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Is a specific diagnosis necessary for SSDI benefits eligibility?

On Behalf of | Oct 16, 2024 | Social Security Disability

Social Security Disability Insurance (SSDI) benefits exist to protect people from financial hardship when they cannot work because of medical issues. However, many people find the idea of applying for SSDI benefits to be prohibitively intimidating. People worry that they may not receive approval from the Social Security Administration (SSA) when they apply.

They know that they can’t work, but they may question whether their medical condition is one of the ailments that the SSA recognizes as sufficiently debilitating. Particularly in cases where people have rare conditions or an unusually severe presentation of a medical condition that usually isn’t debilitating, they may worry that their ailment doesn’t qualify for SSDI benefits.

Does an applicant have to have a specific medical condition to be eligible for SSDI benefits?

The SSA provides a thorough list

There is an extensive list broken into multiple categories exploring various conditions that may qualify. Mental health disorders, musculoskeletal conditions, neurological disorders and respiratory illnesses are just some of the types of illnesses explored at length on the SSA website.

The organization recognizes specific conditions and symptoms as potentially qualifying medical conditions. However, applicants don’t necessarily have to have a malady that made it onto one of those numerous lists to qualify. Instead, what they need is medical documentation affirming the severity of their symptoms and how long medical professionals expect the condition to last.

The SSA considers each application on its own merits, not simply on the basis of the diagnosis reported. The same condition can be more debilitating in one case than the next. Therefore, a diagnosis alone is not necessarily an indicator of someone’s eligibility for benefits.

People worried that their rare condition may not qualify for benefits should still consider applying. The main factors are whether the condition should last for 12 months or longer and if it prevents the applicant from maintaining any sort of gainful employment. In some cases, specific conditions might qualify people for expedited application processing, but even then, they need documentation affirming how the condition presents and affects their ability to work.

Understanding how the SSA reviews medical conditions can give people the confidence they need to move forward with an SSDI application. Many people qualify for benefits despite having unusual conditions or particularly severe forms of conditions that otherwise may not qualify.