limited in the manner described in the SSI definitions of disability.

SSI disability qualifications are different for adults and children. Adults who apply for SSI benefits are evaluated using the same definition of disability that is used for Social Security Disability applicants. According to Social Security and SSI disability laws, disability is an adult’s “the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted, or can be expected to last, for a continuous period of not less than twelve months. Our article “What Is Disability According to Social Security Disability Laws?” explains the definition and our article “How Does the Social Security Administration Apply Social Security Disability Laws to Determine If I Am Disabled?” includes a step-by-step explanation of how Social Security applies adult disability laws to your situation to determine if you are disabled.

When a child who is eligible for SSI turns eighteen, his or her eligibility for SSI has to be re-reviewed. The former child’s medical condition will undergo a new disability review to determine whether he or she meets the adult definition of disability. Additionally, his financial eligibility and potential benefit amount will be re-determined without consideration to his or her parents’ income and resources.

The SSI Definition of Disability for Children

A child is disabled for SSI purposes if he or she has “a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than twelve months.”

Determining a Child’s SSI Disability Status

If a child who is under age eighteen applies for SSI benefit and it is determined that he or she meets the non-medical eligibility requirements, the local Social Security office determines whether the child is performing work that is Substantial Gainful Activity, which is called SGA for short. Usually, gross work earnings as an employee or net income from self-employment is considered to be SGA if the earnings reach $1,800 for a blind person or $1,070 for a non-blind person. If the child is performing SGA is performing SGA, then the child is not disabled. As mentioned, a more complete discussion of SGA can be found in the article “What Is Disability According to Social Security Disability Laws?

If the child is not performing Substantial Gainful Activity, then the claim will be sent to the Disability Determining Services, which is called DDS for short. To conduct a medical review of your child’s claim, the DDS will review the medical and other information you provide on the SSI application form. The DDS may also ask you for additional information, contact your child’s medical providers and educators, or ask that your child to attend a Consultative Examination. The examination, if requested, will be for evaluation purposes only and will not include any treatment. For more information about Consultative Examinations and about who decides if your child is disabled, see our articles “When Applying for Disability Benefits Will I Have to See a Social Security Doctor?” and “Who Decides If I Am Disabled? If Both My Doctor and the Social Security Disability Doctors Say I Am Unable to Work, Will I Be Approved?

In its first step, the DDS evaluates whether your child has a physical or mental impairment that is medically determinable and whether it is severe enough to cause more than minimal functional limitations. If no impairment is supported or functional limitations are only minor, the claim will be denied. On the other hand, if your child has a severe impairment, then the review proceeds to the next step.

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15 Comments

  1. Karl says:

    Kay,

    You have to be one of the busiest people I have ever seen. I have several questions but I will try to narrow them down.. I became unable to work January 8th 2013. I started my application the same month by the discretion of my physician which is also the Dr. that SS uses for my area. That being said.. I have been turned down twice and am now waiting for my interview with the ALJ. I have Diabetes Diabetic Neuropathy , Dystaloic Heart Failure , High Blood Pressure, a-fib, Edema and a host of other illnesses. And what my illnesses doesnt effect my dearn medicine does. Several of these are on the Blue Book for SSDI. Yet I have been denied 2x.. I am only 33 years old and look healthy as a horse other than I can barely walk. I am 6’2 and 325lbs.. I have had Diabetes for over 20 years and I am insulin Dependent. There has been several people that has stated the only reason that I have been denied was because of my age.. Even though my illnesses are listed on the blue book. Is this True?? If so it is a cryin shame that someone that is legitimately sick that has hard medical evidence is having to go through this when others who can work get it right away. (I’m sure you’ve heard that before)

    And I have been contemplating getting my congressman here in Arkansas involved in my case. I have a very reputable lawyer but she stated that it was still going to take several more months. My appeal is at the “judges office” in my words but they have not looked at it. Would it be more of an advantage to have my congressman look into it or verses my attorney. Just looking for your opinion??

    And the last question and I know that this is alot. I was the only income in the home and it abruptly stopped. My wife doesnt work. I was told that I could reicive SSI for the months that I was waiting for SSDI but when my SSD kicked in I would make to much then it would stop. That being said… I have seen several post’s that were statign a hold up on benefits because of SSI and SSDI. Is this going to be the same in my case. My quoted monthly benefits were 1479.00 fir SSD. If so should I go ahead and cancel that SSI app.. Just and opinion as stated before.. Thanks in advance !! Have a great day

    • Kay Derochie says:

      Dear Karl,

      You raise several issues, which I will try to address. First, because you are under age fifty, you must be disabled from all occupations that you could perform given your limitations, education, and experience. This would include jobs you could perform seated. The Blue Book does list medical conditions that are considered disabling, but only if they also have certain laboratory or clinical findings accompanying them. Those required findings are also listed. You might ask your attorney whether any of your conditions actually meet the findings.

      With regard to the status of your hearing, it can take a year or more to get a hearing date. The appeal isn’t actually looked at until around the time the date is set. You, of course, have the right to request your congressman to look into the claim, but it will not necessarily speed anything up. Whether or not you contact the congressman, you need your attorney to present your case in court. A congressperson will not go to court with you and will have less knowledge of Social Security law than your attorney.

      You have to be medically approved for Supplemental Security Income (SSI) the same as for Social Security Disability (SSD). You cannot get SSI until you are approved at the hearing. I recommend not withdrawing your SSI claim. Social Security has a five-month unpaid waiting period, so if your are approved your SSD will not start until July 2013, whereas SSI would begin February 2013. It is true that it can take a bit longer for both claims to be processed to payment after an approval, but it could result in more overall income and possibly payment of recent unpaid medical bills as Medicaid eligibility often accompanies SSI eligibility with limited retroactivity.

      For interim assistance, try contacting your state’s department of human services to see if they offer temporary cash payments to disabled individuals who are awaiting a decision from Social Security. If so, this would be repaid from any SSI you received. You might also apply for food stamps and energy assistance for help with heating bills.

      Sincerely,

      Kay

  2. Alicia says:

    Hi Kay,
    I have asked you for advice before. I applied for S.S.D.I.and S.S.I. in August 2013.i said on my initial claim i had depression, generalized anxiety disorder,panic disorder, bipolar(that decision was ruled out in my discharge paperwork after completion of a behavior health program) when I initially applied I did not know that bipolar was ruled out until after I received my discharge paper work) .Also,I put I have scoliosis,arthritis and G.E.R.D.i also did not know I did not have arthritis my hands and wrists hurt, burn,and I get a numbness, tingling feeling when I try to use a can opener and sometimes I can not get my fingers to work,I wake up every morning with swollen fingers and stiffness and pain throughout my body,but the S.S.D.I. Doctor that I was sent to said I did not have arthritis in my hands.He wrote chronic pain on my x-ray sheet and I was sent to x-ray.I have had depression since 1999, Generalized Anxiety Disorder 2005,Scoliosis 2007,(which my chiropractor put me on a 10 lb. lift restriction in 2012 for the rest of my life)Degenerative Disc Disease L4,L5-S1 2012,Panic Disorder with Agoraphobia2013, Major Depressive affective Disorder2013 and G.E.R.D. Since 2009 & Lung fibrosis 2013. Kay, I was denied because they feel I can do light unskilled work.My mental condition has gotten worse and I am still in physical pain on a daily basis.How do they expect me to go get a light unskilled job when I go for days without going outside due to my mental issues?My body hurts everyday! I have already received my paperwork for reconsideration and have contacted an attorney to file the reconsideration paperwork.i will be 49 years old in March and I read somewhere if Chronic pain is an issue with psychological disorders at any age, and can not due simple unskilled work the S.S.A. Will reach a decision of Chronic pain disabled. So, why did I get denied?

    • Kay Derochie says:

      Dear Alicia,

      When the Social Security Administration reviews your claim, it looks at more than your diagnosis or diagnoses. They look for evidence of how severe your condition or conditions are and how much they limit you. Apparently, based on the information they had, they determined that you were not limited enough to preclude all work. Because you have several different conditions, it is good that you got an attorney to help with your appeal.

      Best regards,

      Kay

  3. Jessica says:

    Hello, just have a quick question. I have been going through this process for a little over two years now and I’m still waiting g on a decision. I went to my hearing in May of 2013 and its February 2014 every time I call I’m told that its in the writing process what could be making it keep going back and forth to the writer?

