What mental conditions qualify?
by Tim Moore, Disability Representative in North Carolina
Which mental disabilities can you get awarded disability benefits for?
Answer: any mental impairment that results in functional limitations sufficient enough to:
(Read if you live in North Carolina)
1. Prevent you from working (at the last job you did, at one of the jobs you did in the past, or at a suitable form of “other work”, as determined by the social security administration)
2. Earning a minimum level of income (this is called SGA, or substantial gainful activity) for at least twelve months.
Applying for a mental condition is the same as for a physical condition
In essence, when you file for disability benefits based on a mental condition, the process is exactly the same as if you had filed for disability on the basis of a physical problem (though, in almost every case, a person will usually apply for benefits on the basis of several conditions, often a mix of physical and mental disabilities).
Though most individuals are approved for benefits based on disability via a medical vocational allowance, the social security administration’s impairment listing manual, or blue blook includes “listing criteria” (the criteria by which an individual may be approved for benefits) for a number of mental impairment categories, including:
1. Organic mental disorders (listing 12.02 which may be applied to OBS, or organic brain syndrome, and which may also be applied to TBI, or traumatic brain injury, when applicable).
2. Schizophrenic, paranoid, and other psychotic disorders (listing 12.03).
3. Affective disorders (listing 12.04, and this includes depression, dysthymia, and manic-depression a.k.a. bipolar disorder).
4. Mental retardation (listing 12.05)
5. Anxiety related disorders (listing 12.06, and this includes anxiety disorder, panic attacks, agoraphobia).
6. Somatoform disorders (12.07 – think “psychosomatic”).
7. Personality disorders (listing 12.08 – borderline personality disorders).
8. Autism and other pervasive developmental disorders (listing 12.10).
Documentation for your claim
For each of these mental impairment categories, providing sufficient medical record documentation will, of course, be vital. And since the social security administration, via the disability examiner handling the claim, will be responsible for gathering a claimant’s medical records at the initial claim level, it is likewise vital that an individual filing for Social Security Disability or SSI disability benefits should indicate all known sources of treatment on the SSA-3368 (the disability application form), including names of treating physicians, dates of treatment, as well as names and addresses of facilities that have provided mental treatment.
Getting a letter from your doctor
And as with physical impairments, it may be helpful to obtain a concise and direct statement from one’s treating physician which specifically indicates functional restrictions and the level of impairment that exists. In some cases, this may be fairly easy to obtain since a number of psychiatrists will also be of the mind to choose to provide a summary of their treatment notes versus releasing the actual notes (many doctors do this and it may, in some cases, be for the purpose of providing “clarity” when the actual progress notes are somewhat “hazy”).
Psychological vs Psychiatric problems
The social security administration receives disability applications for practically every type of impairment known to exist. Mental impairments, conditions, or problems, are divided into two camps: those that are psychiatric and those that are psychological.
Psychological problems are those for which there may be an organic cause and for which psychological testing–such as IQ testing and memory scales–is often used to gauge the extent of the condition, such as autism, mental retardation, alzheimer’s disease, borderline intellectual functioning, traumatic brain injury, and long and short term memory loss.
Psychiatric conditions include those problems that most people with think of in unison with counseling and medication such as: anxiety related disorders, affective disorders (depression and bipolar disorder), personality disorders, and schizophrenia, paranoid, and other psychotic disorders.
Criteria for claims
Regardless of the condition, however, the evaluation process for a claim involving mental problems is fundamentally no different from a claim involving only one or more physical impairments. The standard for determining whether or not an individual will qualify for mental disability benefits (under either the Social Security Disability or SSI disability program) is the following:
1. Is the condition medically determinable? (meaning, can it be substantiated through medical documentation which might include physician’s notes, lab testing, imaging studies, blood work, etc).
2. Is the condition severe? This is a subjective judgement to some extent, but disability examiners (the individuals who decide claims at the disability application and request for reconsideration levels) and disability judges (who deliver decisions at social security hearings) must sometimes differentiate between severe and non-severe impairments.
If your mental condition is not severe
If a claimant files for disability but is not found to have a single severe condition, their claim will be denied for NSI, non-severe impairment.
What is a non-severe impairment? The phrase alone is somewhat self-explanatory; however, a good way to think of a non-severe impairment the way that the social security administration looks at such an impairment is simply to state that a non-severe impairment is one that does not impose functional limitations and which does not reduce the range of activities (many of which may be related to the ability to work) that the claimant can engage in.
Getting approved for disability through the list of impairments
3. Does the claimant have an impairment that satisfies the severity requirements of a condition that is listed in the Social Security Disability list of impairments? Otherwise known as the blue book, this is a listing of certain mental and physical conditions along with their approval criteria. This book also functions as a handbook for disability examiners, social security judges, and disability attorneys. Most medical conditions are not listed in the blue book. Therefore, if a person does not meet or equal the requirements of a blue book listing, their claim can still be considered under the following step.
Your condition must be considered to last for at least a year
4. Will the claimant’s condition prevent them from working at any job at what SSA considers to be a substantial and gainful activity level for at least one full year? This is the durational requirement of both the Social Security Disability and SSI disability programs. The state of disability must be so severe that the claimant cannot maintain employment for at least one year at one of their past jobs, or at any other type of work, while earning SGA (substantial gainful activity) level wages (SGA limit).
If, during the processing of a disability application or appeal, it can be shown (via the medical records and statements that are obtained from the claimant’s treating physician or physicians) that the claimant satisfies all the disability criteria listed above, they will be considered to fully meet the social security administration’s definition of disability and should expect to receive a social security notice of award.
Additional pages if you live in North Carolina: