When a client seeks consultation with us regarding Long Term Disability Benefits, they frequently want to know if their injury or illness qualifies them for the benefits. The Social Security Administration (SSA) has created the Blue Book, which serves as a guide to those who are seeking to learn more about potential coverage.
The Blue Book lists various disorders and the conditions that must be met in order for an applicant to be considered disabled by these disorders. However, keep in mind that this is only a guide and that not every medical condition or complication is listed in the Blue Book.
Below, we’ve listed many of the common medical conditions that can result in disability as well as the evidence that is needed to support a claim for disability benefits.
Cardiovascular disorders involve the heart and circulatory system and are some of the most common disorders claimed under Long Term Disability. Cardiovascular disorders are broken into eight subsections.
- Aneurysm of the Aorta Or Other Major Branch: If medical imaging can confirm that there is an aneurysm of the aorta or another major branch, you will be considered disabled. This applies to both thoracic and abdominal aortic aneurysms.
- Chronic Heart Failure: When someone with either systolic or diastolic heart failure meets certain parameters, they may be considered disabled. To qualify, the applicant must meet one of the following conditions: two or more occurrences of heart failure in one year (meaning hospitalization was required and fluid retention occurred), poor performance on an exercise tolerance test, or symptoms that would suggest that exercise and work would be a danger to your health.
- Chronic Venous Insufficiency: This condition impacts the venous walls/valves of the leg veins, causing blood to pool and making it difficult to return blood to the heart for oxygenation. If you have this condition, you will be considered disabled if you have an obstruction and meet of one the following: edema which involves two-thirds of the leg or persistent ulcers that will not heal after three months of treatment.
- Ischemic Heart Disease: One or more criteria must be met in order to qualify for benefits under Ischemic Heart Disease, including Coronary Artery Disease, three distinct ischemic episodes that require revascularization (if possible), or a poor exercise test that proves you fall into the disability category.
- Peripheral Artery Disease: In order to qualify for disability, you must show you have PAD via medical imaging and fall within the restrictions for blood pressure.
- Recurrent Arrhythmia: When it comes to arrhythmia’s, medical evidence must show that the arrhythmia cannot be corrected and that it could cause syncope.
- Congenital Heart Disease: If you have a congenital heart disorder, you must be symptomatic and must present significant medical evidence via imaging or another testing.
- Heart Transplant: For at least a year after a heart transplant you are automatically considered disabled.
There are other medical conditions that can be evaluated for disability under the cardiovascular system, for example:
- Sinus Bradycardia
- Marfan Syndrome
- Mitral Valve Prolapse
- Valve Disorders
- High Blood Pressure
- Budd-Chiari Syndrome
- High Cholesterol
- Clotting Disorders
Just because your medical condition isn’t specifically listed doesn’t mean that you can’t obtain coverage. Contact our law firm to learn more.
When you’ve been diagnosed with a digestive disorder, you know that the condition you have is much more disruptive than just an “upset tummy”. Popping a Tums or Pepto Bismol won’t fix the situation and your life can be put on hold because of the symptoms you’re experiencing.
The SSA breaks digestive disorders into six categories:
- Chronic Liver Disease: There are strict requirements for qualifying for liver disease. First, you must have been hospitalized and required at least two units as part of a blood transfusion or require a shunt or if the disease has progressed to end-stage.
- GI Hemorrhaging: GI bleeds can be life-threatening. To qualify for SSD, you must have needed at least three blood transfusions over six months. In order to count at completely separate transfusions, these treatments must occur with a period of 30 days in between.
- Inflammatory Bowel Disease: An endoscopy, biopsy, and imaging are needed to show that you have been diagnosed with IBD. Additionally, you must have required hospitalization at least twice over a six month period.
- Short Bowel Syndrome: If half or more of your intestine has been removed you will qualify for SSD benefits.
- Severe Weight Loss: If your digestive disorder results in severe weight loss and your BMI is less than 17.5, you can qualify for SSD. However, you must prove that you are following all treatments.
- Liver Transplant: If you have had a liver transplant you automatically qualify for SSD for at least a year.
Other digestive disorders that don’t fall directly into these categories can be covered under SDD. Examples include:
- Crohn’s Disease
- Kidney Failure
- Whipple’s Disease
The endocrine system is basically the system through which your body sends signals to release various hormones. If you’ve been diagnosed with a disorder of this system, the guidelines for determining if you qualify for SSD are not as clear cut as other disorders.
Instead, applications are judged based on how the condition is impacting the body overall as well as the emotional/mental state of the applicant.
