If you’re seeking Social Security disability benefits (SSDI) or looking into your eligibility for SSDI, you may have heard mention of the “Blue Book.” The Blue Book is technically called “Disability Evaluation Under Social Security,” and is used by the Social Security Administration (SSA) in the determination of both SSDI and SSI claims. While the Blue Book started out as a physical book, today it’s all digital–and the full text is available online.
Table of Contents
The Blue Book spells out the disability criteria for a wide range of medical conditions. So, it can provide a helpful reference for someone applying for SSDI benefits. The criteria provide insight into whether an applicant is likely eligible for benefits, and also provides a guide to what the applicant will be required to prove. Social Security disability attorneys also use the criteria when challenging SSDI denials.
But, the Blue Book is not exhaustive. In other words, some applicants whose conditions or combination of conditions aren’t found in the Blue Book may still qualify for disability benefits. And, not everyone who is diagnosed with a listed condition is eligible for SSDI.
What’s in the Blue Book?
The Blue Book sets forth criteria in several categories, including:
- Musculoskeletal Disorders
- Special Senses and Speech
- Respiratory Disorders
- Cardiovascular System
- Digestive System
- Genitourinary Disorders
- Hematological Disorders
- Skin Disorders
- Endocrine Disorders
- Congenital Disorders that Affect Multiple Body Systems
- Neurological Disorders
- Mental Disorders
- Cancer (Malignant Neoplastic Disease)
- Immune System Disorders
There are separate criteria for each of these categories that apply only to children under the age of 18.
Within each category, different conditions have different specific criteria. For example, the Mental Disorders category has 11 separate sub-categories. For each, the applicant must provide medical documentation of the condition and show either a marked limitation of two of four listed criteria, an extreme limitation of one, or that the condition is “serious and persistent.”
Other Information in the Blue Book
The Blue Book also contains general information about disability claims, such as:
- The SSA’s definition of disabled
- How the determination process works
- How medical information is gathered and used
- Non-medical criteria such as work history
- The waiting period for SSDI benefits
- The differences between Social Security disability (SSDI) and Supplemental Security Income (SSI)
- Your options if your application for disability benefits is denied
- When people on SSDI or SSI may qualify for Medicare or Medicaid
- Information about working or participating in vocational programs while receiving disability benefits
This information can help you get an idea of whether you’re potentially qualified for SSDI based on factors outside the medical criteria. For example, if you don’t have sufficient work credits based on your age at the time you became disabled, you won’t be eligible for SSDI–even if you are medically qualified. However, you might still be eligible for SSI. Similarly, you may qualify for SSI based on age or disability, but still be ineligible because you earn too much money.
You’ll also find extensive information about the type of evidence required to establish an SSDI claim, including the difference between technical medical documentation and evidence of symptoms and related limitations.
Eligibility Analysis Can Be Complicated, Even with Clear Criteria
A listing of criteria for each category of disability may create the impression that examiners can run down a simple checklist and quickly determine whether or not an applicant qualifies for SSDI. In reality–as the description of the mental disorders criteria above illustrates–it’s often much more complicated than that. Some reasons the process may be complicated and the disabled worker may have to fight for benefits include:
- It is your responsibility to prove that each of the requirements is fulfilled, meaning that you must present clear and thorough medical evidence in support of each element
- Not every condition that may qualify a person for disability benefits is included in the Blue Book
- Sometimes a combination of conditions will qualify someone for SSDI even though the criteria weren’t met for any individual condition
Familiarity with the Blue Book, including the criteria for the particular condition you’ve been diagnosed with, the type of evidence required to establish that you fulfill those criteria, and what equivalencies you should draw if you are seeking benefits for a non-listed condition or a combination of conditions, can streamline the application and appeals process.
How Does the Blue Book Information Help Me?
As an applicant for SSDI or SSI, you can learn more about what the SSA expects from you and how to put together the right kind of evidence to support your claim from the Blue Book. But, the book is very long and complicated, and not every condition is addressed.
An expert tip from Doug Mann
If you’re preparing to apply for Social Security disability benefits, you should seriously consider working with an experienced Ohio SSDI attorney from the beginning. According to the Social Security Administration, just 33.8% of applications are approved on initial application. In other words, nearly ⅔ of SSDI applicants who want to continue fighting for benefits must take at least the first step in the appeals process. That can mean a significant delay.
Processing time for the initial SSDI application ranges from three to six months–occasionally longer if there is some cause for delay. If the claim is denied after six months, the applicant then has 60 days to request reconsideration. Reconsideration moves fairly quickly compared with other steps in the process, but has an extremely low approval rate. Getting through the initial determination and reconsideration takes at least several months, and perhaps a year. Then, the applicant can request an administrative law judge (ALJ) hearing.
The ALJ hearing stage has the highest approval rate, but it can take a very long time to reach that point. As of spring, 2023, the average wait time for a hearing in various areas of Ohio ranged from 10 months to 17 months. Then, the ALJ may take a few additional months to render a decision.
The upshot is that if your initial application is among the nearly ⅔ of Social Security disability applications that are denied in the first round, it can take two to three years–or even longer–to secure benefits. So, it’s in your best interest to make sure that your initial application is as complete and well-supported as possible.
To learn more, call 937-222-2222 or fill out the contact form on this page. The initial consultation is free, and there’s no obligation.