Social Security Disability & SSI: Definitions & Criteria

Here is Social Security's definition of disability: you are disabled when you are no longer able to perform a "substantial" amount of work as the result of a physical or mental impairment that is expected to last at least 12 months, or possibly result in death. To the Social Security Administration (SSA), a substantial amount of work, called "substantial gainful activity," is defined as making $1,550 or more per month (or $2,590 per month for people who are blind) in 2024.

The SSA looks for certain criteria in your medical records to see whether you can work a substantial amount—if you can't, you'll meet Social Security's disability definition. The criteria the SSA wants to see varies depending on the type of medical condition you have; for instance, cardiovascular, musculoskeletal, respiratory, cognitive, or emotional.

How Can You Meet Social Security's Definition of Disability?

The SSA has two main ways for you to show you meet Social Security's definition—in other words, that you can't do substantial gainful activity (SGA).

Meeting the Criteria of a Listing

The first way is kind of a shortcut to satisfying Social Security's definition of disability. If your condition or impairment meets the level of severity described in the Social Security medical listings book (called the Listing of Impairments), you can skip the rest of the steps in the disability process. The Listing of Impairments is the manual that describes dozens of conditions, ranging from arthritis and anxiety to asthma, heart failure, and depression. Satisfying the severity criteria published in the listing book guarantees you a disability approval.

But most disability applicants don't meet the criteria required in the listings. A disability applicant's medical condition must be very severe to win a disability approval based on meeting the disability criteria in the listing book. Instead, most individuals qualify for Social Security benefits the traditional way: by proving that the limitations caused by their disabling condition are severe enough that they're unable to perform any type of substantial gainful activity.

Showing Your Limitations Prevent Substantial Work

To determine whether you're able to perform SGA, Social Security will look first to see if you're capable of doing your last job, or past jobs you've had in the past five years. Social Security will look at your doctor's treatment notes, and any medical source statements from your doctors, to figure out what physical or mental limitations you have. If Social Security decides your limitations make it impossible to do your past work, they will assess whether you can do "other work." Social Security makes this decision by taking into consideration:

• your limitations
• your age
• your level of education, and
• the type of job skills you learned in the past.

For example, a 55-year-old man with an 11th-grade education who can't do his past work loading delivery trucks (for instance, because it requires heavy lifting) isn't expected to learn to perform other work that goes beyond the job skills he has. And individuals with severe cognitive or mood impairments (such as intellectual disorder or depression) aren't expected to perform other work that requires detailed attention and concentration.

Learn more about how Social Security decides if you meet the definition of disability.

What Medical Details Are Required to Meet the Disability Definition?

When you apply for disability, include a full listing of all of your medical conditions, your impairments, and your symptoms, as well as a list of all the doctors, hospitals, and clinics that have been involved in your treatment (along with their addresses and phone numbers).

The specific criteria for getting approved for various medical conditions are included in Social Security's Listing of Impairments. The criteria often include certain objective test results (such as blood tests, x-rays, MRIs, breathing tests, or exercise tests). It's important that your doctor is familiar with these criteria when ordering tests and submitting statements on your behalf. And you should know about the criteria in the listings as well. But you don't need to try to decipher the medical terminology in Social Security's listings. You can read our articles on the criteria required for each type of medical condition to qualify for benefits to see if you might meet them.

Beyond test results and diagnoses, Social Security is interested in the ways that your symptoms affect your ability to work. You aren't expected to do a job that's beyond your capabilities, mentally or physically. So it's important to explain to your doctor just how your condition limits your daily activities so your doctor can include this information in your medical records.

Learn more about the medical evidence used in disability cases.

Who Decides Whether You Meet the Disability Criteria?

Although you submit your disability application to Social Security, a different agency decides whether you're disabled. Social Security sends your disability application to a state disability agency, usually called Disability Determination Services, or DDS for short. At DDS, claims are assigned to disability specialists known as disability claims examiners. Examiners are the individuals who make the initial decisions on Social Security cases as well as the decisions on reconsideration (the first level of appeal, a paper review).

The disability examiner will do one or more of the following:

• Send letters to your medical sources (doctors, hospitals, and clinics) to request your medical records.
• Call you or your friends or relatives to gather information about your conditions (ADL calls).
• Confer with medical specialists (physicians, psychiatrists, or psychologists) employed by DDS about whether you meet the definition of disabled.
• Send you to a medical examination paid for by DDS if your medical records are missing key information.

What Are the Non-Medical Criteria for Social Security Benefits?

Social Security runs two programs: SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income).

Non-Medical Eligibility for SSDI

To be eligible for SSDI disability benefits, an applicant must have paid Social Security payroll taxes, or self-employment taxes, over a certain length of time. The number of years a worker is required to pay into the Social Security system varies by age, but someone who is 50 must have worked at least seven years, and someone who is 62 or older must have worked at least 10 years. An individual who meets this requirement will be considered insured (covered) for SSDI purposes.

A worker who stops working and paying Social Security taxes will lose their SSDI insurance after five years (or sooner for those 30 or younger). Workers who stop working must be able to show that their disability began before their insured status ran out or they won't be eligible for benefits.

Non-Medical Eligibility for SSI

To be eligible for SSI disability benefits, an applicant must have income and assets under the SSI program's strict limits and meet certain citizen or residency requirements.

You may want to take our disability quiz to help determine whether you may meet the medical and non-medical eligibility requirements for benefits.

What If Social Security Says I Don't Meet the Definition of Disability?

It's not uncommon for Social Security to deny an application in the first round. In fact, it's the norm: for about two decades, the amount of initial applications that are denied has hovered around 64%. Many claims are denied because the applicant's medical record lacks enough documentation to fully establish the severity of the disability.

If your application is denied, it doesn't make sense to reapply right away—a common mistake made by applicants for disability benefits. Instead, file an appeal, and make sure the necessary medical information is in your file this time (a disability lawyer or advocate can tell you what medical evidence will help you win an approval).

Learn more about appealing a denied disability claim.

Hiring a Disability Lawyer or Representative

Once you get a denial letter or notice of hearing for your appeal, you might want to seek the services of a qualified disability lawyer who can guide your case through the disability appeals process. Disability applicants with legal help have a much higher chance of winning at a hearing than those who are not represented (almost three times, according to a recent government study). Many disability lawyers offer free consultations before you hire them.

Learn more about hiring a disability lawyer.