What is a Pre-Existing Condition?

A pre-existing condition refers to a medical condition or disability that existed before your application for SSDI. This could include a wide range of conditions, such as:

• Chronic illnesses (e.g., diabetes, heart disease)
• Mental health conditions (e.g., depression, anxiety)
• Previous injuries (e.g., back injuries, fractures)
• Autoimmune diseases (e.g., lupus, rheumatoid arthritis)

The SSA evaluates whether your pre-existing condition qualifies as a disability under their definition, which requires that your condition:

• Prevents you from working or doing any substantial gainful activity (SGA)
• Has lasted (or is expected to last) at least 12 months or result in death

Can a Pre-Existing Condition Qualify for SSDI?

Yes, you can still qualify for SSDI benefits if you have a pre-existing condition, provided the condition is severe enough to meet the SSA’s disability criteria. The SSA will evaluate your condition based on the Listing of Impairments, which contains a list of physical and mental conditions that may qualify for disability benefits.

To qualify for SSDI with a pre-existing condition, you must show that:

• The condition has worsened over time to the point where it severely limits your ability to work, or
• The condition is severe enough by itself to prevent you from performing daily tasks and working full-time.

For example, if you have a pre-existing heart condition, you may still qualify for SSDI if the condition worsens to the point that it significantly limits your ability to perform work-related tasks like lifting, standing, or concentrating.

How Does the SSA Evaluate a Pre-Existing Condition?

The SSA will review your pre-existing condition in the context of its impact on your ability to work. Here’s how they typically evaluate a pre-existing condition:

A. Severity of the Condition

The SSA will consider the severity of your pre-existing condition and how it limits your ability to work. You will need to prove that your condition prevents you from performing substantial gainful activity (SGA), which means earning more than a certain income threshold.

B. Duration of the Condition

The SSA requires that your condition either has lasted for at least 12 months or is expected to result in death. If your pre-existing condition is chronic and is expected to last for a year or more, you may meet this requirement.

C. Medical Evidence

The most important factor in your application will be the medical evidence you provide. You will need to demonstrate through medical records, diagnostic tests, and doctor’s statements that your pre-existing condition is severe enough to meet the SSA’s criteria for disability. This includes:

• Treatment history: How long you’ve been receiving treatment and whether it has been effective.
• Doctor’s opinions: Statements from your doctors explaining how the pre-existing condition impacts your ability to work.
• Test results: Lab results, imaging, or other diagnostic tests that show the severity of your condition.

Special Considerations for Pre-Existing Conditions and SSDI

While having a pre-existing condition does not disqualify you from receiving SSDI, there are some special considerations to keep in mind:

A. The “Five-Month Waiting Period”

For SSDI claims, there is a mandatory five-month waiting period before you can start receiving benefits after your disability onset date. However, if you have a pre-existing condition that has been disabling for a long time, this waiting period may be less of a concern if you’ve already experienced long-term limitations due to the condition.

B. Aggravation of a Pre-Existing Condition

If your pre-existing condition is aggravated by another injury or illness, you may still qualify for SSDI benefits. For example, if you had a back injury in the past but a recent accident made the condition worse, the SSA will consider the overall impact of both your pre-existing condition and the new injury.

C. Evidence of Work History

The SSA also looks at your work history to determine whether you have worked long enough to qualify for SSDI. If your pre-existing condition prevented you from working at a level of substantial gainful activity, you may still be eligible, provided you’ve paid into the Social Security system during your employment.