Does My Mental Disability Qualify for Social Security?

//Does My Mental Disability Qualify for Social Security?

Does My Mental Disability Qualify for Social Security?

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are two disability programs available for individuals who are disabled and unable to work. Various mental disorders and mental illnesses can qualify as a disabling condition. As the agency that administers both disability programs, the Social Security Administration (SSA) reviews disability applications for mental health conditions. 

4 Criteria a Mental Disability Must Meet for Social Security Benefits

  1. Disability Is Expected to Last at Least One Year
  2. Mental Impairment Must Be Medically Determinable
  3. Must Be Unable to Engage in Gainful Activity
  4. Mental Condition Meets Specific Criteria Outlined in the Blue Book

The SSDI program is for workers who have earned enough work credits and have paid taxes into the system to qualify for disability benefits. The SSI program is for low-income individuals who cannot work or do not qualify for SSDI. 

1. Disability Is Expected to Last at Least One Year

One of the criteria used to determine eligibility for disability benefits is the anticipated length of the illness or disability. Disabling conditions that are not expected to last more than one year do not qualify for disability benefits. Most mental illnesses are expected to continue indefinitely. However, that does not necessarily mean that the individual will not be able to work in the future with proper treatment.

Ongoing disability review for mental illness cases ensures that individuals who no longer qualify for disability benefits for a mental disorder return to the workforce. During a continuing disability review for mental illness, the individual may be required to submit to additional Social Security disability mental exams. SSA often requires applicants and current recipients to submit to a mental exam with a doctor chosen by SSA to verify the mental disability or mental disorders.

2. Mental Impairment Must Be Medically Determinable

A medically determinable impairment is a disability that can be verified and medically documented using standardized methods. An applicant must do more than report to the SSA that the applicant has psychological disorders, intellectual disability, or a personality disorder. You must provide medical evidence that the SSA can verify to prove you have a mental disorder or mental illness. 

The SSA requires objective medical evidence from doctors, psychiatrists, therapists, counselors, and psychologists that provide information about your mental illness, such as how it was diagnosed and what treatments you are receiving for the mental disorder. The SSA will consider evidence from other sources, including statements by a caregiver, evidence from school or vocational training, and work-related evidence as part of a disability application. However, this evidence is not given much weight as medical evidence. 

If the medical evidence is insufficient, the SSA may send you to a doctor for a Social Security disability mental exam. The exam is to confirm or add to the information the SSA already has regarding your mental disability.

3. Must Be Unable to Engage in Gainful Activity

Millions of people are diagnosed with a mental disorder and continue to work. Being diagnosed with a mental health condition does not always mean that you are disabled. Your mental illness must prevent you from engaging in a substantial gainful activity (SGA) to be considered a mental disability. The SSA defines SGA as any activity that you might perform that earns a minimum amount each month. For 2019, the monthly SGA for individuals is $1,220 ($2,040 if the person is blind). If you can earn over the monthly SGA amount, you are not considered mentally disabled.

4. Mental Condition Meets Specific Criteria Outlined in the Blue Book

The “Blue Book” is the common name given to the Listing of Impairments used by the SSA when evaluating a physical or emotional impairment. The Blue Book contains a list of conditions that might qualify for Social Security disability benefits. Section 12.00 deals with mental disorders.

Within section 12.00, mental disorders are divided into a specific list of mental disabilities. The categories of mental disorders that may be eligible for disability benefits are:

  • 12.02 – Neurocognitive Disorders 
  • 12.03 – Schizophrenia Spectrum and Other Psychotic Disorders
  • 12.04 – Depressive, Bipolar, and Related Disorders
  • 12.05 – Intellectual Disorder
  • 12.06 – Anxiety and Obsessive-Compulsive Disorders
  • 12.07 – Somatic Symptom and Related Disorders
  • 12.08 – Personality and Impulse-Control Disorders
  • 12.10 – Autism Spectrum Disorder
  • 12.11 – Neurodevelopmental Disorders
  • 12.13 – Eating Disorders
  • 12.15 – Trauma and Stressor-Related Disorders

The Blue Book provides criteria for determining if a mental illness or psychological disorder reaches the severity of a disability. Each category outlines the specific elements that you must prove to qualify for mental disability benefits. An SSA examiner reviews the evidence you provide with your application and any evidence the SSA may have gathered against the criteria in the Blue Book for your specific condition. If your condition meets or exceeds the criteria, you may be approved for mental health disability benefits.

If your mental disorder does not qualify based on the criteria in the Blue Book, you might still qualify for SSDI or SSI for mental disability. Your physician can submit a Residual Functional Capacity (RFC) report. The RFC assesses your ability to perform work-related functions given your current symptoms. A Mental RFC may discuss your ability to interact with others, understand simple tasks, react to criticism, and carry out work-related tasks. The RFC may also discuss your reliability, ability to maintain appropriate hygiene, and whether your mental condition may disrupt the workplace. 

A thorough RFC can be very convincing because it provides exact details and examples of how your mental disability prevents you from working or performing an SGA. 

