Answers to winning a disability case in NC| Social Security Disability Resource Center

Receiving disability for a mental condition in North Carolina

Note: The SSDI, SSI disability system is federal and nationally standardized, though there are state differences in approval rates, wait times, the number of appeals available–as of the time of this writing–and even the name given to the stage disability agency (DDS, or the Bureau or Division of Disability Determination). Now, to answer the question…

The process for receiving disability benefits in North Carolina based on any type of condition, be it physical or mental, can be difficult.

As with any claim, it requires filing a disability application at a local Social Security office where the chances of being denied are as much as 70%. Then it typically requires filing a reconsideration appeal which has an even higher chance of denial, usually about 85% to 87%.

And then, finally, for most claimants, it requires requesting a hearing before a federal administrative law judge, where, unfortunately, the chances of approval are significantly higher (generally, over 60% when a claimant is represented).

However, the process can be a bit more difficult when the person filing a claim is doing so on the basis of a mental condition.

The problem that comes into play when pursuing a claim for disability based on a mental condition very often has to do with medical evidence.

As a disability examiner at NC DDS (North Carolina disability determination services), I was able to observe, over several years, that a case was often lacking in the following ways:

1. Sometimes the claimant listed a particular mental condition, such as depression or anxiety, but did not have a diagnosis of the condition in their medical records.

2. Quite often, even when the individual had been previously diagnosed with a certain condition, there had been very little follow-up treatment, or none at all, in the last several months.

When a person has not received treatment for a condition in the last 90 days, Social Security takes the position that there is no “recent evidence”, making it necessary for them to be sent to a CE, or consultative examination (SSA schedules this and also pays for it, and the exam is performed by an independent doctor, not an employee of Social Security).

This type of exam seldom provides the basis for a disability award, though it does so more often in the case of a mental impairment, since mental examinations are typically more detailed and take longer to administer (such as an intelligence test, or a full psychiatric exam).

3. All too often, the diagnosis had come from a general practitioner, or family doctor, not a mental health professional, such as a psychologist, or psychiatrist.

If you file for disability in North Carolina, through either the SSD or SSI program, you will need the following in your records:

A. A clear diagnosis of your condition. That diagnosis should come from a qualified mental health professional, not a family doctor.

B. A history of treatment for your condition. In some ways, this is even more important than having a longitudinal history of treatment for a physical condition.

The mental consultants, who work at disability determination services alongside disability examiners, usually like to see an extended history of treatment for a mental condition versus a recent diagnosis.

If your mental condition has only been recently diagnosed, and it is not organic in nature, such as a drop from a premorbid IQ level, then it is safe to assume that a disability examiner examiner will conclude that your condition will not last the necessary durational amount of time required to qualify for disability benefits.

In other words, you will be denied on the basis that your condition will not be severe enough to be disabling for a full year.

C. Recent treatment for your mental impairment. This is particularly important because to Social Security it indicates that your condition is both ongoing, and also requires continuing care, which indicates to Social Security that you have symptoms which need to be managed.

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

Contact Tim Moore and Mac Travis in North Carolina for help with your SSD or SSI claim. Complete the form or call 919-278-7874. After submitting, scroll to the bottom to see the confirmation.
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