Schizophrenia, Social Security Disability, and Applying for Benefits
Can you be approved for Social Security Disability or SSI if you have a mental illness?
Yes. However, disability claims based on mental impairments seem to be treated by the social security administration even more arbitrarily than claims that are based solely on physical impairments.
If you file an application for disability on the basis of one or more mental impairments, prepare for the strong probability of being denied at the initial claim level, and prepare for the likelihood of having to file appeals. However, on the bright side, it should be noted that a large percentage of claims that are brought before administrative law judges at disability hearings are approved, and this is particularly true for represented claimants. The downside to this fact, however, is the fact that the appeals process leading to a hearing can take 1-2 years. <!middle_ad_-->
The difficulty of winning disability for Mental Illness (bipolar disorder, schizophrenia, depression)
As a disability examiner for Social Security Disability and SSI disability cases, I was often amazed at the cases that were denied. For example, I've seen individuals with IQs in the fifties get denied and I've seen individuals with long and well documented histories of decompensation get denied. I've also seen fairly severe cases of bipolar disorder get denied on the basis of duration (a durational denial is a denial made on the basis of an assumption that a condition will not last the required twelve months needed to satisfy the social security administration's definition of disability), which is quite ridiculous when one considers the waxing and waning nature of bipolar disorder, and a number of other conditions as well.
Even well-documented and legitimate mental illness cases get denied by social security. However, that depressing fact only makes it more imperative that disability claimants who file on the basis of a mental impairment provide substantial documentation in the form of medical records.
Unfortunately, in our society at present, getting access to needed mental health treatment can be difficult. According to the National Mental Health Council, there are approximately three and a half million Americans who suffer from brain disorders, schizophrenia, and bipolar disorder. And forty percent of these individuals receive no treatment. In many instances, the lack of treatment may be due to an individual never having sought treatment. However, there are too many cases in which those who seek treatment find no avenue by which to continue receiving treatment. For instance, those who become disabled and have long term disability insurance often find that their LTD "coverage" for mental health treatment caps out at the two-year mark.
The schizophrenia listing
Schizophrenia is listed in SSA's disability listings. This means that a person filing for disability can potentially be approved for disability via a medical vocational allowance, a process by which it is shown that they cannot work and earn a substantial and gainful income, or by meeting the requirements, via their medical record documentation, of the listing. Here is the listing that addresses schizophrenia:
12.03 Schizophrenic, paranoid and other psychotic disorders: Characterized by the onset of psychotic features with deterioration from a previous level of functioning.
The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied.
A. Medically documented persistence, either continuous or intermittent, of one or more of the following:
1. Delusions or hallucinations; or
2. Catatonic or other grossly disorganized behavior; or
3. Incoherence, loosening of associations, illogical thinking, or poverty of content of speech if associated with one of the following:
a. Blunt affect; or
b. Flat affect; or
c. Inappropriate affect; or
4. Emotional withdrawal and/or isolation;
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration;
C. Medically documented history of a chronic schizophrenic, paranoid, or other psychotic disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following:
1. Repeated episodes of decompensation, each of extended duration; or
2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or
3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.
About the condition Schizophrenia
Schizophrenia is a severe brain disorder that affects about 1 percent of Americans. It is a complicated disorder that is commonly treated by antipsychotic drugs, which can alleviate symptoms in some patients, but not cure the disease. While the medical community has known about schizophrenia for a long time, no known cause has been found. Fortunately, new studies may hold the key.
Scientists from the studies believe the mental illness may be caused by mutations in various genes that interrupt biological pathways essential to normal brain development. This frees up the idea they are searching for one key gene that is responsible for schizophrenia. Now, they are considering the fact that there might be many different DNA deletions and duplications that disrupt genes linked to pathways crucial to brain development.
One team looked at a group of schizophrenics who developed the disease as children, finding genetic interruptions or glitches in 20 percent, while another study looked at DNA from 268 healthy people and 150 schizophrenics and found that 15 percent of the schizophrenics had these glitches, while only 5 percent of the healthy subjects showed a presence of disruptions. The second study was done by researchers at the University of Washington and Cold Spring Harbor Laboratory in Cold Spring Harbor, New York.
Finding the genes responsible for these glitches in brain development may inspire new drugs to treat schizophrenia and other neuro-developmental brain disorders. More studies are ongoing.
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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