What Medical Conditions Qualify for Social Security Disability Benefits?
The Social Security Disability (SSD) benefits system can be complicated, especially when determining which medical conditions qualify for benefits in Pennsylvania.
The Social Security Administration (SSA) oversees the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs, both of which provide financial support to individuals with disabilities that prevent them from engaging in substantial gainful activity (SGA).
Our Social Security disability attorneys at the Law Office of Shabbick & Stehle in Bethlehem and Palmerton, Pennsylvania, can help explain the medical conditions that qualify for SSD benefits, the criteria used by the SSA to evaluate claims, and the application process.
An Overview of Social Security Disability Programs
The SSA administers two primary disability programs: SSDI and SSI. SSDI is available to individuals who have worked and paid Social Security taxes for a sufficient period, accumulating enough work credits.
SSI, on the other hand, is a needs-based program for individuals with limited income and resources, regardless of work history. In Pennsylvania, both programs follow the same medical eligibility criteria, which are outlined in the SSA’s Listing of Impairments (also known as the Blue Book) or through an assessment of residual functional capacity (RFC).
To qualify for either program, an individual must have a medically determinable physical or mental impairment that:
Prevents them from engaging in substantial gainful activity (SGA), defined in 2025 as earning more than $1,640 per month for non-blind individuals or $2,700 for blind individuals.
Is expected to last at least 12 months or result in death.
The SSA’s Listing of Impairments
The SSA’s Blue Book lists specific medical conditions and criteria that automatically qualify an individual for disability benefits if met. These conditions are organized by body system, and each listing includes detailed requirements regarding symptoms, test results, or functional limitations.
Below is an overview of major categories of medical conditions that may qualify for SSD benefits in Pennsylvania, along with examples of specific disorders. For additional information, contact a Social Security disability attorney.
Musculoskeletal Disorders
Musculoskeletal disorders affect the bones, joints, muscles, or connective tissues, significantly limiting mobility or physical function. Qualifying conditions include:
Major dysfunction of a joint: Severe arthritis, such as osteoarthritis or rheumatoid arthritis, causing chronic pain and restricted movement in joints like the hips, knees, or shoulders.
Spinal disorders: Conditions like degenerative disc disease, spinal stenosis, or herniated discs that cause chronic pain, nerve compression, or difficulty walking.
Amputations: Loss of two limbs or one limb with complications using prosthetics, impacting daily activities.
Fractures: Non-healing fractures of major bones (e.g., femur or pelvis) that prevent weight-bearing activities for at least 12 months.
For example, a Pennsylvania resident with severe lumbar spinal stenosis, unable to walk without assistive devices and experiencing chronic nerve pain, may meet the SSA’s criteria if medical imaging and clinical findings confirm the severity.
Cardiovascular Disorders
Heart and circulatory system disorders can qualify if they severely limit physical exertion or cause significant symptoms. Examples include:
Chronic Heart Failure: Reduced heart pumping capacity, leading to fatigue, shortness of breath, or fluid retention despite treatment.
Ischemic Heart Disease: Coronary artery disease causing angina or heart attacks, with stress tests showing significant limitations.
Arrhythmias: Recurrent irregular heartbeats causing fainting or severe fatigue.
Peripheral Artery Disease: Narrowed blood vessels reduce blood flow to limbs, impairing walking ability.
A Pennsylvania applicant with chronic heart failure, unable to perform light physical tasks and requiring frequent hospitalizations, may qualify if ejection fraction tests and medical records align with SSA criteria.
Respiratory Disorders
Respiratory conditions that impair lung function and oxygen delivery can qualify, such as:
Chronic Obstructive Pulmonary Disease (COPD): Severe airflow obstruction causing shortness of breath and low oxygen levels.
Asthma: Frequent, severe attacks requiring intensive treatment and hospitalizations.
Pulmonary Fibrosis: Scarring of lung tissue leading to reduced lung capacity.
Cystic Fibrosis: Chronic lung infections and reduced respiratory function.
For instance, a Pennsylvania worker with advanced COPD, requiring supplemental oxygen and unable to sustain work due to breathlessness, may meet the listing if pulmonary function tests show severe impairment.
Neurological Disorders
Neurological conditions affecting the brain, spinal cord, or nerves can qualify if they cause significant motor or cognitive limitations. Examples include:
Epilepsy: Frequent seizures (convulsive or non-convulsive) despite medication, impacting daily functioning.
Multiple Sclerosis (MS): Progressive symptoms like muscle weakness, coordination issues, or cognitive impairment.
Parkinson’s Disease: Severe tremors, rigidity, or balance problems limiting mobility.
Cerebral Palsy: Motor impairments affecting movement and daily activities.
Stroke: Residual effects like paralysis, speech difficulties, or cognitive deficits lasting over three months.
A Pennsylvania resident with MS, experiencing severe fatigue and inability to walk without assistance, may qualify if neurological exams and MRI results confirm the diagnosis and severity.
Mental Disorders
Mental health conditions can qualify if they severely impair cognitive, emotional, or social functioning. The SSA evaluates these under categories like:
Depressive, bipolar, and related disorders: Severe depression or bipolar disorder causing marked limitations in concentration, social interaction, or self-care.
Anxiety and Obsessive-Compulsive Disorders: Chronic anxiety, panic attacks, or OCD interfering with daily functioning.
Schizophrenia spectrum disorders: Hallucinations, delusions, or disorganized thinking impacting work ability.
Intellectual disorders: IQ scores below 70, accompanied by significant deficits in adaptive functioning.
Neurodevelopmental disorders: Conditions like autism spectrum disorder with severe communication or behavioral limitations.
For example, a Pennsylvania claimant with schizophrenia, experiencing frequent hospitalizations and inability to maintain employment due to delusions, may qualify if psychiatric records document the condition’s severity.
Immune System Disorders
Disorders of the immune system, including autoimmune diseases, can qualify if they cause chronic symptoms or complications. Examples include:
Systemic Lupus Erythematosus (SLE): Multi-organ involvement causing fatigue, joint pain, or kidney dysfunction.
Rheumatoid Arthritis: Severe joint inflammation and deformity limiting physical function.
HIV/AIDS: Opportunistic infections or significant functional limitations despite treatment.
Sjögren’s Syndrome: Severe dryness and systemic symptoms affecting daily activities.
A Pennsylvania applicant with lupus, experiencing kidney failure and extreme fatigue, may meet the listing if lab tests and medical records confirm organ involvement. For questions, please contact our Social Security disability attorneys at the Law Offices of Shabbick & Stehle.
Digestive Disorders
Chronic digestive conditions that cause significant complications can qualify, such as:
Inflammatory Bowel Disease (IBD): Crohn’s disease or ulcerative colitis with frequent hospitalizations, malnutrition, or obstructions.
Liver Disease: Chronic hepatitis or cirrhosis causing ascites, bleeding, or cognitive impairment.
Short Bowel Syndrome: Significant intestinal resection leading to malabsorption and weight loss.
For instance, a Pennsylvania resident with Crohn’s disease, requiring multiple surgeries and unable to maintain nutrition, may qualify if medical evidence shows ongoing complications.
Genitourinary Disorders
Kidney and urinary tract disorders can qualify if they cause chronic complications, such as:
Chronic Kidney Disease (CKD): Stage 4 or 5 kidney failure requiring dialysis or transplantation.
Nephrotic Syndrome: Severe protein loss causing edema and recurrent hospitalizations.
A Pennsylvania claimant on dialysis for CKD, unable to work due to fatigue and frequent treatments, may meet the listing with lab results showing reduced kidney function. If you have questions, our social security disability attorneys at the Law Offices of Shabbick & Stehle can help.
Hematological Disorders
Blood disorders causing severe symptoms or complications can qualify, including:
Sickle Cell Disease: Frequent pain crises or organ damage.
Hemophilia: Recurrent bleeding episodes requiring transfusions.
Bone marrow failure: Conditions like aplastic anemia can cause severe fatigue or infections.
For example, a Pennsylvania resident with sickle cell disease, experiencing frequent hospitalizations for pain crises, may qualify if medical records document the condition’s impact.
Skin Disorders
Chronic skin conditions causing extensive lesions or functional limitations can qualify, such as:
Chronic infections: Severe dermatological infections resistant to treatment.
Hidradenitis Suppurativa: Painful, recurrent lesions limiting movement.
Psoriasis: Extensive plaques causing pain or joint involvement.
A Pennsylvania applicant with severe psoriasis, unable to perform manual tasks due to joint pain, may qualify if dermatological records confirm the extent of the condition.
Endocrine Disorders
Hormonal imbalances causing significant complications can qualify, such as:
Diabetes Mellitus: Chronic complications like neuropathy, retinopathy, or amputations.
Thyroid disorders: Severe symptoms like heart complications or cognitive impairment.
For instance, a Pennsylvania claimant with diabetes, experiencing vision loss and neuropathy, may qualify if medical evidence shows uncontrolled complications.
Cancer
Most cancers qualify if they’re advanced, metastatic, or inoperable. Examples include:
Lung cancer: Stage III or IV with metastasis.
Breast cancer: Recurrent or metastatic disease.
Leukemia: Acute or chronic forms require ongoing treatment.
Lymphoma: Aggressive forms are unresponsive to therapy.
A Pennsylvania resident with metastatic breast cancer, unable to work due to chemotherapy side effects, may qualify under the SSA’s cancer listing.
Congenital Disorders
Conditions present from birth that affect development or function can qualify, such as:
Down Syndrome: Non-mosaic form with significant developmental delays.
Spina Bifida: Severe forms cause mobility or neurological impairments.
For example, a Pennsylvania adult with Down syndrome, unable to live independently or work due to cognitive limitations, may qualify under the listing.
Other Conditions
The SSA also evaluates conditions not explicitly listed in the Blue Book through an RFC assessment. This process considers how the condition limits the ability to perform work-related tasks, factoring in age, education, and work experience. Examples include chronic fatigue syndrome, fibromyalgia, or combinations of impairments that collectively prevent SGA.
Call a Social Security Disability Attorney
Qualifying for Social Security Disability benefits in Pennsylvania requires a medically determinable impairment that meets the SSA’s Blue Book criteria or significantly limits work ability through an RFC assessment. Our experienced Social Security disability attorneys at the Law Offices of Shabbick & Stehle in Bethlehem and Palmerton, Pennsylvania, can help you determine if you qualify. We also serve residents in Lehigh County, Northampton County, and Carbon County. Contact us today.