The evaluation of disability on the basis of mental disorders requires:
- Documentation of a medically determinable impairment(s) (MDI);
- Consideration of the degree of limitation such impairment(s) may impose on the claimant’s ability to work; and
- Consideration of whether these limitations have lasted or are expected to last for a continuous period of at least 12 months.
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).
As can be seen from the broader categories above, Social Security’s disability listings for mental disorders include a wide range of conditions, including depression-related illness, anxiety-related disorders, psychotic disorders, autism, ADHD, learning disabilities, mental retardation (intellectual developmental disorder) and low IQ.
The listings for mental disorders contain specific requirements or criteria that the disorders must “meet” to be considered disabling. 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.
The Basics of Mental Health and Disability
Mental Illness and Social Security Disability
An overview of how the Social Security Administration evaluates mental illness claims.
Mental Assessment Form for Your Doctor to Fill Out
If your doctor fills out an assessment form detailing your mental limitations, the Social Security claims handler may consider it in evaluating your RFC.
Review Your Disability File Before Appealing a Mental Disability Claim
If you’ve applied for Social Security disability based upon mental or emotional conditions, here’s what to look for when you review your own claim file:
Depression and Mood Disorders
Depression
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.
Bipolar Disorder
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
Anxiety Disorder
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
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.
Psychotic Disorders
Schizoaffective Disorder
Disability applicants suffering from a schizoaffective disorder can qualify for Social Security Disability Insurance and SSI benefits.
Schizophrenia
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.
Memory Loss
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
Autism
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
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.
Personality Disorders
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.
Questions on Mental Disability
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.