If you are applying for disability benefits with the Social Security Administration (SSA), you may qualify on the basis of medical evidence alone if you are not working and you have an impairment that is as medically severe as an impairment listed in the SSA's Listing of Impairments (also known as the Blue Book). In other words, you can qualify for disability regardless of your age, education, work experience, or whether your doctor says you have functional limitations (such as not being able to lift objects or walk).
For instance, if you have a liver transplant (listing 5.09), the SSA won't look to whether or not you can work; you will simply be approved for disability benefits for one year.
What Is In the Blue Book?
The Blue Book describes, for each major body system, the impairments that are considered severe enough to keep an adult from working (in SSA-speak, from doing any gainful activity). In the case of a child under age 18 applying for Supplemental Security Income (SSI), the Blue Book details the impairments that will be approved for disability benefits because they cause severe functional limitations. The criteria for the impairments for adults and children are set out separately in the Blue Book.
How Long Must Your Impairment Last?
Most of the impairments listed in the Blue Book are permanent (or expected to result in death) unless a listing refers to a specific duration. Otherwise, the medical evidence must indicate that the impairment has lasted or is expected to last for the duration of 12 consecutive months.
How Do You Meet or Equal a Listing?
Receiving a diagnosis of an impairment listed in the Blue Book is not enough to establish that you are disabled. To meet a listing, you need to meet all the requirements set forth by the specific listing. In other words, the medical evidence must show that you have the same symptoms, clinical signs, and laboratory findings as the listed impairment. The SSA lists criteria for each listing to ensure that only the most severe impairments are approved for disability based on medical evidence alone.
If your impairment does not meet all the requirements of a listed impairment, you might still qualify for disability if the medical evidence shows that your impairment is equivalent in severity. Additionally, if you have a combination of impairments, but none of them alone meets a listing, the SSA will consider whether your combined impairments are equal to the severity of a listed impairment. For example, you may have diabetes and back pain that are not that severe by themselves. However, in combination, the SSA might conclude that your diabetes and back pain are equal in severity to a listed impairment.
What Medical Evidence Is Required?
A determination as to whether a person's impairment can be considered to equal a listing must be based on medical evidence obtained by medically acceptable clinical and laboratory diagnostic techniques. As part of the disability application process, you are responsible for providing medical evidence to the SSA showing that your impairment is severe enough to prevent you from working.
The SSA is required to give the medical evidence from your treating doctors the most weight because these doctors are in the best position to provide a detailed longitudinal (long-term) history of your impairment. Therefore, it's in your best interest to obtain regular treatment from your doctor. If, however, you have not received regular treatment, the SSA will order a "consultative examination" to supplement your record.
What If You Do Not Meet or Equal a Listing?
If the SSA does not find that you have an impairment severe enough to meet or equal a listing, you may still be found disabled at another step in the disability determination process. Although the medical evidence alone may not be enough to establish disability, the SSA will continue its evaluation by assessing your functional capacity for work and by considering your age, education, and work experience.
What Are the Major Body Systems Covered by the Blue Book?
The Blue Book is organized into two main parts. Part A describes the requirements for evaluating impairments in adults age 18 and over. Part B describes the requirements for evaluating impairments in children under the age of 18. This article describes the major body systems under the listings for adults:
Musculoskeletal System (Listing 1.00) impairments include major dysfunction of a joint, reconstructive surgery of a major weight-bearing joint, spinal disorders, amputation, fracture of the femur, tibia, pelvis, or tarsal bones, fracture of an upper extremity, and soft tissue injury such as burns.
Special Senses and Speech (Listing 2.00) impairments include loss of visual acuity, contraction of the visual field in the better eye, loss of visual efficiency, disturbance of labyrinthine-vestibular function, loss of speech, and loss of hearing.
Respiratory System (Listing 3.00) impairments include chronic pulmonary insufficiency, asthma, cystic fibrosis, pneumoconiosis, bronchiectasis, chronic persistent infections of the lung, sleep-related breathing disorders, and lung transplants.
