Pre-Existing Conditions & Your Social Security Disability Claim
When applying for Social Security Disability Insurance (SSDI), individuals with pre-existing conditions often wonder how their medical history will affect their claim. Pre-existing conditions can make the application process hard, but it’s important to understand how the Social Security Administration (SSA) evaluates these conditions and their impact on your ability to work.
Many applicants worry that having a pre-existing condition will automatically disqualify them from receiving SSDI benefits. However, the SSA evaluates each case based on medical evidence and work limitations, not just on the presence of a prior diagnosis.
Serving Metairie, Louisiana, our experienced SSDI attorneys at Leavitt Meunier Law LLC are here to help. Knowing how to present a comprehensive and well-documented case is key to improving your chances of success.
The Basics of Pre-Existing Conditions and SSDI Eligibility
A pre-existing condition is any medical issue that existed before you applied for SSDI benefits. The SSA doesn’t automatically deny claims based on pre-existing conditions, but it does assess how these conditions limit your ability to perform substantial gainful activity. To qualify for SSDI, you must demonstrate that your condition meets the SSA's definition of disability.
The SSA defines a disability as a condition that prevents an individual from engaging in SGA for at least 12 months or is expected to result in death. Therefore, when dealing with pre-existing conditions, the key factor is whether the condition has worsened to the point of being disabling.
Additionally, the SSA considers whether an individual can adjust to other types of work given their age, education, and work experience. This means that even if a pre-existing condition doesn’t fully prevent you from working if it significantly limits your ability to perform jobs for which you’re qualified, you may still be eligible for SSDI benefits.
How the SSA Evaluates Pre-Existing Conditions
When reviewing an SSDI claim, the SSA considers medical evidence that supports your inability to work. This includes medical records, test results, treatment history, and doctors' statements. If you have a pre-existing condition, the SSA will examine whether it has deteriorated or interacts with other conditions to prevent us from working.
Some factors the SSA considers include:
Progression of the condition: Has the condition worsened over time?
New complications: Are there new symptoms or secondary conditions that contribute to your disability?
Treatment history: Have you followed prescribed treatments, and have they been effective?
Impact on daily activities: How does the condition affect your ability to perform everyday tasks and maintain employment?
Consistency of medical evidence: Are your medical records consistent and comprehensive?
The SSA may also request that you undergo a consultative examination to assess the severity of your condition further. This evaluation is conducted by an SSA-approved medical professional who provides an independent opinion on your disability claim.
Common Pre-Existing Conditions Considered in SSDI Claims
Certain pre-existing conditions are more commonly seen in SSDI claims. These include, but aren’t limited to:
Chronic pain conditions: Conditions such as arthritis, fibromyalgia, and back injuries can worsen over time, making it difficult to work.
Mental health disorders: Depression, anxiety, and bipolar disorder may have existed before applying for SSDI but can become severe enough to prevent gainful employment.
Heart disease: Individuals with pre-existing cardiovascular conditions may experience worsening symptoms that limit their physical capacity.
Diabetes and related complications: Diabetes can lead to significant complications, such as neuropathy or vision loss, which impact your ability to work.
Respiratory conditions: Chronic obstructive pulmonary disease (COPD) and asthma can severely affect your ability to perform physical activities.
Neurological disorders: Conditions such as epilepsy, multiple sclerosis, and Parkinson’s disease can progressively impact your functional abilities.
Strengthening an SSDI Claim with a Pre-Existing Condition
While pre-existing conditions may complicate the application process, there are several steps you can take to strengthen your SSDI claim:
Comprehensive medical documentation: Gathering thorough and up-to-date medical records is crucial. These records should demonstrate the severity and progression of your condition.
Consistent medical treatment: Following prescribed treatments and attending regular medical appointments show that you’re actively managing your condition.
Statements from medical professionals: Supporting statements from treating physicians can provide valuable insight into how your condition limits your ability to work.
Work history documentation: Demonstrating how your condition has affected your ability to maintain employment can provide additional support for your claim.
Daily activity logs: Keeping a record of how your condition affects your everyday life can provide detailed insight into your limitations.
Legal representation: Working with a knowledgeable SSDI lawyer can help work through the challenges of filing a claim and presenting a strong case to the SSA.
Potential Challenges and How to Overcome Them
One of the primary challenges individuals with pre-existing conditions face is the misconception that the SSA will automatically deny their claim. This belief can discourage applicants from pursuing the benefits they rightfully deserve. However, it’s important to understand that medical evidence and legal support can significantly improve your chances of success.
Another common issue is the lack of sufficient medical evidence. Without thorough documentation, proving the severity of your condition can be difficult. Making sure that you have comprehensive and consistent medical records that reflect the progression of your condition is crucial.
Many SSDI claims involving pre-existing conditions are initially denied. This can be frustrating, but it’s not the end of the road. The appeals process allows us to present additional evidence and address any concerns raised by the SSA. With persistence and the right legal representation, a denied claim can be overturned.
Inconsistent medical records can also pose a challenge. If different healthcare providers have recorded conflicting information about your condition, the SSA may question the legitimacy of your claim. Regular visits to the same providers and clear communication about your symptoms can help maintain consistency in your medical records.
Finally, insufficient work credits can prevent us from qualifying for SSDI. The SSA requires a certain number of work credits based on your employment history to be eligible for benefits. If you don’t meet these requirements, exploring other options such as Supplemental Security Income (SSI) may be necessary.
How Family and Caregivers Can Help in the SSDI Process
Family members and caregivers can play a crucial role in supporting your SSDI claim. They can provide important insights into how your condition affects your daily life and overall functioning. Statements from those who witness your struggles firsthand can offer valuable evidence that strengthens your claim.
In addition to providing statements, family members can help you stay organized by keeping track of medical appointments, managing medications, and making sure that you follow treatment plans. Their support can demonstrate to the SSA your commitment to managing your condition and the extent of your limitations.
Furthermore, caregivers can document changes in your condition over time and provide detailed records of how your ability to perform basic tasks has declined. This information can serve as powerful supplementary evidence in your claim.
Appealing a Denied SSDI Claim Involving Pre-Existing Conditions
If your SSDI claim is denied, it’s important not to lose hope. The appeals process provides an opportunity to present additional evidence and clarify any misunderstandings about your condition. During the appeals process, you can:
Request a reconsideration of your claim with updated medical records.
Present your case before an administrative law judge.
Seek further appeals if necessary.
Submit witness statements from family, friends, or coworkers who can attest to your limitations.
Having a skilled SSDI lawyer by your side can make a significant difference in achieving a favorable outcome.
Get in Touch Today
Having a pre-existing condition shouldn’t deter you from pursuing SSDI benefits. If you’re struggling with the challenges of the SSDI process, working with an experienced lawyer can provide the support and advocacy needed to secure them.
Luckily, Leavitt Meunier Law LLC is on your side. We serve clients in Metairie, Louisiana, and throughout New Orleans, Metairie, Baton Rouge, Lafayette, Hammond, Alexandria, Shreveport, Monroe, Lake Charles, Northshore, Mandeville, Covington, and Madisonville. Contact our firm today.