Can Mental Illness Serve as the Basis for a Social Security Disability Claim?
Yes, you can be found eligible for Social Security Disability benefits for either physical or mental medical conditions (or a combination of both). However, it is usually more difficult to collect disability for a mental disability than for a physical impairment.
Why? Because you cannot prove a mental illness with an objective medical test like an X-Ray or MRI. Although a mental health expert like a psychologist or psychiatrist can diagnose mental illnesses, it may take several visits to the doctor to evaluate the symptoms of a mental condition and assess a diagnosis. Moreover, even if a diagnosis is established, it may take even more time to determine the severity of the condition as severity is difficult to measure objectively.
How the SSA Views Mental Disability Claims
Social Security Disability claim examiners are not licensed psychologists or psychiatrists, and they do not always understand the full scope of limitations caused by certain mental illnesses. For example, some disability examiners do not recognize the cycling nature of mental illnesses such as bipolar disorder (sometimes called by its older name of “manic depression”), and may assume a claimant is cured because he or she does not currently display certain symptoms. However, in reality, those symptoms may have just dissipated for the moment, and are almost certain to return in the relative near future. In addition, some disability examiners are biased against disability claims for mental illness.
Mental Impairment Listings
In evaluating a mental health condition, the disability examiner will first refer to Social Security’s official Listing of Impairments (often referred to as the Blue Book). The Listings in the Blue Book specifically identify medical conditions that the Social Security Administration recognizes as conditions that are inherently disabling. In other words, Social Security accepts that anyone who satisfies all the requirements of a listed condition would be unable to work (or engage in substantial gainful activity). The disability examiner will review the medical evidence to determine whether a disability applicant’s symptoms meet the criteria of any mental condition listed in the Blue Book.
The listings for mental disorders are arranged in nine diagnostic categories:
- Organic mental disorders (Listing 12.02);
- Schizophrenic, paranoid and other psychotic disorders (12.03);
- Affective disorders (12.04);
- Mental retardation (12.05);
- Anxiety-related disorders (12.06);
- Somatoform disorders (12.07);
- Personality disorders (12.08);
- Substance addiction disorders (12.09); and
- Autistic disorder and other pervasive developmental disorders (12.10).
Each listing (except 12.05 and 12.09) consists of: (1) a statement describing the disorder and (2) two sets of criteria that must be satisfied for the listing: paragraph A criteria (a set of medical findings) and paragraph B criteria (a set of impairment-related functional limitations). There are additional functional criteria (paragraph C criteria) in listings 12.02, 12.03, 12.04, and 12.06.
Social Security will assess the paragraph B criteria before it applies the paragraph C criteria. Social Security will assess the paragraph C criteria only if it finds that the paragraph B criteria are not satisfied. Social Security will find that you have a listed impairment if the diagnostic description in the introductory paragraph and the criteria of both paragraphs A and B (or A and C, when appropriate) of the listed impairment are satisfied. However, even if your disorder does not “meet” the listing, if you can prove you cannot do even a simple, unskilled job due to emotional, psychiatric, or brain-related problems, you could qualify for disability benefits due to a mental impairment.
Here is what the Social Security Administration will look for when reviewing claims for specific mental health issues:
Depression and Mood Disorders
Social Security will consider how your depression and resulting limitations affect your ability to do work activity. Even simple, unskilled work requires you to:
- understand, remember, and carry out simple instructions,
- make simple work-related decisions
- respond appropriately to supervision and to co workers, and
- handle changes in routine.
If depression is the only impairment you identified in your application for disability benefits, being approved for disability will be a long shot unless you have severe, disabling depression that is well-documented in your medical records. If you also have another mental impairment or physical impairment in addition to your depression, you have a better chance of being approved for benefits.
Individuals with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” One state of mind is called a manic episode and it usually involves being in an overly joyful or overexcited state. The other state of mind is a depressive episode, which makes the individual extremely sad or hopeless. Sometimes, a mood episode called “mixed state” may involve symptoms of both mania and depression.
Some individuals with bipolar disorder may also be explosive and irritable during a mood episode.
Extreme changes in energy, activity, sleep, and behavior often go along with these changes in mood. It is possible for someone with bipolar disorder to experience long-lasting periods of unstable moods rather than shorter episodes of depression or mania.
It would not be unusual for an individual experiencing an episode of bipolar disorder to experience a number of manic or depressive symptoms for most of the day, nearly every day, for a week or longer. Sometimes symptoms are so severe that the individual cannot function normally at work, school, or home.
Anxiety disorders can affect people in many different ways. Nausea, headaches, stomach-aches, heart palpitations, and shortness of breath are common symptoms. Cases can cause as little as occasional nervousness or can be as extreme as some of the instances listed above. In any form, anxiety disorders can cause life-affecting psychological and physical damage.
Agoraphobia is a type of anxiety disorder, defined by its panic attacks, or periods of intense fear and horror. A panic attack is a short period of intensely heightened anxiety, characterized by chest pain, choking, dizziness, nausea, a racing heart, sweating, and trembling. They appear at moments of incredible stress.
Agoraphobia specifically causes anxiety in environments that are not familiar or which are thought to have no easy escape. Places like shopping malls, airports, or bridges are common areas for an agoraphobic attack, which are most likely to occur in wide-open spaces or social situations in which the person has no control.
Post Traumatic Stress Disorder (PTSD)
PTSD, which is characterized by extreme emotional disturbance, may qualify for disability. You must have at least one detailed record of a mental episode caused by post-traumatic stress disorder in your medical records. What brings on symptoms, how long they last, and how frequently they occur should be well-documented. Your doctor should note whether or note he agrees that how you describe your mental state matches his opinion of it and the guidelines of being diagnosed with the disorder. Most importantly of all, your medical records must have a clear explanation of how the disorder has affected your daily life and your ability to function in a work environment.
Disability applicants suffering from a schizoaffective disorder can qualify for Social Security Disability Insurance and SSI benefits.
The effects of schizophrenia usually begin with trouble sleeping or concentrating and a tense, irritable state of mind. As the disease develops, it is normal to experience a lack of emotions, appearances of hallucinations and delusions, and a tendency to isolate oneself. Many patients claim to hear voices, which adds to the false assumption that it causes multiple personalities. Schizophrenia patients may qualify for Social Security disability, especially where the medical records evidence that they are limited in functioning socially, focusing on tasks, or in other ways.
Brain Disorders That Affect Mental Function
Traumatic Brain Injury (TBI)
One can also qualify for disability by meeting the requirements of organic mental disorders. These are extreme changes in personality, mood, or cognitive function brought on by brain damage. Disorientation, an inability to concentrate, disruption of daily activities, and problems with social function are all common symptoms.
If you have memory loss that is quantifiable and the memory problems interfere with your personal, social, or work functions, you may qualify for disability benefits.
Developmental Disabilities and Autism
Attention Deficit Hyperactivity Disorder (ADD and ADHD)
Attention Deficit Hyperactivity Disorder, commonly known as ADHD, is a chronic neuropsychiatric disorder that affects a person’s inability to focus, stay on task, and remember directions. While this diagnosis is more common in children, and many children learn to adapt, some adults that struggle with ADHD into adulthood find it very hard to work.
The symptoms of ADHD might seem trivial when a person is young. As employees, the consequences of these symptoms could be dangerous and even fatal if not appropriately managed. Symptoms include:
- Trouble concentration
- Paying attention
- Staying organized
- remembering details
- Managing impulsivity
- Following directions
Autistic adults have symptoms that can be either very mild or severe to the point of being debilitating. Those with autism are usually extremely attached to specific objects, get unnaturally distressed at any change in normal routine, have difficulty starting or maintaining conversations, have heightened or abnormally low senses, prefer to spend time alone, use repetitive body movements and throw aggressive tantrums when agitated.
Though many autistic adults lead typical lives, others are incapable of upholding their desired routines without the assistance of family or others. The individual symptoms of autism may include the widely known effects listed above, but can also include unique quirks of the person with the disorder. However, in general, diagnosis is made based on signs of repetitive behavior, restricted interests, and communication impairment.
Asperger’s is one of a handful of developmental disorders that deal with social skills and communication, and is a milder variation of autistic disorder, affecting two out of every 10,000 children. Asperger’s syndrome is characterized chiefly by social isolation in children who fail to understand and empathize with others and frequently can’t make friends. Those with the illness have very limited interests, usually focusing on only one or two narrow topics to an obsessive extent. Their tendency to dominate conversations with discussion only about these topics is one of the more obvious social inconsistencies noticeable in the disease.
Asperger’s affects the child’s ability to speak with a normal comprehension, often straying in and out of topic and never reaching a point or even explaining the conversation’s base logic. The illness blocks the child’s ability to comprehend whether or not the listener is interested in the subject, and the ability to understand much humor is lost. Physical clumsiness is also common. Causes for why Asperger’s syndrome occurs are debatable, though it is most likely a genetic disorder.
Pervasive Developmental Disorder
Pervasive developmental disorder is characterized by qualitative deficits in the development of reciprocal social interaction, in the development of verbal and nonverbal communication skills, and in imaginative activity. Often, there is a markedly restricted repertoire of activities and interests, which frequently are stereotyped and repetitive.
Borderline Personality Disorder
Though there is no specific listing for borderline personality disorder, there is a general listing for personality disorders characterized by an inability to function in a social or economic capacity. To be eligible for this listing, you must have the following symptoms: a tendency towards isolation, unprompted hostility towards others, uncommon thoughts, speech or behavior and frequent alterations in mood. You must also have at least two of the following signs: difficulty with concentration, inability to perform daily activities, inability to maintain a steady social relationship and recurring instances of worsening symptoms.
If your condition is not specifically listed in the blue book, or if your condition is not as severe as the Blue Book listing requires, you may still be eligible for disability. You must have been diagnosed with a mental condition that is preventing you from working, and you must demonstrate that your disability has lasted (or is likely to last) for a period of at least twelve months. If your mental residual functional capacity (RFC) shows you have intellectual, social, or functional limitations, you may be eligible for a medical-vocational allowance, depending on your mental limitations, age, education level, and job skills. You can download a free Mental RFC to use in your disability claim.
Frequently Asked Questions: Social Security Disability for Mental Disorders
What Are the Common Reasons Mental Impairment Claims Are Denied?
Two common reasons mental health claims are denied are (1) Missing or poor treatment records and (2) noncompliance with recommended treatment, including taking medication as prescribed.
Can I Receive Disability Benefits Because of Severe, Chronic Insomnia?
Social Security is not likely to grant a disability claim for insomnia alone, but it may help you qualify for benefits when combined with other physical or mental impairments.
Can I Get Social Security Disability Benefits for Borderline Personality Disorder?
You may qualify for disability benefits with BPD if the condition is so severe that it makes you have trouble conforming to social expectations, working, and/or keeping a job.
What Mental Health Symptoms Are Social Security Looking For to Approve a Claim for Social Security Disability or SSI?
Social Security does not focus on an individual’s specific symptoms. Social Security looks at the claimant’s overall functional capacity in light of the claimant’s condition(s).
What Are “Episodes of Decompensation”?
Episodes of Decompensation are times when the claimant has difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace. If a claimant has frequent, sustained, or extended periods of decompensation, then he or she may qualify for disability.
How Does Special Education and Difficulty in School Relate to Getting Disability?
School records can demonstrate limited ability to learn or perform job tasks, and may, therefore, be important for adults claiming disability, even where the claimant is primarily alleging physical impairments.
If you have a disabling mental health condition and are looking to see whether you qualify for disability benefits, call attorney Nick A. Ortiz. Mr. Ortiz represents Social Security Disability claimants nationwide. Call (888) 321-8131 for a free case evaluation.