Mental Health Disability Claims
If you suffer from a disorder related to your mental health, disability benefits may be available from the Social Security Administration (SSA). As with physical disabilities, those claiming Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits must be able to prove that their mental disorder prevents them from being able to work. But it is often more difficult to prove mental impairment, as opposed to physical disability, while a social stigma against mental illness continues to persist.
The following information will help you better understand how the SSA handles mental health disability claims. See FindLaw's "Social Security Disability" index for more articles and resources about SSDI and SSI claims.
Which Mental Impairments are Covered by the SSA?
The SSA maintains an official list of mental impairments explicitly recognized as "inherently disabling," meaning anyone suffering from one of the listed ailments is presumed unable to perform "substantial gainful activity." The SSA will determine whether your symptoms meet the criteria for the mental impairments contained in its official listing.
The following is sampling of mental impairments listed in the SSA's blue book (see the agency's "Disability Evaluation Under Social Security" for full listings or to search for a particular disorder):
- Autistic Disorders
- Mental Retardation
- Bipolar Disorder
If your particular mental condition is not listed in the official blue book or your symptoms do not meet the SSA's listed criteria, you may still pursue disability benefits. You must be able to prove that your mental condition prevents you from working (i.e. performing substantial gainful activity) and that it is likely to last for at least 12 months.
How Does the SSA Assess Mental Disorders?
Mental impairments are much more difficult to assess than most physical disabilities, and the impairment itself often prevents the claimant from accurately describing his or her symptoms or complying with the prescribed treatment. Also, mental impairments sometimes come and go on a cyclical basis; so a claimant with an otherwise valid claim may not show symptoms at the exact time he or she is being assessed for disability benefits.
Adding to this difficulty is the fact that very few tests exist for evaluating the severity of an individual's mental impairment, which means the criteria tend to be relatively subjective. Without hard evidence, examiners are left to base their decisions on information from physicians' records; an activities of daily living (ADL) questionnaire; and feedback from friends and family members.
If there is not enough information to support your mental health disability claim, an independent physician will conduct what is known as a mental consultative exam. Claimants with ongoing mental symptoms such as depression or memory loss sometimes are sent for an exam because they lack a recent medical evaluation (within the past 60 days), or perhaps never sought treatment before. Others are subjected to an exam just to be sure, but it really depends on the individual case.
The exam, paid for by the SSA, involves a standard mental or psychiatric evaluation, depending on the mental impairment in question. The examiner then sends a written report to your local Disability Determination Services (DDS) agency (within a 10-day window), which is used to either approve or deny your claim.
What is Residual Functional Capacity, or RFC?
In addition to assessing the presence of a mental impairment, the SSA also must determine whether the condition affects your ability to perform substantial gainful activity. To do this, agents will look at your "residual functional capacity." The RFC is a measure of which kinds of work you are able to perform in light of your disability.
A combination of medical records (including psychological tests) and reports from nonmedical sources (such as family, friends, and coworkers) is used to determine your RFC.
The following RFC levels (assigned to four specific areas of psychological and mental functioning) are used to determine the limits of your ability to work and how much you will receive in benefits:
- Not Significantly Limited
- Moderately Limited
- Markedly Limited
- Insufficient Evidence
You probably will not receive benefits unless the SSA finds you "markedly limited" in at least one of the following areas:
- Understanding and Memory
- Social Interactions
- Sustained Concentration and Persistence
Claims for Substance Abuse
You may claim SSDI or SSI disability for mental (and physical) impairments that resulted from past drug or alcohol abuse, as long as the drugs and/or alcohol are no longer contributing factors to your disability. You must exhibit one of the following behavioral changes caused by substance abuse in order to file a claim for mental disability:
- Organic Mental Disorders
- Depressive Syndrome
- Anxiety Disorders
- Personality Disorders
The SSA will deny your claim if it determines your impairment will improve with the cessation of drug or alcohol use. But current drug and/or alcohol addiction is not considered a valid reason for claiming benefits. This can become difficult for claimants who suffer from depression or anxiety, which may trigger substance abuse (which in turn may exacerbate the disorder).
See the SSA's section on substance addiction disorders for a more complete list, including physical ailments.