Some Illnesses Automatically Qualify for Social Security Disability Benefits

The Social Security Administration has a list of the most serious medical conditions that will be fast-tracked for approval for financial assistance.

Author Attorney Greg Reed:
Updated: 9/25/2023

Applying for Social Security Disability can be a long and rigorous process, but did you know that some disorders are so severe they almost automatically qualify for benefits?

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The Compassionate Allowance program identifies medical conditions that meet its criteria for disability, reducing the waiting time for disability determination.

The Social Security Administration’s definition of disability – “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months” is applied to all impairments in its Blue Book.

The Compassionate Allowance program (CAL) identifies diseases and medical conditions that meet its criteria for disability, reducing the waiting time to reach a disability determination. As a result, the Social Security Administration is able to provide assistance on an expedited basis to applicants with the most serious disorders.

Compassionate allowance diseases and medical conditions include advanced and aggressive cancers, brain disorders, chromosomal abnormalities and rare pediatric diseases.

Some examples of compassionate allowance conditions are:

•   Stage IV breast cancer
•   Lou Gehrig’s disease (ALS)
•   Acute Leukemia
•   Gallbladder cancer
•   Small cell lung cancer
•   Pancreatic cancer
•   Adult non-Hodgkin Lymphoma
•   Adult brain disorders
•   Early-onset Alzheimer’s disease
•   Heart transplant failures and wait list

On August 14 2023 the SSA added some additional impairments to its Compassionate Allowances List

•   1p36 Deletion Syndrome
•   Anaplastic Ependymoma
•   Calciphylaxis
•   Cholangiocarcinoma
•   FOXG1 Syndrome
•   Leber Congenital Amaurosis
•   Metastatic Endometrial Adenocarcinoma
•   Paraneoplastic Cerebellar Degeneration
•   Pineoblastoma – Childhood
•   Primary Omental Cancer
•   Sarcomatoid Carcinoma of the Lung – Stages II-IV
•   Trisomy 9

Social Security updates its list of compassionate allowance conditions regularly using input from the public, counsel from medical experts, research from the National Institutes of Health, the Social Security and Disability Determination Service communities and information from public outreach hearings.

For a full list of conditions considered under the CAL program see: https://www.ssa.gov/compassionateallowances/conditions.htm.

If you have been denied disability don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.

The process for applying for a Compassionate Allowance is the same as applying for Social Security Disability or Social Security Income; there is no separate application.

First, check the Compassionate Allowance condition list on the Social Security Administration’s website to confirm that your disorder is included. Clearly state the illness on your claim and note on your application “Compassionate Allowance Claim.” Social Security will flag the claim automatically and process it within weeks instead of months.

As with other SSDI claims, you will need to fill out the application carefully and thoroughly. Social Security will want to see the following medical evidence:

•   Reports from medical providers confirming the diagnosis
•   Exam results
•   Bloodwork
•   Surgery reports
•   Biopsy results
•   X-rays, CATs, MRIs
•   Cognitive test results (for Alzheimer’s)
•   Treatments and therapies implemented, such as chemotherapy and radiation)

The Social Security Administration also considers an applicant’s financial situation, so if you earn above Substantial Gainful Activity (SGA), which in 2024 is $2590 for statutorily blind individuals and $1550 for non-blind individuals, your claim will be denied.

If a medical condition is not included under CAL, the Social Security Administration allows applicants to propose their condition as a new listing for consideration.

To suggest a disease or condition for addition to the Compassionate Allowance list you will need to submit:

•   Your contact information
•   Name of the medical condition
•   Alternate names for the condition
•   Description of the condition
•   Diagnostic testing, physical findings and ICD-10-CM coding (International Classification of Diseases) if available
•   Onset date of disease
•   Progression of disease
•   Treatment

Claiming a Compassionate Allowance is almost always enough to qualify for a disability determination.

An applicant may receive an award decision in as little as 10 days, but the average time for Social Security to process a compassionate allowance application was 19 days in 2018. Even though applicants receive a decision quickly and most receive Compassionate Allowance benefits from a few weeks to 2 months after the application is received, applicants will still have to wait five months after their disability onset date to receive retroactive benefits.

If you do not qualify for a Compassionate Allowance, Social Security has two other programs to fast-track applications.

  Quick Disability Determinations (QDD).

The Quick Disability Determination (QDD) program has been in use since 2008. The Social Security Administration runs each initial application through a predictive model algorithm. The algorithm takes into account the type of disability, date the disability started, the availability of medical evidence, and other factors to determine if the Social Security Administration will be able to process the case quickly. QDD cases are prioritized and expedited. The examiner for a QDD case does not have to have a medical consultant evaluate your file as would be needed for a standard claim. If your QDD claim is denied, it goes back through the standard determination process where a medical consultant will have an opportunity to view the claim.

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  Terminal Illness Program (TERI).

Terminal illness cases are those that are expected to result in the death of the applicant. TERI cases are handled on an expedited basis with special consideration for the emotional state of the claimant. An application does not need to state that an illness is terminal, but a Social Security claims examiner can refer an application to the TERI program when a doctor, family member, or friend states that the applicant’s illness is terminal, or if the applicant is in hospice care. Also, if an individual applies for disability with ALS (Lou Gehrig’s Disease), or AIDS, their application is processed under the TERI program.

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  Presumptive Disability Program

The previously described programs place the applicant’s cases on a fast-track where those cases are prioritized and may even be able to skip certain steps. The Presumptive Disability program does not fast-track the applicant’s case. Instead, it allows for disability payments and Medicaid coverage while eligibility is still being determined. Presumptive Disability is only paid to initial applicants to the Supplemental Security Income program who meet income requirements and have claims that are likely to be approved. If your claim ends up being denied for medical reasons, you will not have to pay back any benefits you have received. These programs help those who are unable to work maintain their financial situation.

If you have a serious illness or medical disorder listed under the Compassionate Allowance program, a qualified disability attorney can provide valuable assistance in filing your claim.

Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court – all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.