Is it Difficult to Win Social Security Disability in Texas if you have Mental Illness?

Answer: Yes. It can be fairly difficult to win a case in Texas if your primary allegation that you list on a disability application involves a mental condition.

Why is this? I'll draw upon my experience as a former disability examiner for the social security administration to answer this question.

1. Disability examiners know very little about any specific mental illness, or mental illness in general. True, they have the impairment listing manual available to them (also known as the "blue book", a manual that lists the disability criteria for a number of conditions) and they are trained to look for indications of functional limitations in a claimant's medical records.

However, meager training with regard to the nature of mental illness logically leads to a meager understanding of the functional limitations that are part and parcel of mental illness. And this, without a doubt, has an impact on decisional outcomes.

2. Disability examiners (and their unit supervisors and unit psychological consultants) are far too quick to make the determination that a claimant's mental condition has not, or will not, satisfy duration. What do I mean by duration? The definition of disability used by the social security administration carries with it the requirement that, for a condition to be considered disabling, it must last at least 12 months.

Unfortunately, certain forms of mental illness tend to exhibt a pattern of exacerbation and remission. That is, they appear to get better and worse. Bipolar disorder is a good example of this phenomenon.

However, the appearance of a condition remissing may amount to nothing more than "appearance" and may give rise to a conclusion that is entirely incorrect. For instance, a disability examiner may conclude that a claimant's state of disability did not last long enough to satisy the social security administration's defintion of disability when, in actual fact, the condition, from a practical standpoint, never ceased to be functionally limiting at all.

Under Social Security Disability or SSI disability you can win on the basis of a mental disability (and this includes but is not limited to any one of the following impairments: depression, anxiety disorder, bipolar disorder, autism, mental retardation, organic brain syndrome, schizophrenia, personality disorder, somatoform disorder, etc)? The answer, of course, is yes.

However, as with any case based on one or more impairments, there is always the chance that an approval will not be made on the basis of satisfying a listing in the listing book but, rather, on the basis of a medical vocational allowance (simply put, if the medical evidence indicates that you can no longer perform your past work or reasonably be expected to perform some type of other work, you may be approved). Also, as with all cases, there is the strong statistical likelihood that a case will not be approved at the disability application level. If a case is denied at the application level, however, a claimant may (and should) file a disability appeal.

The first appeal is the request for reconsideration and the second appeal is the request for hearing before an administrative law judge.

What are your chances of being approved in Texas at either appeal level? At the reconsideration level, in most states, a claimant stands approximately an 85 percent chance of being denied a second time. However, at the disability hearing level a claimant has approximately a forty percent chance of winning benefits if they are unrepresented and approximately a 60 percent chance of winning benefits if they are represented by a disability lawyer or by a non-attorney claimant's representative.

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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These pages provide answers to basic questions about pursuing disability benefits

What to Prove to Qualify for Disability Benefits
Applying for disability benefits, SSI and SSDI
What Disabilities Qualify for SSI and Social Security Disability?
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Social Security Disability And SSI Qualifications
Permanent Disability Qualifications for SSD and SSI
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Texas disability requirements
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