The Social Security Administration (SSA) has a very specific legal definition for disability. A medical diagnosis alone is not enough to get Social Security Disability Insurance (SSDI), and the process can take months before getting approval
The key requirements are:
- Severity of the condition
- Work limitations
- Duration of the illness
The SSA determines disability based on how disabled a person is, what they can and cannot do for work, and if the condition will last 12 months or longer, or end in the person’s death.
What the SSA Means by Disability
“Disability” is what prevents you from working. The SSA looks at how disabled you are, what kind of work you can or can’t do, and if you are long-term disabled. That is, if your condition is expected to last longer than 12 months or is terminal.
The condition must be medically determinable, or demonstrable with medical evidence. Symptoms alone are not enough to qualify for disability.
What Is Substantial Gainful Activity?
This is the SSA’s “litmus test” for determining whether an individual earns too much for SSDI.
The SSA examines if a person can engage in substantial gainful activity (SGA) to support themselves with meaningful employment. If a person is unable to do the job they were doing, how much can they do in a different occupation? Can they support themselves with this occupation?
If a person is currently working and earning more than SSDI would provide, they are likely engaged in SGA and don’t need SSDI.
For 2026, the monthly SGA amount is $1,690 for non-blind individuals and $2,830 for statutorily blind individuals. If a person earns above that, they are generally able to support themselves, including through part-time work. The individual who earns substantially less may be approved.
What Counts as a Medically Determinable Impairment?
The SSA does not rely only on a claimant’s description of their symptoms. To be awarded SSDI, you must provide medical evidence from acceptable medical sources, including medical records, imaging, diagnostic tests, and exam findings.
Ongoing medical treatment and accompanying documentation are also required to demonstrate treatment for a verified and documented condition.
Why Duration Matters
Long-term disabilities are those that will last, or are expected to last, for 12 continuous months. The SSA also approves claims for conditions expected to end in death. Short-term and temporary conditions don’t qualify for SSDI.
For instance, pregnancy or a broken leg that will heal in less than 12 months would not qualify for SSDI. Longer-term illnesses, such as cancers or a terminal condition, are more likely to be approved.
The SSA’s Blue Book
The SSA has a listing of impairments, called the “Blue Book,” with the criteria for each type of condition. This is the SSA’s medical guide listing all the medical conditions severe enough to qualify for disability. The Blue Book is the framework for the SSA to consider each claim for approval or denial.
Part A is for adults, and Part B is for children. The guide breaks down impairments by system, such as musculoskeletal, respiratory, cardiovascular, etc.
An individual is not automatically denied if they do not meet all the listing’s criteria. Some conditions may meet a listing if they are severe enough. The SSA may still approve a claim based on a person’s functional limitations.
How the SSA Reviews Disability Claims
The SSA has a five-step sequential process to determine if someone is qualified for SSDI in order:
- How much substantial gainful activity (SGA) a person is doing
- The severity of the impairment(s)
- Checking the impairments against the Blue Book listings
- Prior relevant work and employment, and an assessment of Residual Functional Capacity, or RFC, establishing what someone can do despite their limitations, to determine if the person can still perform other jobs held in the prior 15 years
- Other work capacity, or the type of employment someone could adjust to doing, taking into account a person’s age, education, and work experience
The SSA will examine all aspects of your claim to decide.
Common Mistakes That Hurt Claims
Even if you believe you have everything you need for your claim, make sure to avoid these mistakes that can lead to denial:
- Filing without enough medical evidence
- Assuming a diagnosis automatically qualifies as a medically determinable impairment
- Working above the SGA limit
- Missing treatment appointments or having gaps in care
- Failing to explain how the condition limits daily activities and work
A VA disability attorney can prepare you for the stages and ensure that your claim is completed correctly for the best possible results.
How a Disability Lawyer Can Help
Claimants are not required to have a disability lawyer, but can benefit from getting legal help. A disability lawyer can:
- Help gather and organize medical evidence
- Identify whether your condition meets a Blue Book listing or qualifies based on functional limits
- Strengthen your application and appeals record
- Improve the odds of avoiding preventable denials
Getting help early in the process will make it easier and give you one less thing to do while you’re taking care of yourself.
Let Herren Law Help with SSDI
Social Security Disability requirements are more than just a diagnosis. Your claim must show that you are unable to work, back it up with medical evidence, and explain how long you will be disabled.
Unsure about SSDI? Attorney William Herren is a disability attorney who has helped over 6,000 Houstonians get the benefits they deserve. Call The Herren Law Firm today at 713-682-8194 (or use our online contact form) to schedule your free consultation. We’ll discuss your case for free, and there’s no obligation. You’ll only owe us a fee if we win your case.
