Why does mental illness present special obstacles in getting a claim for Social Security disability benefits approved?
A lack of mental health treatment or treatment notes related to mental illness, not taking medication, and having an episodic mental illness are the most common reasons claims for Social Security disability due to mental illness.
The following assessment goes into a little more detail on the specific issues that often cause a claim for Social Security Disability benefits for mental illness to be denied. Here are the top 4 reasons you will be denied disability for mental illness:
Top 4 Reasons A Social Security Disability Claim for Mental Illness Will Be Denied
Poor Treatment Notes
One of the biggest problems we face in a disability claim for a mental illness is the fact that many mental health providers (psychologists, psychiatrists, counselors, etc.) keep relatively poor notes. Sometimes the notes are too abbreviated to collect any useful information from them. Some mental health providers still prefer to keep notes by hand, and at times the medical records will be illegible, and impossible to read.
Your doctor, psychiatrist, or other mental health providers will sometimes submit a summary of their notes to the claims examiner or the Administrative Law Judge because the notes and medical records from office visits provide little detail with regard to your impairment and related limitations. Brief medical evidence is unhelpful for the Social Security Administration (SSA) when evaluating the extent and severity of the underlying mental illness and in trying to determine your eligibility to receive disability benefits.
No Record of Treatment for Mental Illness
All too often we encounter disability claimants who have filed a claim for mental illness, but there is no record of mental health treatment for the condition(s) listed on the disability application. This is especially true in disability claims involving depression.
This is most frequently because the claimant’s family care physician has diagnosed depression and prescribed a common antidepressant. However, the claimant may never have been referred to a mental health specialist such as a psychologist or psychiatrist. In such instances, the claimant will often not have sufficient mental treatment records to support the disability claim.
Noncompliance with the Recommended Course of Treatment or Prescribed Medications
In some cases, a mental health provider will recommend a course of treatment like counseling sessions or group therapy, and such recommendations are noted in the claimant’s medical records. However, the records will also note if the claimant refused to attend counseling or failed to show up for group therapy. Later treatment notes will document the fact that the claimant was “non-compliant” with the recommended treatment plan. Complying with the provider’s treatment plan enhances the chance of the claim being approved.
In other instances, the medical records will show that a claimant has been diagnosed with a specific mental impairment and has been prescribed medication for the illness, but records may further note that the claimant has not taken the medication. This is a particularly large problem for mental disability claims because the Social Security Administration (SSA) focuses on what a claimant is still able to do despite the limitations of his or her condition. A claimant’s limitations cannot be accurately measured if the claimant is not taking his or her medications as prescribed, and the chance of being approved for benefits decreases dramatically.
Why is medical non-compliance an issue for some disability claimants? Sometimes it is due to the cost of care or medication. Unfortunately, the SSA is not typically concerned with whether or not a claimant can afford care or medication.
If you cannot afford recommended care or medications, inform the claims handler or judge that this is the reason that you don’t take the medication prescribed for your mental illnesses. According to SSA rules and regulations, an excuse such as this should be an acceptable nonmedical excuse for failing to take medication. If the SSA can help you find free medication, however, this will no longer be a valid excuse. For more information and help with your claim, see our article on failing to follow the prescribed treatment plan.
Lack of Duration
Some Social Security disability claims are denied on the basis of duration. This means that a disability examiner or ALJ has concluded that the applicant’s condition has not lasted for at least one year or is not expected to last for one year. This is especially problematic in a disability claim with a medical condition that has a tendency to “cycle,” (where the condition switches between getting better and getting much worse with regularity). This is an issue in both claims based on a mental condition (like bipolar disorder) and in claims involving a physical disorder (such as lupus).
Improve Your Chances of Being Approved by Working with a Social Security Disability Lawyer
Due to the challenges described above, many people seek legal advice and choose to hire a disability lawyer to represent them in their claims for disability benefits with the Social Security Administration. If you are unable to work, or your doctor has recommended that you file a claim for disability benefits, we can help. Nick A. Ortiz is a Social Security Disability attorney who represents the disabled nationwide.
We assist Social Security Disability claimants during the trial phase, which means from the initial application through a hearing before an Administrative Law Judge (ALJ). If you need to apply for Social Security Disability or appeal a denied claim for benefits, we can help. We will ensure that both your application for benefits and any appeals are filed as promptly as possible.
We will not only assist you in obtaining all of your medical evidence—we also prepare custom medical source statements that are specific to your mental health condition. If you would like to learn more about how an experienced disability attorney can help with your disability benefits claim, we encourage you to call our office at (888) 321-8131 or complete our contact form to schedule your free consultation.