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Social Security Disability and SSI Mental Claims and Criteria




 
Continued from: The Social Security Disability and SSI Process for Mental Claims based on Mental Disorders

Disability examiners working on social security disability and SSI claims review medical records looking for signs of limitations in these basic areas. When limitations are found, they are recorded in the examiner's informal writeup of the case, which may then be used to complete a mental residual functional limitation form, which is the next step in the evaluation process.

3. The disability examiner will complete a form known as a MRFC, or mental residual functional capacity form. This form will be based on the mental evidence that has been received and read by the disability examiner and it will indicate the claimant's abilities and limitations in a wide variety of functional areas. The MRFC form assesses the claimant's ability to A) understand and remember, B) sustain concentration and persistence, C) Interact socially (with the general public, supervisors, and coworkers) and D) Adapt (including the ability to adapt to changes in the work environment).

After the disability examiner completes his or her write-up of the case and completes an MRFC form, the examiner will meet with the mental consultant who is part of the examiner's case processing unit. This individual is usually a psychologist who holds a Ph.D., though sometimes it will be an M.D. physician who has practiced as a psychiatrist.

4. The examiner's unit mental consultant will also complete an MRFC form and in addition to this will compete a PRTF, a psychiatric review technique form. The PRTF is used to evaluate by the mental consultant to evaluate the severity of a mental impairment for a social security disability or SSI claim. The form rates the following:

A) Whether or not the claimant has a medically determinable impairment.

B) Whether or not the claimant's condition is severe.

C) Whether or not the claimant's condition is severe but unlikely to last 12 months or longer (the one-year duration is the litmus test for whether or not a condition is disabling, in the eyes of the social security administration).

D) Whether or not the claimant's condition is severe enough to meet or equal a listing in the blue book, the social security disability list of impairments.

The PRTF form is also used by the mental consultant to note the presence of, as demonstrated by the medical records, certain psychological or psychiatric characteristics displayed by the claimant such as memory impairment, changes in personality, mood disturbance, delusions, hallucinations, decreased energy, sleep disturbances, lowered IQ, obsessions, compulsions, changes in appetite, difficulty with concentration, and even suicidal thoughts.

5. The evaluation of the claimant's medical evidence will conclude with one of the following determinations:

A) The claimant is denied due to the fact that their condition is not severe.

B) The claimant is denied because their condition, while severe, will not last 12 months.

C) The claimant is denied because their condition, while severe, is not severe enough to prevent them from going back to one of their former jobs, or from doing some type of other work.

D) The claimant is approved because their condition is severe enough that they either meet or equal a mental listing in the Social security disability and SSI blue book (a list of impairments and their approval criteria; the book is published under the title "Disability Evaluation under Social Security").

E) The claimant is approved because their condition, while not meeting or equaling a blue book listing, is severe enough to make it impossible for them to perform any work activity (past work or other work) at a level that would allow them to earn a substantial and gainful income.

Whether a social security disability or SSI claim is processed at the disability application level, or the reconsideration appeal level, this will be the process that is used to determine the claim.

If a claimant's social security disability or SSI benefits case has progressed to the level of a disability hearing, the manner in which the medical evidence will be viewed will be the same; however, neither a disability examiner nor a medical consultant will be involved. At a disability hearing, the case is presented by a claimant, or his or her disability attorney, to a federal administrative law judge who has been trained to adjudicate disability claims.

While disability representation at the hearing level is important for all types of claims, at the hearing level it may be particularly important due to the sensitive nature of mental treatment records and the sheer importance of obtaining supporting statements from a claimant's mental health treatment provider.

Related: What can I expect from a Social Security Mental Examination or Evaluation?















Return to:  Social Security Disability Resource Center, or read answers to Questions





























Related pages:

When does social security consider you eligible for disability benefits?
Who is eligible for SSI Disability?
Disability Criteria - Eligibility For Social Security and SSI Disability
Can I Be Eligible For SSI And Social Security Disability At The Same Time?
Social Security Disability and SSI Mental Claims and Criteria
Can you apply for disability on the basis of multiple health problems?
What makes a person eligible to receive disability benefits?
Inability to Work and Eligibility for Social Security Disability and SSI Benefits
What makes you eligible for Social Security Disability or SSI?
If You Are Currently Working Are You Eligible To Receive Social Security Disability Benefits?
Will Being A Veteran Affect Your Eligibility And Chances For Social Security Disability?
Are SSD and SSI disability cases decided the same way in terms of Eligibility?
Is the Medical Criteria to Get Social Security Disability or SSI Benefits hard?
Criteria for how Social Security Disability is Awarded
Social Security Disability SSI Criteria and the Evaluation Process



Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI


These pages answer some of the most basic questions for individuals who are considering filing a claim.

Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria