How sick do you have to be to win Social Security Disability benefits?

social security disability

How sick do you have to be for SSDI?

I’m a Social Security Disability attorney, and I get this question a lot. People send me comments on YouTube, or they send me emails, and they describe various physical or mental health conditions and say, “Am I sick enough? Am I ill enough? Is my condition serious enough for me to win?”

Of course, every case is going to be looked at case by case, but let me just say it this way. We have to start by understanding how Social Security defines disability. It’s the inability to engage in what is called substantial gainful activity, or really, any kind of full time work, because of a medically determinable condition or conditions that has lasted, or is expected to last, 12 consecutive months, or result in death. I will tell you that, one of the things, again, about the definition, there’s a duration requirement. It’s got to be 12 consecutive months.

What do judges look for?

Very difficult to win based on the thought that your condition could be disabling or could keep you out of work for 12 consecutive months. Normally, what judges look for, and certainly the adjudicators at the state agency level, they look for people who’ve been out of work for at least 12 consecutive months. Knowing that there’s a duration requirement, if you have a condition that is likely to improve, then you’re going to have a problem winning disability benefits, and in fact, Social Security has changed the number of the listings.

I’m going to do another video about this, but in the endocrine listing, there’s a number of conditions — hypothyroidism, hyperthyroidism — that used to be listing level, and they changed it and made it non-listing level, meaning that you can’t win without going through the whole hearing process, basically, because the Social Security has determined that these conditions now are medically treatable and manageable, certainly to allow you to return to work within 12 months.

Again, if you have a condition, somebody wrote me the other day, “I have severe endometriosis.” Well, again, that’s a condition that doesn’t necessarily say it’s going to last 12 consecutive months. It might, but there’s certainly a possibility with treatment that it might not. While Social Security cannot require that you have surgery, your condition needs to be serious enough where it’s, at least, let’s call it, semi-permanent. I think the duration requirement’s a big issue.

The second thing is, how serious is it? Is it something that’s going to keep you from working? Again, there are certain conditions that are going to cause mild impairment. They’re going to be uncomfortable, and for vocational purposes, as vocational witnesses will testify, that if you have a mild level of pain, and that would be maybe a three or four on a 10-point scale, you can still do simple, entry-level type of repetitive work. It would not allow for something where you have to do a lot of analysis or decision-making, but if you’re doing the same, repetitive type of thing over and over, you can be uncomfortable. You can have a certain level of depression, but you’ve got to go more than that if you want to win disability.

What do I, an experienced Social Security Disability Attorney, look for?

Some of the things that I look for when I’m evaluating cases would be a condition that causes you to have to take frequent bathroom breaks — IBS, Crohn’s, colitis, that sort of thing — or even some sort of other gastrointestinal issues. Interstitial cystitis could be one, where you’ve got to go to the bathroom frequently, because vocational witnesses will testify, almost without exception, that if you have to take a bathroom break once an hour, that is too much. No unskilled employer … No unskilled job supervisor’s going to let you take that many breaks.

I think if you have radiating pain into your arms or legs, that suggests a severe disc issue, and that would be, again, you’d want to have an MRI or a CT, some sort of objective evidence backing that up, but if you’ve got radiating pain, that’s kind of shorthand for a judge that you’ve got something really serious going on.

Diabetes that’s uncontrolled, and uncontrolled over time, because diabetes is one of these conditions that if you have really high blood sugar for two, three, four years, it’s going to start impacting organs, it’s going to affect your eyesight, it’s going to cause permanent nerve damage in your hands and feet, and again, if you testify that you have a hard time feeling your feet, or you can’t use your hands for fine motor manipulation, or you have blurred vision and you’ve had uncontrolled diabetes for two or three or four years, despite your best efforts to take medications and do what your doctor says, exercise and lose weight and so forth, a judge would likely believe that your diabetes is going to be disabling, and prevent you from being a reliable employee.

Circulatory system problems always, I think, give you a good shot at winning. Things like DVT, or anything related to blood pumping through your body, because again, these are conditions it’s hard to kind of work through that. You’re going to be fatigued. In the case of DVT or blood clots, you’re going to have to keep your legs extended. You can’t walk around very much, and again, that’s a practical problem when you’re trying to do an unskilled, entry level job. You’re not going to get any sort of accommodation, most likely, from your employer.

Heart problems are always strong cases. Congestive heart failure, problems with your heart pumping enough blood to keep your … where you have to keep your legs extended, that sort of thing. Cardiac issues, again, objectively determinable. You can take tests to see what’s going on there, and they don’t simply clear up on their own, so heart cases, serious heart problems, usually going to be winning cases.

Severe depression or PTSD, again, depression’s becoming more difficult. It’s got to be severe. What I look for would be in-patient hospitalizations, more than one, multiple suicide attempts, ongoing treatment, drug resistant, where you’ve tried multiple different drugs and you still cannot function in a normal fashion. But again, depression, you’ve got to have something more than just you’re taking medication for three or four years and you have crying spells periodically. I’m not minimizing, I’m just telling you that in this current climate, those cases just are not getting approved.

Obviously, MS, multiple sclerosis, where you’ve got interference with your ability to use your arms or your legs, those are strong cases.

You kind of get the sense that there’s obviously a lot more medical conditions that are winnable cases, but as you can see, there’s got to be something compelling in terms of your diagnosis. You’ve got to have objective evidence supporting that, and it’s got to be at a really, really serious level. The days where you could walk in and say, “I’m just in a lot of pain. I don’t really know why,” you’re not going to get approved. That’s why fibromyalgia, chronic, or I guess they used to call it chronic regional pain syndrome, that sort of thing, those are just much more difficult to win those cases nowadays.

Even conditions like lupus, or even HIV, which are somewhat manageable, and at times, can be difficult to win, unless you’ve got a lot of evidence supporting your contention that you would not be a reliable employee, so that’s really what I look at is a level of impairment or level of disease or disorder that is so severe, that there is extensive medical record, there’s objective medical evidence, and you’ve got really compelling testimony that you’ve tried your best to work through it, but you simply can’t.

That’s kind of a short answer to how sick do I have to be, how serious does my illness have to be, for me to win disability benefits.

I hope this helped

I hope you found this helpful. If you did, please give it a thumbs up on YouTube, like it on Facebook, and if you’ve not already done so, go to my website at ssdAnswers.com. Subscribe to my Free Secrets To Winning Disability Survival Kit. That’s a free download. If you have any questions, reach out to me through YouTube or Facebook. I’ll be happy to try to answer those, or prepare another video to answer your questions.

Until next time, this is Johnathan Ginsberg, wishing you the best. Thanks a lot.

Hi. This is Johnathan Ginsberg, and I hope you found this video helpful. If you’d like to know more about how to win your Social Security Disability case, I’d like to invite you to download my Secrets To Getting Approved Early Survival Kit that I created just for people like you. Currently, I’m making the Survival Kit available at no cost, and I encourage you to grab your copy now.

Some of the topics I cover include: how do I know if I have a case; is it the right time for me to file my claim; nine common mistakes that can doom your case; the three must-have arguments you use to win your case; and a topic that every disability claimant wants to know, how to avoid trick questions from the judge.

If you or a loved one need to win Social Security Disability benefits, you’ll find this Survival Kit essential reading. Download your Survival Kit right now and at no cost. Just visit ssdAnswers.com/survival, and sign up. It’s that easy. Please act now, and as always, I wish you the best.

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