    • Kay Derochie says:

      Dear Jessica,

      If you have been told it was in writing, then on the judge’s desk, and then back in writing, it could be that when the judge looked the letter over to be sure it was correct before it was sent out, he or she found an error or omission and requested that it be revised. The good news is that it appears the decision has been made and notification is in process.

      Sincerely,

      Kay

  4. j.lee says:

    I have been going through this process for 3 yrs and like so many others do not know how I can wait much longer with no way to live. I have 3 kids who have all become very depressed and have lost hope, it breaks my heart. I have type 2 diabetes and on insulin but still uncontrolled, peripheral neuropathy and severe vein disease in legs so have constant pain and wide spread edema. I also have COPD,sleep apnea and obesity. I have DDD and herniated discs in cervical and lumbar spine that push into the thecal sac with narrowing of spine and bone spurs and have fibromyalgia too. Theres more…Depression and anxiety. I take a lot of pain meds that of course have many side affects. My case has just been remanded back to LJ from appeals council, the VE testified there is no work I could do but it did not help as I was still denied. My question is the LJ did not feel my depression was signifigant enough to interfere with life but I have since been diagnosed with PTSD and bipolar depression, will the LJ look at the new info since it does prove a signifigant mental impairment??

    • Kay Derochie says:

      Dear J.

      In most instances additional evidence can be filed for a second hearing when a claim is remanded to the judge. However, the reasons for the remand can govern whether or not additional evidence will be considered. What reasons were given for the remand? If you submit evidence, it should be directed to a specific point and if possible to one of the reasons that the claim was remanded to the judge. Also, any evidence (such as new diagnoses) that came into being after the date you were last insured (the date you last had enough work credits) will probably not help you win Social Security Disability Benefits, though it could help with a Supplemental Security Income (SSI) claim. Other determining factors are why evidence that existed prior to the hearing date wasn’t it filed prior to the original hearing? If you do not have an attorney to help you analyze the remand order and assist you regarding possible submission of evidence, it could be a good idea to get one.

      Sincerely,

      Kay

  5. j.lee says:

    I forgot to mention the LJ had denied me for several reasons, she said although I had the above severe impairments she felt the COPD and sleep apnea were under control, felt my pain was also under control with meds and it appeared to her I was not following treatment orders with diabetes (not true) and I had failed to lose any weight which were all contributing to worsening of symptoms. The psych Dr she sent me to diagnosed me with major depressive disorder but only had minimum affect on my life. She said I should be able to return to light work and could stand or sit 8 hrs a day, even after the VE testified I could not. So, I do have more medical records to prove otherwise but wondering if the new diagnosis of PTSD and bipolar will be looked at too….?

  6. Hello Kay, my name is cynthia, good to meet you. You are very knowledged in this SSI and SSDI. I have been denied 3X’s and the 4th appeal I finnaly made it too the Judge. I didn’t know where to start, had no legal advice, and under so much pressure I thought I was going pop!Seconds before going in this guy told me to only speak when I’m given a question-and never call him sir, he hates that, only address him as ‘your honor’.Great!
    I had my ssi and ssdi from 1987 until 2001. Some terrible trouble happened and I lost it. Lost my housing {hud} my 2-checks and my daughter ran away with her boyfriend. I just could not even to go into that apt. by myself.Started to stay up all night-having been arested 7x’s for really stupid reasons. Jay-walking, be in fights, drunken disorder, never paid the fines, had to work off my fines at 10 cents an hour, you got it, prison for not paying my fines and 1 time such a tiny roach-it was considered “un-determend amount,” My public pretender told the judge I was a danger to myself!That she {me}should get max time. Ended doing 7 months, and only chiped off 1/2 of one huge fine. Got accepted to a half way house. A dear friend paid off my fines, and thought I could get the charge expunged. Making my appearence better. I lived on the streets for almost 4 years, so I made a claim for my social benifits. That “felony”charge {I feel} led to the denial of my benifits. Disability is corneal dystrophy-with corneal erosions, I currently and will probably never be off the anti-depressents, or the anxiety pills. Had a stroke in Sept. and my comprehention {and spelling} has gone back to the beginning of time. It is very hard to remember what I did last week, I have no short memory, but some past from years ago.What would you do? Or what do you and others think I should do.?When I talked to Bender&Bender, they had to fly out from New York, so I said no because that was part of their cut. Do you know a winning advocate that speakes for us in the court room? I only heard of it, that I wouldn’t have to go to court at all, could this be right? Thank you, Sincerely, Cynthia

