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Qualifying Medical Conditions

In this article:
SSDI Qualification and the Blue Book | Denied benefits for a listed condition | My condition is not listed in the Blue Book?

Many applicants wonder whether or not the SSA has a "master list" of conditions they consider automatically disabling. Although the SSA uses a five step disability evaluation process to determine if a claimant is disabled, including evaluating whether or not the claimant is currently working, whether their condition is severe, or whether they can retrain for new work, a part of that process is evaluating whether the claimant's condition is on the SSA Listing of impairments, formally referred to as the Disability Evaluation under Social Security.

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So assuming you are not working and making too much money and you have sufficient work credits to qualify for SSDI benefits or a limited income and resources for SSI, the next step is to review your condition and determine if it is on the Disability Evaluation under Social Security (also known as the Blue Book).

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Automatic SSDI Qualification and the Blue Book

The SSA Blue Book is comprised of the most common medical conditions and their symptoms which are so severe they will keep a claimant from working. Claimants whose condition and corresponding conditions are listed in the Blue Book will be automatically approved for SSDI or SSI, assuming they have met the nonmedical requirements to qualify for benefits.

There is a Blue Book for both adults and children with sections describing conditions for the following body systems: Musculoskeletal, Special Senses (Vision and Hearing), Respiratory System, Cardiovascular System, Digestive System, Genitourinary System, Hematological Disorders, Skin Disorders, Endocrine Disorders, Multiple Body Systems, Neurological, Mental Disorders, Neoplastic Diseases (Cancer), and Immune System Disorders.

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Denied Disability benefits for a listed condition

What if you are denied benefits but your condition is on the listing? It is not unusual for claimants to have a condition listed in the Blue Book but continue to be denied SSI or SSDI benefits. This can happen for two reasons. First, the SSA may have determined that although you have been diagnosed with a listed condition, your condition does not meet the severity of the condition listed. Next, you may have a listed condition but simply lack evidence of your condition.

If you are denied for either of the reasons listed above you have the right to challenge the denial within 60 days. To appeal the denial you need to provide additional medical evidence which can be used to establish the severity of your condition including clinical findings, laboratory tests and doctor's notes.

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What if my condition is not listed in the Blue Book?

If your impairment does not match the requirements of a listing, the disability examiner has a couple of options. First, they may decide that your condition is equivalent to a listed condition in severity and it "equals" a listing. In this case the SSA disability examiner will find you disabled. If, however, your condition does not "meet or equal" a listing the SSA will use the medical vocational process to determine if you have the residual capacity to continue to work. Using this process, the SSA will evaluate your age, work history, physical and mental limitations, and your educational background to determine if you could retrain for new work. If the SSA examiner determines you do not have the residual capacity to retrain for work they will approve your case; if not, you will be denied.