Your Essential Guide to SSDI Rules, Medical Reviews, and Regulations

Navigating Social Security Disability Insurance (SSDI) can be overwhelming—but with the right knowledge, you can take control of the process and make confident, informed decisions about your claim or appeal.

What Is SSDI and Who Can Qualify?

SSDI (Social Security Disability Insurance) is a federal benefit program providing monthly income to individuals who are unable to work due to a disabling medical condition. To qualify, applicants must:

• Be considered "disabled" by SSA's standards.
• Have earned enough work credits through payroll taxes.
• Be unable to engage in substantial gainful activity (SGA), meaning the condition prevents full-time work for at least 12 months or is expected to result in death.

The SSA uses a structured method to evaluate claims, involving regulations from the Blue Book, internal guidance known as POMS, and supporting legal acts.

Understanding the SSA Blue Book

The SSA Blue Book, officially titled Disability Evaluation Under Social Security, is a medical reference used to determine whether a condition automatically qualifies for SSDI.

How the Blue Book Is Organized

The SSA Blue Book is divided into categories based on major body systems. Each section includes detailed criteria for what medical evidence is needed to qualify under that listing.

• 1.00 – Musculoskeletal System
• 2.00 – Special Senses and Speech
• 3.00 – Respiratory Disorders
• 4.00 – Cardiovascular System
• 5.00 – Digestive System
• 6.00 – Genitourinary Disorders
• 7.00 – Hematological Disorders
• 8.00 – Skin Disorders
• 9.00 – Endocrine Disorders
• 10.00 – Congenital Disorders that Affect Multiple Body Systems
• 11.00 – Neurological Disorders
• 12.00 – Mental Disorders
• 13.00 – Malignant Neoplastic Diseases (Cancer)
• 14.00 – Immune System Disorders

Each listing includes diagnostic criteria, medical test requirements, and functional limitations that must be proven with clinical evidence.

What is the SSA POMS Manual?

The Program Operations Manual System (POMS) is the official internal policy guide used by the Social Security Administration (SSA) to process disability claims and other Social Security programs. Unlike the Blue Book, which focuses on medical criteria, POMS provides detailed instructions to SSA claims representatives, Disability Determination Services (DDS), and judges on how to interpret laws, evaluate evidence, apply regulations, and make procedural decisions. It serves as a step-by-step operational manual for both technical eligibility and medical assessments.

POMS has evolved over decades as SSA policy has expanded. It includes updates based on federal regulations, case law, court rulings, and legislative changes. Each section in POMS is organized by subject and coded with a prefix such as DI (Disability Insurance), GN (General), SI (Supplemental Security Income), or NL (Notices), followed by section numbers. For disability claims, the DI series is the most relevant and includes key guidance on how to evaluate impairments, determine residual functional capacity, and handle Compassionate Allowance cases.

While POMS is written for SSA staff, it is publicly accessible in a redacted format and frequently used by attorneys, advocates, and claimants to understand how SSA applies rules in practice. Some content—such as internal security protocols, fraud detection procedures, or system access instructions—is reserved for SSA’s internal version and not available to the public for confidentiality and security reasons. You can browse the public POMS manual online at https://secure.ssa.gov/apps10/.

What Are DI Numbers in the SSA POMS Manual?

A DI number is a reference to a specific section within the Social Security Administration’s internal manual, called the Program Operations Manual System (POMS). These sections provide official instructions that SSA staff use to process disability claims, evaluate medical evidence, and apply legal standards. For example, DI 24580.020 explains how to evaluate Amyotrophic Lateral Sclerosis (ALS) under standard medical review procedures. Meanwhile, DI 23022.100 outlines how to process ALS as a Compassionate Allowance (CAL) case for expedited review.

It’s important to understand that DI numbers are not medical codes or condition identifiers. Instead, they are like chapter numbers in a policy book, guiding how SSA applies rules behind the scenes. Compassionate Allowance conditions are actually flagged using diagnostic codes (such as 335.20 for ALS) and internal workflows, not DI numbers. In legal or research contexts, you might see a citation like “SSA POMS DI 24580.020 (ALS Evaluation Criteria)” or “DI 23022.100 (ALS – CAL Processing)”, which points readers to specific SSA rules, not to the condition itself.

How SSA Claims Representatives Review Medical Records

SSA and DDS (Disability Determination Services) claims representatives use a methodical process to evaluate every claim:

1. Initial Screening: Review work credits and determine SSDI/SSI eligibility.
2. Medical Review Against the Blue Book: Check if the diagnosis meets a listed impairment using objective medical evidence.
3. Residual Functional Capacity (RFC): If a listing isn’t met, assess what tasks the claimant can still perform.
4. Consistency Checks: Ensure medical records support reported symptoms and restrictions.
5. Educational and Vocational Factors: Evaluate age, education, and work history to determine adaptability to other jobs.

Much of the medical review process is handled by state-based offices called Disability Determination Services (DDS).

How Medical Records Are Compared to the Blue Book

Medical records are not just proof of diagnosis—they must demonstrate that the condition meets specific criteria outlined in the Blue Book. SSA looks for:

• Imaging, labs, and clinical testing described in listings
• Consistent documentation of symptoms and progression
• Functional limitations that prevent sustained work activity

For instance, back disorder claims must show nerve root compression, muscle weakness, and other signs under Listing 1.15. SSA reviewers match these facts directly to Blue Book language.

Education and SSDI Evaluation

Education is a critical factor in determining your ability to adapt to other work. SSA reviews:

• Highest level of education completed
• Literacy, language, and communication abilities
• Special education history and vocational training

Applicants over age 50 with limited education may qualify more easily based on SSA's vocational grid rules.

Major Federal Acts That Guide SSDI

SSDI is shaped by several cornerstone laws:

• Social Security Act of 1935: Established the Social Security system.
• Disability Amendments of 1956: Created SSDI benefits.
• Rehabilitation Act of 1973: Encouraged vocational support for disabled persons.
• Americans with Disabilities Act of 1990: Protected civil rights for people with disabilities.
• Ticket to Work Act of 1999: Created work incentives for SSDI recipients.

How HIPAA and Confidentiality Protect Claimants

Your medical records are protected under the HIPAA Privacy Rule, even during an SSDI claim. Here's how information flows securely:

• You must sign a HIPAA-compliant release form (SSA-827).
• Doctors send records directly to SSA or DDS via secure systems.
• Your attorney or advocate can access records with your permission.
• SSA securely stores data in your electronic disability file (eFolder).

No one outside of SSA or authorized legal reps can view these documents. Attorneys are also bound by attorney-client confidentiality.

Start Your Disability Claim the Right Way

Starting a disability claim correctly can make all the difference. Here’s what to do:

1. Apply online at ssa.gov/applyfordisability.
2. Gather medical evidence that clearly documents your condition and limitations.
3. Request RFC forms from your treating physicians.
4. Consider working with an SSDI attorney or advocate for support and strategy.

With the right preparation, you can move through the process more efficiently and improve your chances of approval.