If you want to apply for disability benefits but aren’t sure whether you qualify, a good place to start is to understand what’s considered a disability for Social Security.

While the SSA’s rules can be confusing, this article explains the disability definition, rules, and what’s needed to prove a disability.

Read on for a better understanding and next steps.

Definition of a Disability by the SSA

The Social Security Administration (SSA) has specific criteria to decide if you qualify for one or both of its disability programs. You must have a physical or mental condition that prevents you from working and earning an income.

The SSA wants to know if you can do substantial gainful activity (SGA). In 2026, it defines GA as earning $1,690/month or $2,830 of you’re blind gross income. If you earn more than the SGA limit, you’re not considered disabled. Also, your condition must prevent you from working for at least 12 months or be expected to result in death. Unlike private insurance or workers' compensation, there’s no partial or short-term disability.

How the Social Security Administration Decides Disability Claims

SSA field offices and state agencies, called Disability Determination Services (DDS), process disability claims. SSA workers verify non-medical requirements such as your age, employment, marital status, and Social Security coverage. DDS examiners and medical staff collect medical evidence from your sources and decide your claim.

Quick SSA Disability Check

The SSA follows a five-step evaluation process to determine if you have a qualifying disability. In short, they follow this checklist:

1. Are you working full-time or earning above SSA’s limit?
2. Do you have a medically proven condition?
3. Is your condition on SSA’s “Listings?”
4. Can you still do your past jobs?
5. Could you switch to any other job?

Medical Evidence and Documentation Required

When evaluating your claim, DDS will first see if your condition is on the SSA’s Listing of Impairments, or Blue Book. About 300 medical conditions are on the list. Each listing describes the medical evidence needed to prove it’s severe enough to determine you’re disabled.

Evidence includes a diagnosis from a doctor, psychologist, psychiatrist, or other medical professional, symptom patterns, lab tests, imaging scans, and treatment history, including hospitalizations. The documentation must be current and relevant. Your evidence needs to show your limitations, not just your symptoms.

Examiners also look at your medication history and side effects. They may schedule a consultative examination (CE) with a provider in their service if more evidence is needed.

When Your Condition Doesn’t Match a Listing

If your condition isn’t on the list, don’t worry, that’s common. In these cases, examiners see if your conditions are as severe as a listing. They use a Residual Functional Capacity (RFC) assessment to see how your symptoms affect your ability to work.

Residual Functional Capacity (RFC) Criteria

The RFC shows what you can do in a typical day, despite your limitations. It evaluates physical and mental limitations, symptoms, medical evidence, and non-medical evidence, such as statements from you, family, and other sources.

The RFC also considers factors such as your age, education, and work experience to determine whether you could switch to other types of work. 

What If Your Condition Fluctuates?

Symptoms from many conditions change day-to-day. If you are dealing with a physical condition like an autoimmune disorder or a mental health issue that causes good days and bad days, it’s crucial to document your condition’s impact over time. Record days with flare-ups. Be specific. What can you do these days? What can’t you do these days?

Examiners look for specifics such as “when I have a flare-up, it’s hard to get out of bed and dress myself,” or “my brain fog is so strong, I can’t remember what I’m doing.”

Why Daily Limitations Matter More Than Diagnosis

Proving a disability requires more than a diagnosis. The diagnosis is a starting point. The RFC is a measure of your functional capacity in the real world.

• Can you sit, stand, walk, or lift things for eight hours a day?
• Can you concentrate, follow directions, and learn new things?
• Do you struggle to be around people or leave your house?

All limitations that affect your ability to do SGA are important to share.

For example, if you’re a 55-year-old warehouse worker with degenerative disc disease who now can’t safely lift more than ten pounds, you clearly can’t do your previous work. Similarly, if you’re a teacher with major depressive disorder experiencing prolonged episodes, you can’t be in a classroom eight hours a day.

Can You Do Previous Work or Switch Jobs?

The SSA looks at your work history, education, and age to determine if you can do your previous work or switch to another type of work (in theory).

For example, if you’re young and highly educated, your skills may be transferable to other jobs. Maybe you could do more sedentary work. But if you’re older, the SSA realizes it’s much harder to switch to a new line of work.

How an Advocate Helps Gather RFC-Supporting Evidence

Direct Payment to Eligible Non-Attorney Representatives (EDPNAs) understand what the SSA needs to see and can help you gather strong evidence to support the RFC. How a disability representative can help:

• Gathering and reviewing records: Advocates gather medical records, doctors' reports, and test results from hospitals, clinics, and specialists. They find any missing or incomplete evidence that could weaken a claim.
• Getting doctors’ statements: They’ll get detailed medical statements from doctors, psychiatrists, psychologists, and other providers. They can also explain legal requirements to providers and help them properly document your limitations. (Many providers aren’t familiar with SSA rules and criteria.)
• Streamlining the process: With signed HIPAA release forms, your advocate can directly request evidence, saving you time and reducing stress.
• Ensuring consistency: Consistency across statements, evidence, and opinions is key for successful disability claims. Advocates ensure the story is clear and well-supported.
• Highlighting limitations: An advocate combines evidence and statements to show how all of your health conditions impact your ability to earn an income.
• Supplementing evidence: If your medical records are insufficient, your advocate can suggest you see another provider to fill the gap. They can help coordinate medical exams if the SSA asks for a CE. Plus, they can also interview your family, friends, and former colleagues about your limitations.
• Organizing and presenting your case: Knowing exactly what DDS examiners are looking for, advocates organize your evidence to present a clear, strong case. Plus, your representative will follow up with the SSA and keep you updated.

Applying for Disability Benefits

If you’re ready, you can apply for disability insurance benefits online at www.ssa.gov or call 800-772-1213. You can also go to your local SSA office to apply in person or get the forms to mail in. Applying is free of charge.

Still unsure if you qualify for disability benefits or overwhelmed by the application process?

Help is here for you. Advocate can help you prepare and submit a strong case.