    • Kay Derochie says:

      Dear Cynthia,

      It does sound as if you need an attorney to represent you. I do not know where you live. If you do not live in a fairly large urban area there may not be experienced Social Security/SSI disability attorneys in your area. You can start by looking in the yellow pages of your phone book or in the phone book of an urban area near you. And, of course, the internet is a source. These resources should be available in a public library. If you can not locate an attorney locally as you wish, you might talk with your local social services office to see if they know of any volunteer advocates who are knowledgeable.

      Sincerely,

      Kay

      A few hearing appeals are decided favorably without a hearing, but the overwhelming majority require appearance at a hearing.

  7. Cindy says:

    I have metastatic Neuroendocrine stage 3 Cancer, along with several other conditions, I am a nurse, and have not been able to work since diagnosed, initially the CTC had treated me for the wrong cancer and given me the wrong chemo, then following the PETSCAN no improvement because I had received the wrong treatment, was sent a letter from the oncologist that was treating me no longer took my insurance, but come to find out that was not true, I think he realized he had made a mistake, had gone to Mayo and found out that Cancer I had needed surgery as the tumors were wrapped around my jugular, carotid artery and cervical area, had I stayed with them according to the new radiation Dr I would have been dead within months had I stayed, so surgery , radiation, and chemo were started immediately. My question is I have since been accepted for disability but what is SSI for and can you collect both, also the amount of disabilty I will collect how is it calculated, as I find it hard to believe that they expect a person to live on it, my husband has left me I have used up my savings and was living on credit cards, I refinanced my home to lower the payments, but have no other income, what does one do when speaking with the Social Security Dept, they told me I had to sell my belongings to qualify for SSI benefits, I declined as I need what little I do have, and what exactly is it they want you to sell and what is it they you can have, I find it hard to believe that the many years that one has worked and payed all the Govt taxes and retirements, that to live you give up all you have to receive assistance, and not only that but to have to fight to get what one rightfully deserves they have no problem taking their taxes without asking or getting a lawyer to get them from me but I have to wait years to get a response and fight to get assistance, this a sick and undeserving position they put you in, especially when you are sick and to have to go through their expectations without regard to situation, when you can’t buy food pay rent or have medical bills coming at you left and right and the threatening phone calls from bill collectors, I think someone in the Government has really lost priorities, bailing out banks, wars, helping Wall street, with billions of our dollars and I’m trying to get a disability check and FIGHT I might say to get it. So anyway sorry back to question can you get both, and how do they decide on the amount you should get?

    • Kay Derochie says:

      Dear Cindy,

      Your Social Security benefit is calculated related on your earnings under Social Security. You can request an earnings statement of your taxed earnings from your work and look it over to be sure that all your earnings are listed. If they are all listed, then the calculation is highly likely to be correct because it is performed by a computer program.

      Supplemental Security Income (SSI) can be paid to disabled individuals who have countable income and assets below a certain limit. If your Social Security (or your Social Security and other income together) is $741 or over, you are not eligible for SSI. The resource (asset) limit for an individual is $2,000. Your home, usually one vehicle, and normal household and personal items are not counted. Countable assets usually include investments of most kinds, including 401ks and IRAs, second vehicles, boats, valuable collections of art,some insurance policies, etc. If a representative of Social Security suggested selling items, I would think that it would not refer to the essential excludable items such as home or vehicle.

      I hope this information is helpful.

      Sincerely,

      Kay

  8. Cindy says:

    Please let me know also what is Medicaid and how do you get that? And why can’t you leave the country for more than 30 days, what does that have to do with getting disability?

    • Kay Derochie says:

      Dear Cindy,

      If you are a U.S. citizen, you can live abroad in many countries and still receive Social Security benefits without restriction. The thirty-day restriction for being out of the country applies to individuals who receive Supplemental Security Income (SSI). The reason behind the law is that the program is a public assistance welfare program for residents of the U.S. who are citizens or meet certain limited legal alien qualifications.

      Sincerely,

      Kay

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