Mental Health Disability Claims

Some people with mental health issues do not seek treatment because they lack access to healthcare services. Others forego mental health treatment to avoid social stigma. Oftentimes people with mental disorders don't reach out for help because they worry they will be ignored. After all, they do not “look" disabled.

Do you struggle with a mental health disorder? If so, you may qualify for disability benefits from the Social Security Administration (SSA). You will have to show that your mental impairment prevents you from working. But it's often more difficult to prove disability for a mental illness.

This article discusses claims for mental health entitlements under Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). FindLaw's Social Security Disability section has more articles and resources about SSDI benefits and SSI benefits.

How Does the Social Security Administration Assess Mental Health Disorders?

Mental illnesses are often more difficult to assess than physical disabilities. People with mental health disorders often struggle to describe their symptoms. They may also fail to follow prescribed treatment or keep medical appointments. Also, mental health symptoms sometimes come and go. People may forget to report symptoms to their mental health professional if they do not experience symptoms on the appointment day.

Also, very few reliable tests exist for diagnosing mental illness. Without hard evidence like x-rays or lab testing, SSA decision-makers often base decisions on subjective information. This information may include your reports to providers or your own testimony. It may also include your Function Report and statements from friends and family members. Unfortunately, sometimes this evidence isn't enough to prove your claim.

The Social Security Administration may order and pay for a consultative examination if there isn't enough evidence. The exam involves a standard mental or psychiatric evaluation by a qualified mental health professional. The examiner submits the evaluation to your local Disability Determination Services (DDS). The DDS, a state agency funded by the federal government, will approve or deny your claim. An Administrative Law Judge (ALJ) takes similar steps at the hearing level. The Social Security Administration prefers that your treating source conducts the consultative examination. But an independent source chosen by the Social Security Administration may also conduct the examination.

What Is the Social Security Administration's Listing of Impairments?

The Social Security Administration's Blue Book lists mental health impairments. This list is called the “Listing of Impairments." The Social Security Administration may find you disabled if your mental health condition meets or equals one of the Listings. The SSA will weigh the evidence against your condition and the Blue Book's criteria to make that determination.

The following are examples of adult mental disorders in the Listings:

  • Schizophrenia and bipolar disorders
  • Autism
  • Depressive disorders
  • Anxiety disorders, including panic attacks, and obsessive-compulsive disorders
  • Trauma and stressor-related disorders (may encompass post-traumatic stress disorder)

You can find the full listing of impairments and criteria in the Social Security Administration's "Disability Evaluation Under Social Security."

If your condition meets the criteria in the Listings, the Social Security Administration will find you entitled to social security disability benefits. If your condition doesn't meet the criteria for the Listings, the Social Security Administration moves on in the process. The Social Security Administration next determines your mental “residual functional capacity." This helps decide if you're eligible for disability benefits.

What Is Residual Functional Capacity?

What happens if the Social Security Administration determines your condition doesn't meet a Listing of Impairments? All is not lost. The SSA will still find you're disabled if you cannot do your prior work or any other work in the national economy. To do this, the Social Security Administration decides your mental residual functional capacity. The mental residual functional capacity represents the most work you can do despite your mental health impairment and its limitations.

The Social Security Administration evaluates the medical evidence of record to determine your mental residual functional capacity. This may include medical reports, including psychological tests. If your case is at the hearing level, the ALJ may consider the testimony of a vocational witness. The evidence might also contain a mental residual functional capacity assessment completed by your healthcare provider. To determine your residual functional capacity, the Social Security Administration may consider that assessment. They may also consider a medical consultant's review of the mental residual functional capacity assessment.

Your treating source or a consultative examination may describe your limitations in these terms:

  • Not significantly limited
  • Moderately limited
  • Markedly limited
  • Insufficient evidence

The treating source or consultative examination will provide an opinion on how limited you are in four main functional areas:

  • Understanding and memory
  • Social interactions
  • Sustained concentration and persistence
  • Adaptation

It's up to the Social Security Administration to review all evidence of record to determine your mental residual functional capacity. You probably won't receive benefits unless the Social Security Administration finds you "markedly limited" in at least one of the areas above.

See the Social Security Administration's SSR 96-8p for more information about assessing residual functional capacity.

Claims for Substance Abuse

Many people with mental illness also struggle with substance abuse. It is not uncommon for people to use drugs or alcohol in an attempt to relieve uncomfortable mental health symptoms. In those cases, the medical record may reference the claimant's drug or alcohol abuse.

The good news is that the Social Security Administration may still find you disabled even with evidence of drug or alcohol addiction. The key is that drugs or alcohol must no longer contribute to your disability. The SSA will find you disabled if your mental limitations would remain if you stopped using drugs or alcohol.

See the Social Security Administration's section on substance addiction disorders for a complete list, including physical ailments.

Don't Go At It Alone: Get Legal Help With Your Disability Claim

The Social Security disability claims process can be complex and overwhelming. Professionals are ready to help guide you through the process. Consider contacting an experienced Social Security disability attorney. A Social Security disability lawyer can provide you or a loved one with legal advice on disability eligibility, qualifying medical conditions, and the appeals process.

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Can I Solve This on My Own or Do I Need an Attorney?

  • The initial Social Security process doesn’t require an attorney
  • An attorney primarily handles claims that are denied
  • It can be helpful to have an attorney during Social Security benefit disputes or appeals

A Social Security lawyer can help protect your rights to your benefits.

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