List of Mental Disabilities that Qualify for Social Security Benefits

A variety of mental disorders may qualify for Social Security disability benefits: 

  • Bipolar Disorder
  • Obsessive-Compulsive Disorder
  • Developmental Disabilities
  • Anxiety Disorder
  • Post-Traumatic Stress Disorder (PTSD)
  • Impulse-Control Disorders
  • Personality Disorder
  • Alzheimer’s
  • Schizophrenia
  • Mood Disorders
  • Autism
  • Psychotic Disorders
  • Down’s Syndrome

The above list is not an exhaustive list of mental impairments that may qualify for SSDI or SSI benefits. If a person has mental health issues, a medical professional can often determine if mental functioning is impaired to the degree of being disabled.

Because the SSA uses different criteria for each mental disability to judge if a mental disorder is a disabling condition, some mental disabilities may be easier to get approved than others. For example, proving that schizophrenia or autism impairs a person’s ability to work may be easier than proving depression or mood disorders prevent someone from performing any substantial gainful activity. 

Individuals diagnosed with schizophrenia and autism often require substantial supervision and are unable to take care of basic living needs without assistance. However, someone can suffer from depression and still hold a job, raise a family, and function normally with the assistance of antidepressants and counseling. On the other hand, someone with depression could become so depressed that he or she cannot function at even a minimal level.

You should not give up applying for Social Security disability benefits for mental disability if your condition prevents you from working. Your initial application for SSI or SSDI based on a mental illness may be denied, but there are four levels of appeal within the SSA that may produce a different result. 

How Difficult is it to Get Disability for Mental or Emotional Conditions?

An application for SSDI or SSI is reviewed by an agent who reads the evidence you provided and reviews your medical reports. The agent then compares your case to the criteria for mental health disabilities in the Blue Book. It can be difficult to paint a complete picture of how mental illness impacts your ability to work and function in life with facts on a piece of paper. Hiring an attorney can greatly increase the chances of your claim being approved.

The first appeal is called Reconsideration. Another SSA agent reviews your case. In cases involving some mental health issues, the first appeal will also be denied. However, an administrative law judge hears the next appeal. After the administrative law judge, you have the Appeals Council and the federal court review to hear appeals. 

During your appeal, you can present testimony from witnesses and experts who describe the severity of your mental disorder and how it impacts your daily life. By presenting live testimony, you usually have a better chance of convincing a judge you are mentally disabled than you do when someone is reading dry facts on a piece of paper.

Drugs, Alcohol, and Mental Disabilities

The SSA will typically deny an application if alcoholism or drug addiction is the material factor in causing the disability. For instance, if you are unable to work because of panic attacks caused by drug use, but the panic attacks go away when you quit using the drugs, then the SSA is not likely to approve a disability claim. 

Being addicted to drugs or alcohol does not always mean your Social Security disability application will be denied. The SSA considers several health factors to determine if the condition is a disabling impairment with and without drug or alcohol use.

However, the SSA views drug addiction and alcoholism slightly different when the disabling conditions are related to a mental disorder or mental illness. An individual may not be able to abstain from using drugs or alcohol because of their mental health condition. Abusing drugs and alcohol is a common symptom of mental illness. 

SSA does not give a “free pass” to mental health patients who use drugs and alcohol. If the SSA determines that the person could abstain from using drugs or alcohol or the person’s condition may significantly improve if he or she stops self-medicating with drugs and alcohol, it may deny the mental health disability claim. 

When alcohol and drug abuse are an underlying factor in causing mental health problems, the SSA has historically denied a claim for benefits. When the disability claim involves mental illness, personality disorder, or other mental health issues, the question of drug and alcohol use must be examined very carefully to determine if the illness is a cause or a symptom of mental disability.

What Can Disqualify You from Receiving Benefits for Your Mental Disability?

Social Security disability benefits cover a variety of mental health conditions, such as mood disorders, psychotic disorders, developmental disorders, and impulse-control disorders. When a psychiatric disability prevents you from working, you may qualify for Social Security disability benefits based on your mental illness. 

Unfortunately, disability claims for mental illnesses are often denied because they are difficult to prove. The actions of the individual applying for disability benefits can sabotage the claim. When applying for mental health disability benefits, it is important to remember that your actions or inactions could have a significant impact on the outcome of your claim.

Failing to Seek Treatment

Failing to attend doctor appointments, refusing treatments, and failing to take prescribed medications can be reasons to deny a claim or terminate benefits. The SSA is very particular in requiring applicants with mental health conditions to seek out and comply with treatment plans to qualify for and remain eligible for disability payments. You can improve your chance of receiving disability benefits if you follow your doctor’s treatment plan. 

Lack of Supportive Evidence

Another reason why a mental disability claim is denied is due to a lack of supportive evidence. You must have substantial supportive evidence that you have been diagnosed with a mental illness or disorder which prevents you from working. You may have statements from caregivers, employers, educators, and others that describe the nature of your mental disorders, but without mental health records from qualified, licensed professionals, your claim will likely be denied.