Cardiovascular System (Listing 4.00) impairments include chronic heart failure, ischemic heart disease, recurrent arrhythmias, symptomatic congenital heart disease, heart transplant, aneurysm of aorta or major branches, chronic venous insufficiency, and peripheral arterial disease.
Digestive System (Listing 5.00) impairments include gastrointestinal hemorrhaging requiring blood transfusion, chronic liver disease, inflammatory bowel disease, short bowel syndrome, weight loss due to any digestive disorder, and liver transplants.
Genitourinary Impairments (Listing 6.00) refer to chronic renal (kidney) disease.
Hematological Disorders (Listing 7.00) include chronic anemia, sickle cell disease, chronic thrombocytopenia (low blood platelet count), hereditary telangiectasia (malformations of various blood vessels), coagulation defects (hemophilia), bone marrow disorders, and aplastic anemias with bone marrow or stem cell transplantation.
Skin Disorders (Listing 8.00) include ichthyosis, bullous disease, chronic infections of the skin or mucous membranes, dermatitis, hydradenitis suppurative (chronic disease of a sweat gland), genetic photosensitivery disorders, and burns.
Endocrine Disorders (Listing 9.00) include pituitary gland disorders, thyroid gland disorders, parathyroid gland disorders, adrenal gland disorders, and diabetes mellitus, and other pancreatic gland disorders.
Impairments that Affect Multiple Body Systems (Listing 10.00) refer to non-mosaic Down syndrome.
Neurological Impairments (Listing 11.00) include convulsive epilepsy, nonconvulsive epilepsy, central nervous system vascular accident, benign brain tumors, Parkinsonian syndrome, cerebral palsy, spinal cord or nerve root lesions, multiple sclerosis, amyotrophic lateral sclerosis, anterior poliomyelitis, myasthenia gravis (neuromuscular disease characterized by muscle weakness), muscular dystrophy, peripheral neuropathies, subacute combined cord degeneration, degenerative disease not listed elsewhere, cerebral trauma, and syringomyelia (damage to spinal cord due to formation of cyst).
Mental Disorders (Listing 12.00) include organic mental disorders (psychological or behavioral abnormalities associated with dysfunction of the brain), schizophrenic, paranoid and other psychotic disorders, affective disorders, mental retardation, anxiety-related disorders, somatoform disorders, personality disorders, substance addiction disorders, autistic disorder, and other pervasive developmental disorders.
Malignant Neoplastic Diseases (Listing 13.00) refer to cancers, and include soft tissue tumors of the head and neck, skin, soft tissue sarcoma, lymphoma, leukemia, multiple myeloma, salivary glands, thyroid gland, breast, skeletal system-sacrcoma, maxilla, orbit or temporal fossa, nervous system, lungs, pleura or mediastinum, esophagus or stomach, small intestine, large intestine, pancreas, kidneys, adrenal glands orureters-carcinoma, urinary bladder-carcinoma, cancers of the female genital tract-carcinoma or sarcoma, prostrate gland-carcinoma, testicles, penis, metastatic carcinoma or sarcoma, and malignant neoplastic diseases treated by bone marrow or stem cell transplantation.
Immune System Disorders (Listing 14.00) include systemic lupus erythematosus, systemic vasculitis, systemic sclerosis, polymyositis and dermatomyositis, undifferentiated and mixed connective tissue disease, immune deficiency disorders (excluding HIV infection), human immunodeficiency virus (HIV) infection, inflammatory arthritis, and Sjogren's syndrome.
How Can You Use the Blue Book To Help Your Claim?
If you think that you have one of the impairments listed in the Blue Book, read our article on the severity criteria for the particular listing, and then consult your doctor for help in documenting whether your impairment is severe enough to meet or equal one of the listings. For example, if you have not had some of the laboratory tests required by the listing, you should arrange to have them performed. Generally, the SSA requires quite a bit of medical evidence to decide if your impairment is as severe as one listed in the Blue Book. The more medical evidence you can provide to the SSA, the better your chances of being qualified for disability benefits.