There are specific blood disorders that are specifically addressed by the SSA, including:
- Chronic Anemia: A blood transfusion once every other month is needed to show that you qualify for benefits with chronic anemia.
- Chronic Thrombocytopenia: A platelet count of 40,000 with consistent testing needs to be shown and you must also prove that you had bleeding severe enough to require a transfusion in the past several months.
- Hemophilia: The SSA won’t approve benefits for hemophilia unless you can show that you have three spontaneous bleeding events that required transfusions over the past five months.
- Sickle Cell Disease: Any variant of sickle cell disease that has caused three or more crises requiring hospitalization can qualify you for SSD benefits.
Additional blood conditions that could qualify you for SSD benefits include:
- Deep Vein Thrombosis (DVT)
- Multiple Myeloma
- Bone Marrow Transplant
Cancer is a word that indicates an abnormal growth and sometimes those growths are benign. However, many growths are malignant, meaning they can spread and potentially result in the death of a patient. When you are fighting a malignant tumor, both the disease and the treatments can make you incredibly ill and may prevent you from being able to work.
Cancer is evaluated on a case by case basis but at a minimum, the SSA will need to see medical records that prove:
- Where the original malignancy was found.
- The location of all existing areas of malignant cancer.
- Information on the treatments that have been attempted.
- The response to those treatments.
- The impact those treatments had on the body.
Generally speaking, anyone who has undergone a bone marrow transplant or stem cell transplant are automatically qualified for SSD.
There are many neurological disorders whose qualifications are outlined by the SSA, including:
- Cerebral Palsy: If your IQ is less than 70, the CP causes severe emotional or behavioral issues, or if it makes it impossible to see or hear in order to work, then you may qualify for SSD benefits.
- Epilepsy: Depending on the type and frequency of your seizures, you may qualify for benefits. According to the SSA:
- Grand Mal seizures must still be occurring at least monthly despite three months of ongoing treatment. The residual after effects must show to interfere with normal functioning.
- Petit Mal seizures can be covered if the seizures are occurring more than once a week despite ongoing treatment. The seizure must result in the loss of consciousness, alter the general state of awareness, or cause behavioral issues.
- Parkinsonian Syndrome: If you have the following signs, you qualify for benefits:
- Long term disturbance of fine motor skills.
- Long term disturbance of gross motor skills.
- Disturbance of gait.
- Tremors in multiple extremities.
- Myasthenia Gravis: If the myasthenia gravis causes difficulty swallowing, breathing, speaking, or severe muscle weakness, you may qualify for benefits.
Other neurological conditions that are commonly claimed on SSD forms include:
- Traumatic Brain Injury
- Chronic Migraines
- Transverse Myelitis
- Motor Neuron Disease
- Tourette’s Syndrome
Respiratory System Disorders
When you can’t properly breathe, you are unable to take in the required about of oxygen that is needed to function during everyday tasks. The SSA understands the seriousness of respiratory conditions and when evaluating a claim, takes into consideration:
- How long the patient has had the condition.
- What treatments have been attempted or could be attempted.
- How long the condition will last.
Respiratory conditions that frequently render a worker disabled include:
- Asthma: Serious asthma attacks must occur at least once every two months. The attack is considered severe if medical intervention and hospitalization is required.
- Cystic Fibrosis: If you’ve been diagnosed with CF and you have had at least six episodes of bronchitis, pneumonia, or hemoptysis in a year, you may qualify for disability benefits. If an episode requires more than 24 hours of hospitalization, this can count as two episodes.
- Sleep Apnea: Depending on the circumstances, sleep disorders can be reviewed as a mental or respiratory disorder.
- Chronic Pulmonary Insufficiency: Your weight, height, and breathing capacity will be reviewed. The SSA may request additional blood and respiratory tests.
Additional respiratory conditions that have been claimed include:
- Acute Respiratory Distress Syndrome
- Pulmonary Tuberculosis
The attorneys at the Disability Guys have helped thousands of clients that have been diagnosed with a respiratory condition obtain the benefits they need from Long Term Disability. Even if your condition isn’t listed above, we can help.
The idea of a skin disorder being so terrible that a patient is unable to work is difficult for many to grasp – until it happens to them. Skin disorders can cause extreme physical pain, emotional trauma, and mental anguish. Conditions that are listed in the Blue Book include:
- Bullous Disease: This condition, which causes large fluid-filled blisters, often impacts areas like the armpits, upper thighs, and abdomen. In order to qualify for benefits, the applicant must have the lesions for at least three months over a large percentage of the body.
- Burns: Burns must be severe enough to have lasted and required treatment for one year or are expected to last one year.
- Dermatitis: After three months of suffering from dermatitis, you may qualify to receive benefits.
- Photosensitivity Disorders: For example, the condition xeroderma pigmentosum automatically qualifies you for disability from birth. Other disorders are evaluated on a case by case basis.
Additional skin disorders that have been covered by long term disability include:
- Chronic Skin Diseases
If you have been suffering from a skin disorder, contact The Disability Guys to learn more about how we can help you obtain the benefits you need.
Special Senses Disorders
There are many disorders that can impact the “special senses”, which include vision, hearing, speech and balance. Examples include:
- Macular Degeneration
- Meniere’s Disease
If you are unable to speak, hear, see, or if you have a disorder that causes dizziness, our legal team may be able to help you obtain benefits.
Long Term Disability isn’t just for physical conditions. There are many categories in the Blue Book under mental disorders that could qualify you for benefits, including:
- Affective Disorders: These disorders are also known as mood disorders. Generally speaking, you must have documentation that shows that you have been undergoing treatment for two years and cannot function outside of that supportive environment.
- Anxiety Disorders: In order to qualify for an anxiety disorder, you must show evidence that you have at least one of the following symptoms – constant irrational fear, recurring weekly panic attacks, compulsions and obsessions that prevent you from functioning and cause serious distress, or constant anxiety with symptoms.
- Autism: In order to qualify for benefits, it must be shown that you have difficulty communicating and that you have issues functioning in a normal work environment.
- Mental Retardation: If medical documentation shows an IQ of less than sixty, or issues operating independently, or in IQ of less than 70 in combination with other medical issues, SSD benefits can be obtained.
- Personality Disorders: The personality disorder must prevent you from adapting to a normal work environment and must have caused long term issues. One of the following must be occurring:
- Constant mood disturbances
- Unreasonable suspicion
- Autistic thinking
- Impulsive behavior
- Psychotic Disorders: Medical evidence must show that you have had the condition for two or more years and that it severely impacts your ability to function in a work environment.
- Somatoform Disorders: These mental disorders manifest with physical symptoms. Medical evidence supporting this and showing that the physical symptoms have lasted for several years, causing significant lifestyle changes must be presented.
Disorders that haven’t been specifically listed but have qualified other applicants for long term disability benefits include:
- Asperger’s Syndrome
- Drug Addiction
- Memory Loss
- Social Anxiety
- Postpartum Depression
Seeking legal help with your claim for a mental disorder is a great first step towards getting the help you need through Long Term Disability.
What Should I Do If My Condition Isn’t Listed In The Blue Book?
Many Long Term Disability applicants do not have a condition listed in the Blue Book or their condition is listed and they don’t meet the criteria to be considered disabled for that condition, yet they are disabled because they suffer from more than one medical condition and the combination results in disability.
Keep in mind that while most of the conditions listed in the Blue Book have a duration which specifically lists how long the patient must have had the condition in order to be considered disabled, patients who have conditions not listed or a combination of conditions that result in disability must show that they have been impacted or are expected to be impacted by their medical conditions for at least 12 consecutive months.
These applicants must also prove that their medical conditions are severe enough to prevent them from returning to work. The first step to accomplishing this is to ensure that medical records are complete and that the issues causing disability are well documented by all treating physicians. These medical records will be carefully reviewed and any missing records or mistakes in a record could result in a delay or denial of benefits.
If you are fighting for Long Term Disability Benefits for a condition that isn’t listed in the Blue Book, you may want to improve your chances of receiving approval by consulting with an experienced attorney.
How Can An Attorney Help Me?
You’re already dealing with a serious medical disorder, the last thing that you need on your plate is the stress of collecting all of the evidence that is needed to support your claim. Our legal team knows exactly what is needed to show that you should be covered by Long Term Disability and we are always prepared to present this evidence during your hearing.
Our legal team will walk you through the process of filing for these benefits step by step and will help answer any questions that you may have.
We understand that this process is long, dehumanizing, and upsetting. We understand the financial and physical stress you are under. That’s why we take a personal approach to every case. You aren’t “just another applicant” to us.
How Long Does It Take To Obtain A Decision?
This is a very difficult question to answer. If you have a clearly disabling medical condition and can provide the necessary paperwork, you may be awarded benefits in as little as 30 days. However, claims are not always approved this quickly and it can take months or even years to obtain benefits.
Contact Our Local Law Firm For A Free Consultation
To discuss your situation and the potential legal steps you can take to receive help, contact The Disability Guys today for your free Long Term Disability Consultation.