Pre-Existing Conditions & Your Social Security Disability Claim
Applying for Social Security Disability Insurance (SSDI) involves proving that a medical condition prevents substantial work. When a pre-existing condition is involved, the Social Security Administration (SSA) looks at whether it contributes to the applicant’s current disability.
A previous diagnosis does not automatically disqualify someone, but it does add another layer of review. The SSA considers how the condition limits work-related activities rather than when it first developed.
Here at Leavitt Meunier Law LLC in Metairie, Louisiana, we’ll be able to help you through this process so you understand how to proceed accordingly.
How Pre-Existing Conditions Affect SSDI
Applicants should be prepared to present clear medical evidence showing how the condition has worsened or interferes with work. In some cases, symptoms that were once manageable may have become debilitating over time, making it impossible to maintain employment.
A well-documented claim with a thorough medical history can help establish the severity of the condition.
How the SSA Evaluates Pre-Existing Conditions
The SSA reviews medical records, employment history, and functional limitations to determine eligibility. If a condition worsens over time or contributes to a disabling condition, it may still qualify for SSDI.
Key factors the SSA considers include:
Whether the condition meets the criteria in the SSA’s Listing of Impairments
How the condition limits daily activities and job performance
Medical evidence supporting the claim, including doctor’s assessments and test results
The extent to which treatment and medication have improved or failed to improve symptoms
Testimony from medical professionals and vocational experts
The focus is not on when the condition began but rather on how it affects daily life and workability now.
Distinguishing Between Pre-Existing and New Conditions
Some applicants have a condition that existed before their disability claim but worsened significantly. Others may develop a new condition that interacts with an existing one, creating greater limitations. The SSA reviews all medical factors together to determine whether an applicant meets SSDI requirements.
For example, someone with arthritis may have managed the condition for years but now experiences severe mobility restrictions. If medical evidence supports this, the SSA may recognize the condition as disabling, even though it was pre-existing.
Likewise, conditions such as diabetes or cardiovascular disease may not have been disabling before but have progressed to a point where daily functioning is severely impacted.
The Influence of Medical Evidence
Medical documentation is critical in any SSDI claim. For those with pre-existing conditions, consistent medical records showing progression, treatment, and limitations help strengthen a case.
Supporting medical evidence often includes:
Imaging results, such as MRIs or X-rays
Physician statements detailing functional limitations
Treatment history, including medications and therapies
Records of hospitalizations or surgical interventions
Psychological evaluations for mental health conditions
Physical therapy or occupational therapy reports
The SSA considers records from doctors, specialists, hospitals, and rehabilitation providers. Without sufficient documentation, the SSA may assume the condition has not significantly impacted the applicant’s ability to work.
Work History and Functional Limitations
The SSA assesses whether an applicant can perform past work or adjust to a different job. When a pre-existing condition plays a role in a disability claim, work history and functional capacity become essential factors. If an applicant’s limitations prevent any substantial work, the SSA may approve the claim.
Some questions the SSA considers include:
Can the applicant perform their previous job duties?
Does the condition restrict physical or cognitive abilities?
Would reasonable accommodations allow for continued employment?
Are other jobs available that match the applicant’s abilities?
Applicants with a long and stable work history may have a stronger case, especially if they can show that they worked despite their condition for years but can no longer continue.
The SSA will also examine how symptoms interfere with essential job functions, such as lifting, standing, focusing, or interacting with coworkers and customers.
The Importance of a Doctor’s Support
A doctor’s evaluation can be a deciding factor in SSDI claims. Physicians who document symptoms, treatments, and functional limitations provide critical evidence for claim approval.
If a doctor states that a condition significantly limits work abilities, the SSA is more likely to recognize the claim’s validity. However, a lack of support from a physician can weaken a case, so it’s important to work with medical professionals willing to document the full extent of an applicant’s condition.
Common Pre-Existing Conditions Considered for SSDI
Many conditions may qualify for SSDI if they prevent substantial gainful activity. Some common pre-existing conditions reviewed by the SSA include:
Musculoskeletal disorders (e.g., arthritis, degenerative disc disease)
Cardiovascular conditions (e.g., heart disease, stroke complications)
Neurological disorders (e.g., multiple sclerosis, epilepsy)
Respiratory conditions (e.g., COPD, pulmonary fibrosis)
Mental health conditions (e.g., depression, PTSD, schizophrenia)
Autoimmune disorders (e.g., lupus, rheumatoid arthritis)
Endocrine disorders (e.g., diabetes, thyroid disorders)
We can help you understand if your condition qualifies.
The Five-Step Evaluation Process
The SSA follows a structured process to assess SSDI eligibility. Applicants with pre-existing conditions must go through the same five-step evaluation:
Substantial gainful activity (SGA): The SSA determines if the applicant is working and earning above the SGA threshold.
Severity of condition: The condition must significantly limit basic work activities for at least 12 months.
Listed impairments: The SSA checks whether the condition matches an impairment in its official listing.
Previous work ability: The SSA evaluates whether the applicant can perform past work.
Other work ability: If past work is not possible, the SSA assesses whether the applicant can adjust to new work.
Challenges in SSDI Claims Involving Pre-Existing Conditions
Applicants with pre-existing conditions sometimes face additional scrutiny. The SSA may argue that a condition was not severe enough to prevent work before, so it shouldn’t now. In these cases, medical evidence showing progression or worsening symptoms becomes essential.
Common challenges include:
Lack of recent medical records supporting claim severity
Inconsistent treatment history or gaps in care
SSA attributing limitations to aging rather than the condition itself
Difficulty proving how conditions interact to create disabling limitations
Conflicting opinions from SSA-appointed medical reviewers
We can argue on your behalf by pointing out specific details that help your claim.
Strengthening an SSDI Claim with a Pre-Existing Condition
A well-documented application improves the chances of SSDI approval. Steps to strengthen a claim include:
Keeping up with regular doctor visits and following prescribed treatments
Obtaining detailed physician statements about work limitations
Providing records that show worsening symptoms over time
Submitting statements from family or coworkers describing daily struggles
Working with vocational experts to assess work capacity
Our attorneys can review your application and make suggestions.
How an SSDI Attorney Can Help
An attorney can help applicants gather strong medical evidence, address SSA concerns, and prepare for appeals if necessary.
Understanding how the SSA reviews pre-existing conditions allows attorneys to present a clear case, reducing the likelihood of denial. A legal professional can also represent applicants in hearings and provide guidance throughout the process.
Appealing a Denied SSDI Claim
If the SSA denies an application, there are appeal options. Many claims involving pre-existing conditions are initially denied but later approved on appeal. The appeals process includes:
Request for reconsideration: A second review of the application with additional evidence.
Administrative law judge (ALJ) hearing: A hearing before a judge to present medical and vocational evidence.
Appeals council review: A higher-level review if the ALJ denies the claim.
Federal court appeal: A lawsuit filed in federal court if all other appeals fail.
Contact Leavitt Meunier Law LLC Today
A pre-existing condition does not automatically disqualify someone from SSDI. The SSA evaluates how the condition currently affects an applicant’s ability to work.
At Leavitt Meunier Law LLC, we’re located in Metairie, Louisiana, and serve clients throughout New Orleans, Metairie, Baton Rouge, Lafayette, Hammond, Alexandria, Shreveport, Monroe, Lake Charles, Northshore, Mandeville, Covington, and Madisonville. Call today to get started.