Criteria for Determining SSD Eligibility

The criteria for determining eligibility for Social Security disability benefits are extremely strict and the Social Security Administration is reluctant to award such benefits even in the face of what you believe is compelling proof that you are, indeed, disabled. In short, you must be completely unable to do any kind of “substantial gainful work” for which you are suited, and the disability must be expected to last for at least a year or result in death.

Aside from the medical disability standards imposed by the government, you must also have worked long enough and recently enough at a job covered by Social Security in order to be eligible for benefits. The number of work credits you need depends on your age when you become disabled if you are less than 31 years old. For most workers, in general, you must have the same number of credits as you would need to qualify for social security retirement benefits, and have earned at least 20 so-called credits (or quarter year equivalents) in the last ten years.

If you have earned sufficient work credits to qualify for disability benefits, your application is reviewed by a physician and a disability evaluation specialist at the Disability Determination Services (DDS) office in your state, which will decide if you are entitled to receive benefit payments. This evaluation team will review reports submitted by your physician about your disability. Your physician will also be asked for information about the nature of your condition and when it began, the medical tests that have been conducted, as well as the treatment you have received. Your doctor will also be asked about how your condition limits your everyday activities and your ability to perform work related tasks such as walking, sitting, lifting, and carrying.

In many cases, a determination can’t be made by the DDS team without further information, and you may be required to take another medical examination. The Social Security Administration will make arrangements with a consulting physician to conduct the examination at no cost to you. In fact, the Social Security Administration pays for the cost of this examination and any other medical tests it may need, and may even pay for your travel expenses related to the examination.

In determining whether or not you are disabled under Social Security’s rules, the Social Security Administration ask five basic questions:

  1. Are you working? If you are and your earnings average more than $1,090.00 per month, you cannot generally be considered disabled.
  2. Is your condition so severe that it interferes with basic work related activities?
  3. Is your condition found on the Social Security Administration’s list of “disabling impairments?” If so, you are automatically considered disabled. If not, Social Security compares your disability to those on the list to determine if it is of equal severity to a listed condition. If it is, then your claim is approved; if not, the process goes on to the next question.
  4. Can you continue to do the work you did during the last 15 years? If the answer is yes, your claim is rejected. If the answer is no, the evaluation process goes on to ask the final question.
  5. Can you do any other type of work, when your age, education, past work experience and transferable work skills are taken into account? If you can, no benefits are awarded. But if you can’t, you will be entitled to receive disability payments.