Are SSI and Social Security Disability Requirements Tougher For Mental Claims?

Are SSI and Social Security Disability Requirements Tougher For Mental Claims? Social Security Disability requirements for mental impairments are no more difficult than those for physical impairments on the face of it.

The definition of disability for Social Security purposes is any medically determinable physical or mental impairment that has prevented a person from performing substantial gainful activity (a monthly earnings amount that Social Security has determined to be self supporting) for twelve continuous months or is expected to prevent the person from performing SGA for twelve continuous months, or is expected to result in the death of the person.

Considering Social Security's definition of disability, all impairments should be considered equally. However it seems tougher for individuals with mental impairments to win Social Security Disability benefits.

From my experience as a Social Security Disability examiner, I think that the evaluation of mental limitations is often more subjective than the evaluation of physical impairments. Disability examiners are regular people with their own opinions and biases, which could explain why it is often more difficult for a disability applicant to win their disability based upon a mental impairment.

In the past, Social Security sometimes considered mental impairments other than mental retardation, learning delays, or organic brain syndrome as a durational situation (situations in which the disability claimant is likely to be no longer be disabled within twelve months) rather than as a lifetime disability.

Recently, I have noticed that Social Security is beginning to look at mental impairments more realistically. For example, there is really no way that a person with schizophrenia will no longer be schizophrenic in twelve months time so a durational denial is utterly ridiculous.

As far as the evaluation process for mental impairments vs. physical impairments goes, there is very little difference in the process. Individuals alleging disability based upon a mental impairment are subjected to the same five step sequential evaluation process that is used for individuals with a physical impairment.

The first step involves the performance of substantial gainful activity, or SGA. If an individual is performing SGA-level work, they will be denied prior to a medical determination no matter whether their impairment is, mental or physical.

Translation, if you are working and earning at least the SGA cutoff amount when you file for disability benefits, the social security office will not bother to send your case to a disability examiner and medical records will not be gathered on your behalf. Your case will simply be denied immediately because you are working and earning too much to be considered for disability benefits.

If a person is not performing SGA, the second step involves a determination as whether or not the individual has a medically determinable impairment. If the individual does have a medically determinable impairment, step three involves determining if an individual has a severe impairment. Both of these questions can be addressed and answered after the medical records have been requested and reviewed by a disability examiner.

If it is determined that the claimant's disabling impairment meets or equals the severity criteria of an impairment listing (in the Social Security Disability list of impairments, otherwise known as the blue book, and officially titled "Disability Evaluation under Social Security"), they will be medically approved for disability benefits.

If the individual has a severe impairment that does not meet or equal the criteria of an impairment listing (and this is usually the case), they may still be approved for disability benefits, but on the basis of a determination that involves reviewing both their medical history and vocational work history. Such approvals are known as a medical vocational allowance.

How does a medical vocational allowance work? This can occur if the claimant is determined to be unable to perform any of their past work (Step 4) and are also found to be unable to perform "other types of work" when their limitations are considered (Step 5).

In other words, individuals who do not meet or equal an impairment listing but have a severely restricted residual functional capacity may be approved when their A) age, education, and work history are considered and B) the combination of these factors shows that they cannot be expected to work at a former job or at some other job and earn what is considered to be a supportive living wage (substantial gainful activity).

One tip that might help an individual with a mental impairment be approved for disability benefits would be to have a medical history that includes clinical notes, a history of prescribed medications, documentation regarding response to medications, and counseling notes that support the claimant's allegation of being unable to maintain employment.

Claimants should also remember that, no matter what their impairment is, they must be able to show that their condition has prevented them from performing substantial gainful activity. Even though the evaluation of mental limitations can be more subjective on the part of disability examiners, it is hard to deny objective medical evidence that supports that a person is disabled by their mental impairment.

Note: When Social Security Disability and SSI disability cases are taken to hearings (at which the final decision lies in the hands of a federally appointed administrative law judge), a claimant's disability lawyer or non-attorney disability representative will often attempt to secure an opinion from the claimant's treating physician (or treating physicians if the claimant has more than one) that details the claimant's diagnosis, prognosis, and functional limitations.

In the case of a mental impairment, the claimant's representative will also often obtain a synopsis statement from a treating psychiatrist or psychologist that condenses and explains the claimant's history of treatment. This is often done because many mental health professionals are hesitant to release their actual records, presumably out of concern for the claimant's well-being, and possibly due to the fact that the mental health professional's treatment notes do not adequately address their patient's status and functional limitations.

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

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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