Can Mental Illness Qualify Me for Social Security Disability Benefits?

Can Mental Illness Qualify Me for Social Security Disability Benefits?

How Depression, Anxiety, PTSD, Bipolar Disorder, and Other Mental Health Conditions Can Affect Your Ability to Work

Many people understand that a serious physical condition can prevent someone from working.

A severe back injury can prevent lifting.  Heart disease may severely limit physical exertion.  Neurological problems can make walking or using your hands difficult.

But what if the condition preventing you from working is something other people cannot see?

What if you suffer from severe depression and cannot get out of bed several days a month?

What if anxiety or panic attacks make it difficult to leave home?

What if PTSD causes flashbacks, hypervigilance, or an inability to tolerate being around other people?

What if bipolar disorder causes periods when you function relatively well followed by periods when you cannot reliably function at all?

You may wonder: “Can I really qualify for Social Security Disability because of a mental health condition?”

Yes.

Social Security recognizes numerous mental disorders that can be disabling, but having a diagnosis—even a serious diagnosis—does not automatically mean Social Security will find you disabled.  The more important question is: How does your mental health condition affect your ability to function and work on a regular and continuing basis?

That distinction is at the heart of a Social Security Disability claim based upon mental illness.

Recommended Reading: Why Restrictions Matter More Than Your diagnosis-Permanent Restrictions

Mental Illness Can Be Just as Disabling as a Physical Injury

Mental health conditions can affect nearly every part of a person’s ability to work.

A person may physically be capable of sitting at a desk for eight hours, but can that person:

Remember instructions?

Stay focused long enough to complete assignments?

Maintain an acceptable work pace?

Deal appropriately with supervisors?

Work around coworkers or the public?

Handle criticism?

Respond appropriately when something unexpected happens?

Show up for work consistently?

Complete a normal workday without symptoms interfering?

Those are work abilities.

And severe mental illness can interfere with them just as seriously as a physical condition can interfere with lifting, standing, walking, or using your hands.

What Mental Health Conditions Does Social Security Consider?

Social Security’s adult Listing of Impairments includes an entire section—12.00 Mental Disorders—devoted to mental conditions.

The current Listings include categories for:

• Neurocognitive disorders;
• Schizophrenia spectrum and other psychotic disorders;
• Depressive, bipolar, and related disorders;
• Intellectual disorder;
• Anxiety and obsessive-compulsive disorders;
• Somatic symptom and related disorders;
• Personality and impulse-control disorders;
• Autism spectrum disorder;
• Neurodevelopmental disorders;
• Eating disorders; and
• Trauma- and stressor-related disorders, including conditions such as PTSD.

But there is an important point:  Social Security does not award disability benefits merely because the name of your condition appears in its regulations.

A diagnosis is the beginning of the analysis—not the end.

Recommended Reading: Is My Diagnosis Enough to Qualify for Social Securit Disability Benefits?

“My Doctor Diagnosed Me With Depression. Is That Enough?”

Usually, no.

Two people can have the same diagnosis and have completely different abilities to work.  Consider two people diagnosed with major depressive disorder.

One takes medication, continues working full-time, maintains concentration, interacts appropriately with others, and rarely misses work.

The other experiences severe symptoms despite treatment.  That person may have difficulty concentrating, isolate from other people, struggle to complete simple tasks, experience periods of severe worsening, and miss work repeatedly.

Same diagnosis.

Very different functional limitations.

Social Security is interested in the second part of the equation: What does the condition actually prevent you from doing?

Social Security Looks at Four Important Areas of Mental Functioning

When Social Security evaluates the severity of an adult’s mental impairment, 20 C.F.R. §§ 404.1520a and 416.920a require consideration of four broad areas of mental functioning.

They are:

1. Understanding, Remembering, or Applying Information

Can you understand instructions?

Can you remember what you were told?

Can you learn a new task?

Can you follow directions without repeatedly being reminded?

Can you use judgment to make work-related decisions?

2. Interacting With Others

Can you appropriately deal with supervisors?

Coworkers?

Customers?

The general public?

Can you respond appropriately to criticism?

Can you cooperate with other people without becoming overwhelmed, angry, frightened, withdrawn, or excessively anxious?

3. Concentrating, Persisting, or Maintaining Pace

Can you remain focused?

Can you complete tasks?

Can you work at an acceptable pace?

Can you ignore ordinary workplace distractions?

Can you continue working without excessive breaks?

Can you finish what you start?

4. Adapting or Managing Yourself

Can you handle changes in your routine?

Can you respond to ordinary workplace demands?

Can you control your behavior?

Can you recognize hazards?

Can you set realistic goals?

Can you function independently when circumstances change?

These are not abstract medical questions.  They are abilities people use every day at work.

Recommended Reading: How Does Social Security Evaluate My Ability to Understand, Remember, and Follow Instructions? This is the first of four areas of mental functioning Social Security specifically considers when evaluating a mental impairment.

How Severe Do My Mental Limitations Have to Be?

Social Security rates limitations in these four areas using five levels: see 20 C.F.R. Part 404, Subpart P, Appendix 1, § 12.00F(2):

• None: You are able to function in the area independently, appropriately, effectively, and on a sustained basis.
• Mild: Your ability to function that way is slightly limited.
• Moderate: Your ability to function that way is fair.
• Marked: Your ability to function that way is seriously limited.
• Extreme: You are not able to function in that area independently, appropriately, effectively, and on a sustained basis.

For the paragraph B criteria of most adult mental-health Listings, Social Security generally requires an extreme limitation in one of the four areas or marked limitations in two of the four areas.

An extreme limitation does not necessarily mean that a person has absolutely no ability to function in that area. Social Security uses the term to describe an inability to function in that area independently, appropriately, effectively, and on a sustained basis.

However, failing to satisfy this standard does not necessarily mean the disability claim is over.

I Don’t Meet a Mental Health Listing. Can I Still Be Disabled?

Yes.

This is one of the most important things to understand about Social Security Disability.  If your condition meets or medically equals the requirements of a Listing and satisfies the other requirements, Social Security may find you disabled at that stage of its evaluation.  But many successful disability claims do not depend upon meeting a Listing.

If your mental impairment is severe but does not meet or medically equal a Listing, Social Security generally moves on and determines your Residual Functional Capacity, commonly called your RFC.

Your RFC is essentially an assessment of what you can still do despite your limitations.

For a mental impairment, that requires a much more detailed evaluation of your ability to meet the mental demands of work.  The question then becomes whether, considering your RFC and the applicable vocational factors, you can perform your past relevant work or adjust to other work.

Recommended Reading: What Is Residual Functional Capacity and Why Does It Matter in My Social Security Disability Claim?

“But I Can Do Things Around the House.”

That does not necessarily mean you can sustain full-time employment.  You may be able to:

Watch television.

Prepare a simple meal.

Drive occasionally.

Go to the grocery store.

Visit a family member.

Take care of a pet.

Use Facebook.

Attend church occasionally.

Social Security may consider those activities, but the important issue is not simply whether you can perform an activity once.

There is a major difference between doing something occasionally, in your own time and under your own conditions, and sustaining competitive employment day after day.

At home, you may be able to stop when your anxiety becomes overwhelming.  You can lie down when depression becomes severe.  You may avoid other people on a bad day.  You can postpone household chores.

A job is different.

An employer generally expects you to arrive when scheduled, remain at work, maintain productivity, follow instructions, interact appropriately with others, and perform reliably.

That is why the ability to perform isolated daily activities does not necessarily establish the ability to sustain employment.

What If I Have Good Days and Bad Days?

Many psychological conditions fluctuate.  Someone with bipolar disorder may experience periods of improved functioning followed by severe episodes.

A person with PTSD may function reasonably well until something triggers significant symptoms.

Someone with depression may have several better days followed by days when getting out of bed is extremely difficult.

Social Security’s regulations specifically require consideration of functioning on a sustained basis, and its mental-impairment evaluation considers episodic limitations as part of the overall picture.  So the question should not simply be: “Can you function on your best day?”

The better question is: “Can you function reliably enough to maintain a regular work schedule?”

That leads to an issue we will address separately in this series: attendance and reliability.

Missing Work Can Be Just as Important as What You Can Do at Work

Imagine a person who can perform relatively simple work when present, but because of severe depression, panic attacks, PTSD, or another psychological condition, the person would predictably miss work several days each month.

That creates a different problem.

The issue may not be whether the person can physically perform the individual tasks of a job.  The issue may be whether the person can sustain employment.  The same can be true when symptoms cause someone to be off task for significant periods during the workday or require excessive unscheduled breaks.

These are vocational questions that can become extremely important when Social Security determines whether work exists that the person can actually perform.

Recommended Reading: Can Mental Illness Prevent Me From Sustaining Full-Time Work Even If I Can Do Some Activities?

Concentration Problems Can Matter Even If You Are Physically Able to Work

Suppose your previous job involved bookkeeping.  Physically, you can still sit at a desk, but severe depression and anxiety now cause you to lose concentration repeatedly.

You forget what you were doing.

You make mistakes.

You need instructions repeated.

Tasks that once took thirty minutes now take two hours.

You become overwhelmed when several things require your attention.

The fact that you can physically sit in the chair does not answer whether you can still perform the job.  Mental RFC addresses limitations that physical RFC alone cannot.

Recommended Reading: How Do Problems With Concentration, Persistence, and Pace Affect a Social Security Disability Claim?

What If I Cannot Deal With Other People?

Not every job requires constant contact with the public, but virtually all competitive employment involves some degree of interaction with other people.

Employees generally have to deal with supervisors. Many have coworkers.  Some jobs require customers or members of the public.  Severe anxiety, PTSD, paranoia, depression, personality disorders, or other psychological conditions may substantially interfere with those interactions.

For example:

Can you accept instructions from a supervisor?

Can you respond appropriately to correction?

Can you work near other employees?

Do crowds trigger panic?

Do you isolate yourself?

Do ordinary workplace disagreements cause extreme reactions?

These limitations may be relevant even when the person can understand and physically perform the work itself.

Recommended Reading: Can Problems Dealing With Supervisors, Coworkers, or the Public Help Qualify Me for Social Security Disability?

What If I Cannot Handle Stress or Changes at Work?

People sometimes say: “Everyone has stress at work.”

That’s true, but that does not mean everyone has the same ability to respond to it.  For someone with a serious mental-health condition, seemingly ordinary workplace demands can produce significant symptoms.

A change in schedule.

A new supervisor.

An unexpected assignment.

Production deadlines.

Being corrected.

Having several tasks at once.

A change in routine.

For some individuals, those are ordinary inconveniences; for others, they can produce panic attacks, worsening depression, anger, withdrawal, confusion, or an inability to continue functioning.

Social Security’s fourth broad area of mental functioning—adapting or managing oneself—specifically considers the ability to regulate emotions, control behavior, and maintain well-being in a work setting.

Recommended Reading: How Does Social Security Evaluate My Ability to Handle Stress and Changes at Work?

Treatment Records Can Be Extremely Important

Mental-health disability claims are often built over time.  Records from psychiatrists, psychologists, counselors, therapists, primary-care physicians, hospitals, and other medical providers may help document:

• Diagnoses;
• Symptoms;
• Medication changes;
• Panic attacks;
• Depression;
• Mania or hypomania;
• Suicidal thoughts;
• Hallucinations or other psychotic symptoms;
• Problems concentrating;
• Problems interacting with others;
• Sleep disturbance;
• Changes in functioning;
• Hospitalizations;
• Response to treatment; and
• Side effects from medication.

Social Security generally looks at the evidence longitudinally—meaning over time—rather than simply taking one office visit out of context.  That can be particularly important with mental illness because symptoms may improve and worsen.

What If Treatment Helps Me?

We all want treatment to help us with our ailments, but improvement with treatment does not automatically mean you can work.  The relevant question is how well you function with treatment.

Suppose medication reduces your panic attacks from daily to twice a week.  That is improvement, but two severe panic attacks every week may still significantly interfere with regular employment.

Likewise, someone may be described as “stable” on medication but still have substantial limitations.

“Stable” does not necessarily mean: “Able to work eight hours a day, five days a week.”  It may simply mean that the person’s condition has stopped getting worse or that symptoms have improved from an earlier level.

The medical records need to be considered in context.

What If I Don’t See a Psychiatrist?

Not everyone with a serious mental-health condition receives specialty psychiatric treatment.

Some people receive treatment from a family doctor.  Others have difficulty obtaining mental-health care because of cost, lack of insurance, transportation problems, or limited availability of providers.

The absence of psychiatric treatment does not automatically mean the condition is not real-but evidence still matters because Social Security must have sufficient evidence to establish a medically determinable impairment and evaluate how that impairment affects your ability to function.

That is one reason consistent medical documentation can be so important.

Recommended Reading: Can Social Security Deny My Claim Because I Could Not Afford Medical Treatment?

What If My Mental Illness Is Not My Only Medical Problem?

Social Security does not necessarily evaluate each condition as though the others do not exist.  Suppose you have:

• Severe back problems;
• Depression;
• Anxiety;
• Diabetes; and
• Neuropathy.

Perhaps none of those conditions, standing alone, would establish disability, but their combined effect may prevent sustained employment.

Physical pain may worsen depression.

Depression may affect concentration.

Medication may cause fatigue.

Anxiety may make dealing with other people difficult.

Physical restrictions may eliminate certain jobs while mental restrictions eliminate others.

Under 20 C.F.R. §§ 404.1523 and 416.923, Social Security considers the combined effect of all medically determinable impairments when determining disability.

That means the correct question is often not: “Is my depression disabling?”

It may be: “Considering all of my physical and mental conditions together, what am I realistically still able to do?”

Mental Illness and Physical Pain Often Interact

This deserves particular attention.  Someone living with severe chronic pain may develop depression or anxiety.

Poor sleep may make concentration worse.

Depression may reduce motivation and energy.

Anxiety may intensify the person’s response to pain.

Medication used to treat one condition may cause fatigue or cognitive side effects that affect another aspect of functioning.

Social Security should evaluate the combined functional consequences of medically determinable physical and mental impairments rather than artificially separating the person into individual diagnoses.

Recommended Reading: Chronic Pain and Psychological Injuries

Do I Have to Prove That I Can Never Do Anything?

No.

Social Security Disability does not require a person to be bedridden, institutionalized, or incapable of doing anything at all.  The issue is whether the claimant satisfies Social Security’s legal definition of disability.

For an adult, that generally involves whether medically determinable impairments prevent the person from engaging in substantial gainful activity for the required duration, applying Social Security’s sequential evaluation process.

At the later stages of that process, Social Security considers whether the person can perform past relevant work and, if not, whether the person can adjust to other work considering the RFC and applicable vocational factors.

A person can therefore have some ability to function and still be disabled under Social Security’s rules.

The Law

Social Security uses a special regulatory technique when evaluating mental impairments.

Under 20 C.F.R. §§ 404.1520a and 416.920a, Social Security first determines whether the claimant has a medically determinable mental impairment and then evaluates the resulting degree of functional limitation.

For adults, Social Security considers four broad areas:

1. Understand, remember, or apply information;
2. Interact with others;
3. Concentrate, persist, or maintain pace; and
4. Adapt or manage oneself.

Social Security rates limitation in these areas as none, mild, moderate, marked, or extreme.

If a severe mental impairment meets or medically equals the requirements of an applicable mental-health Listing, the claimant may be found disabled at that stage of the sequential evaluation process.

The adult mental-disorder Listings are found in Section 12.00 of the Listing of Impairments and include depressive and bipolar disorders under Listing 12.04, anxiety and obsessive-compulsive disorders under Listing 12.06, and trauma- and stressor-related disorders under Listing 12.15, among others.

If a severe mental impairment does not meet or medically equal a Listing, the analysis does not necessarily end. Social Security then considers the claimant’s Residual Functional Capacity and evaluates whether the claimant can perform past relevant work or adjust to other work.

Importantly, the broad limitations Social Security uses when evaluating the Listings are not themselves the complete mental RFC assessment. The mental RFC analysis requires a more detailed evaluation of the claimant’s work-related mental abilities.

The Bottom Line

Yes, mental illness can qualify you for Social Security Disability benefits.

Depression, anxiety, PTSD, bipolar disorder, schizophrenia, obsessive-compulsive disorder, autism spectrum disorder, and other mental conditions can be every bit as disabling as a serious physical condition.

But the name of the diagnosis usually does not decide the claim.  The critical question is: What does your condition prevent you from doing reliably, appropriately, effectively, and on a sustained basis?

Can you understand and remember instructions?

Can you stay focused and maintain an acceptable pace?

Can you deal appropriately with supervisors and coworkers?

Can you handle ordinary changes and stress?

Can you show up consistently?

Can you sustain those abilities throughout a normal workday and workweek?

Those questions move the analysis away from “What have I been diagnosed with?” and toward the question Social Security ultimately must answer: “Despite all of my medical conditions, what am I still capable of doing in a real work setting?”

That is where many mental-health disability claims are won or lost.

Experience With Social Security Disability Claims

At Powell & Denny, P.C., we have extensive experience representing individuals whose physical conditions, mental-health conditions, or a combination of both prevent them from working. Mental-health disability claims often require careful development of the medical evidence and, just as importantly, the evidence showing how symptoms affect concentration, memory, interaction with others, attendance, adaptation, and the ability to sustain work.

A diagnosis tells Social Security what condition you have.

A successful disability claim often requires showing what that condition does to your ability to work.

Recommended Reading: How Does Social Security Evaluate My Ability to Understand, Remember, and Follow Instructions? In the next article in this series, we will look more closely at the first of Social Security’s four major areas of mental functioning—and why problems learning, remembering, understanding, and following instructions can matter even when someone appears perfectly capable during an ordinary conversation.

An experienced Social Security Disability attorney can evaluate your medical evidence together with your vocational factors to determine how the law applies to your specific situation.  At Powell & Denny, we have represented injured and disabled workers throughout Alabama for more than 30 years. We understand that serious claims are rarely decided by a diagnosis alone. They are decided by how the injury affects the person’s ability to function, work, and earn a living.

If you have questions about an Alabama Workers’ Compensation claim, or a claim for Social Security Disability benefits, don’t hesitate to contact the experienced attorneys at Powell and Denny today a free consultation; remember. Virtual appointments are available through Zoom so you can meet with one of the attorneys of Powell and Denny from wherever you live, and remember-there is no fee unless you win.

Powell & Denny: We Work When You Can’t.

Offices in Birmingham, Alabama and Huntsville, AL