How limitations from a mental condition can get you disability

How do you win disability for a mental disorder or impairment?

As with any condition, mental or physical, when it comes to winning Social Security Disability or SSI, it's not about the diagnosis, but how the condition affects and limits your work ability. This is why disability examiners, when they work on your case, will not only ask you where you've received your medical treatment (to order records), but also about your job. They need to know what you did on your job to determine if you can go back to it, and they need to determine what your skills are to see if you are capable of doing some other type of work.

See: How to Prove you are disabled and Win your Disability Benefits.

Social Security places the heaviest weight on functional limitations that result from the disabling condition rather than simply being diagnosed with the condition. When you consider the Social Security definition of disability, you can see that you can not only file for disability, but also win disability benefits on the basis of a mental disorder or illness...provided that your medical records document that you have sufficient limitations which would rule out the ability to engage in substantial work activity.

Social Security's evaluation of mental disorders

Social Security's evaluation of mental disorders requires A) documentation of a medically determinable impairment (i.e. medical records that contain a diagnosis, medication, response to treatment, etc.), B) a weighing of the limitations imposed upon an individual by their mental illness and how these limitations may affect their ability to work, and C) whether or not the limitations are likely to have lasted, or can be expected to last, twelve continuous months.

When weighing the severity of your mental impairment, Social Security evaluates the affect your illness has on your daily life by considering the following:

1. Your ADLs, or activities of daily living

Activities of daily living might include, but are not limited to adaptive activities such as cooking, cleaning, paying bills, driving a vehicle, caring for your grooming and cleanliness, or performing household chores. Even if you are able to do many of these routine daily activities, Social Security may still find that you have severe limitations performing them if you cannot perform these activities without direct supervision, or in a fitting manner, or on a consistent and routine basis, or without unnecessary interruptions or distractions. ADLs are typically only given superficial consideration on a disability application, but tend to receive more substantial attention at a disability hearing attended by the disability attorney and yourself.

2. Social Functioning

Social functioning is another factor used to determine the impact your mental illness has upon your ability to work. Social functioning refers to your ability to interact appropriately, effectively, and on a sustained basis with others. Examples of social functioning might include being able to get along with family, friends, landlords, coworkers, or supervisors.

If you have a history of altercations, firings, avoidance of interpersonal relationships, social isolation, or fear of strangers, you may have severe limitations in social functioning. You may be able to interact socially with others, communicate clearly, or participate in groups and yet still have significant limitations. Some work situations require that you must interact with the public, respond to persons of authority, or have cooperative behaviors with coworkers.

Social Security does not define severe limitation of social functioning by a specific amount of different behaviors in which social function is impaired but by the character and extent of interference that the behaviors cause with functionality.

3. Concentration, Persistence and Pace

Concentration, persistence and pace are also considered when determining the severity of an individual's mental impairment. You need to have the ability to maintain concentration, persistence and pace to complete tasks frequently found in work settings in a timely manner. Limitations with regard to concentration, persistence, and pace can be documented by work situations, however they may also be verified through clinical examinations or psychological testing.

While Social Security considers all of the above criteria when making a disability determination based upon mental illness, they still must have medical evidence that documents symptoms, response to treatment, psychological testing (in cases that involve learning disability, mental retardation, etc.), and laboratory findings to make an independent determination. This information should come from psychiatrists, physicians, psychologists, and other acceptable medical professionals who have clinically treated you in their practices or during hospitalizations.

If you have had no mental health treatment in the past ninety days, you may be required to attend a consultative examination with a mental health professional (paid by Social Security) who will conduct either a mental health status evaluation or conduct needed psychological testing. Social Security considers medical treatment records to be current if treatment has occurred within the previous ninety days. If the disability examiner has no current medical treatment records available in the file, they are required to schedule a consultative examination to obtain recent documentation. Note: if you are scheduled for a CE, do not miss the appointment. Typically, your disability lawyer will send a reminder to you to attend this appointment.

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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