Because there is not a standard mental illness test that can conclusively determine the severity of your mental disabilities, a doctor’s evaluation of your symptoms is subjective. A physical disability can usually be measured through diagnostic tests. However, the severity of a person’s intellectual disability, mental functioning, developmental disabilities, or psychiatric disability cannot be determined by a simple blood test or x-ray. This makes it substantially harder to prove that your mental disability qualifies as a disabling condition. You may need to seek a second opinion from a medical provider who specializes in your specific mental health problem to obtain the medical evidence you need to prove you are disabled. 

Temporary Duration of the Mental Disability

To be considered a disabling condition, your mental disorder must have lasted or is expected to last at least one year. This requirement can make it difficult to qualify for disability for mental health conditions that can improve with treatment or time. For instance, depression and bipolar disorder can often be treated with medications and therapy. If your claim is based on a condition that could improve with treatment, it is difficult to obtain disability benefits.

To be considered a disabling condition, your mental disorder must have lasted or is expected to last at least one year. This requirement can make it difficult to qualify for disability for mental health conditions that can improve with treatment or time. For instance, depression and bipolar disorder can often be treated with medications and therapy. If your claim is based on a condition that could improve with treatment, it is difficult to obtain disability benefits.

Lack of Treatment History

When reviewing your disability application, the SSA agent reviews your health treatment history to determine if your condition improved with treatment and how your condition has impacted your ability to work. An erratic medical history or a lack of treatment can hurt your chance of being approved for Social Security disability benefits. If you are unable to afford mental health treatment, you can seek low-cost or free mental health treatment from state and local agencies.

What You Need to Know About Receiving Benefits for a Mental Disability

If you believe your mental health problems qualify as a mental disability, there are a few very important facts to keep in mind:

Don’t Give Up!

Your claim for disability benefits may be denied several times before you are approved for SSDI or SSI. A denial does not mean that you will never receive Social Security disability benefits for a mental disorder. If your claim is granted on appeal, you will likely receive back pay from the date the SSA determines you were disabled.

Your Children May Qualify for Benefits

Children with developmental disabilities, mental disabilities, or intellectual disability may also qualify for Social Security disability benefits. A child’s application for disability for mental illness is judged differently than an adult’s application. In most cases, the mental disability must significantly impact the child’s ability to function at an age-appropriate level in normal daily activities. The SSA is looking for severe and marked functional limitations caused by mental impairment when it reviews a mental disability application for a child.

A child might also qualify for Social Security disability benefits if his or her parent is receiving SSDI. Children can draw from their parent’s SSDI disability benefits until they graduate high school or turn 19 years of age, whichever date comes first.

Compassionate Allowances Conditions List

The SSA has identified some conditions that meet the SSA’s standard of disabled. For example, early-onset Alzheimer’s disease is on the SSA’s compassionate allowances list. If you are diagnosed with a condition on the list, the wait time for approval of disability benefits can be drastically reduced. However, most of the conditions on the list are physical disabilities. Therefore, you can expect your disability application to take several months to process. In some cases, individuals who apply for mental health disability benefits must appeal several times before receiving benefits. The wait can be significant in many cases.

Mental Disability Test Requirement

The SSA may send you to a physician that it chooses to conduct a mental disability test. If you refuse to be examined by the SSA’s physician, your application for mental disability benefits will be denied.

The examination is referred to as a consultative examination (CE). It is a one-time visit with a psychiatrist or psychologist. You are not required to pay for a Social Security disability mental exam. 

Depending on the type of mental health disability you are claiming, the SSA may request one or more types of examinations. A psychological examination is used to evaluate reduced cognitive function. A psychiatric examination evaluates affective or mood disorders and psychosis. A mental status examination evaluates your current mental state, including mood, memory, awareness, and language skills. Lastly, the memory scale examination evaluates symptoms of short-term memory loss.

It is important that you attend the CE when it is scheduled. Your application for mental illness disability benefits is contingent upon your compliance with a scheduled examination.

How Much Does Disability Pay Per Month for Mental Illnesses?

SSI pays the same maximum monthly payment for mental disabilities as it does for physical disabilities. The amount you may receive is based on several criteria, including your housing, utility, and food costs.

SSDI is different for each applicant. The amount of SSDI you can receive for a mental disability depends on your work history. SSDI payments are based on your average lifetime earnings before you become disabled. The maximum SSDI benefit for 2019 is $2,861. The SSA has an online calculator that can help estimate the amount you may receive for mental health disability benefits.

Do I Need A Disability Attorney?

You are not required to hire a disability attorney to apply for disability benefits. However, because it can be difficult to obtain disability benefits for mental illness and mental disorders, seeking assistance from a disability attorney can be greatly beneficial and help you avoid some of the common mistakes many people make when they file for mental disability benefits. 

With the help of an experienced attorney, many people are approved and do receive Social Security disability benefits for mental illnesses. The Social Security disability application process for mental disability is the same as it is for a physical disability. However, the hurdles you must overcome to have a mental disability application approved by the SSA can be challenging. You may need to fight harder to win, but you can win.

The disability attorneys of Acadia Law Group can help. We assist clients in preparing Social Security disability applications and appealing denials of disability applications. If you have questions about disability benefits for a mental disability, contact our office at 1-800-653-4600 for a free case review.