Having a basic understanding of how the Social Security Administration (SSA) evaluates mental impairments can help you prepare your claim for Social Security disability or SSI.
To meet the basic requirements for disability, your mental condition must prevent you from working at the substantial gainful activity level (called SGA). For 2016, SGA means earning $1,130 a month from working (this dollar amount usually changes every year). Your inability to work must be expected to last at least a year.
If you have met the basic requirements for disability, the Social Security Administration (SSA) will decide if your condition meets the requirements of a disability listing (listings are explained below.) If it does meet a listing, you will be automatically approved for benefits. If the SSA decides your mental condition doesn’t meet a listing, the agency must next determine whether you can still do your past work.
If the SSA thinks you can do your old job despite the symptoms of your mental condition, you will be denied. However, if the SSA concludes that you can’t do your past work, the agency will then determine whether there are any other jobs you can do. You will be approved only if the SSA concludes that your mental condition prevents you from working any job on a regular and sustained basis (full time.)
The SSA will use your medical records and, if you don't meet a listing, a mental residual functional capacity assessment (MRFC) to decide your claim. Both medical records and the MRFC are discussed later in this article.
There are certain conditions that the SSA has concluded are serious enough to warrant an automatic approval of benefits. These conditions are described in the Listing of Impairments. Each listing has certain criteria that must be met in order to be approved for benefits. The listing requirements vary depending on the condition.
The listings contain an entire section devoted solely to mental impairments. Here are some of the conditions covered under the “Mental Disorders” listings:
A functional limitation is something that you can’t do because of your impairment. All of the mental disorders listings require that your functional limitations be "marked" (more than moderate but less than extreme) in two of the following areas:
your activities of daily living (paying bills, grocery shopping, etc.)
The listing requirements are quite complicated. You should review them with your psychiatrist or psychologist to see if you meet the criteria needed for your particular condition. You can also read about the listing criteria for most mental conditions in depth on the disability secrets website. An experienced disability attorney will also be able to evaluate your claim and determine whether you may be able to meet a listing.
Here are examples of symptoms needed to meet the listing requirements for some of the more common mental health conditions.
The SSA makes its decision based on the evidence in your file. This means that, regardless of whether you meet a listing, you will need to provide the SSA with the medical records that relate to the treatment and diagnosis of your mental condition (don't send them records that aren't related to your mental impairment). Here are some examples of the types of records you will need to support your claim:
You should also provide the SSA with an Activities of Daily Living form (called an ADL) form. This form allows you to explain in detail how your mental illness affects your day-to day-life. Claimants often underestimate the importance of the ADL, but it is an effective way to tell the SSA about the functional limitations caused by your mental impairment.
If you don’t meet a listing (most applicants don't), the SSA will use the medical evidence in your file to prepare a mental residual functional capacity assessment (MRFC) for you. The MRFC examines how your symptoms limit your ability to perform the mental and emotional tasks needed to work. Here are some areas that are evaluated by the MRFC:
The greater the limitations caused by your mental illness, the more likely the SSA will find you disabled.
It is vital that you ask the doctor(s) who treats you to prepare a MRFC assessment on your behalf. If you have a disability attorney, he or she will make sure that your doctor receives an MRFC form, will review it, and will make sure that any records needed to support your doctor’s opinion are also submitted.
People who suffer from mental illness often suffer from drug addiction or alcohol abuse as well. If your condition would go away if you stopped using drugs or alcohol, you will likely be denied benefits. However, if your mental illness would still be present even if you stopped using or drinking, your eligibility for benefits will probably not be affected (assuming you meet the other criteria). If you have a drug or alcohol problem, or have in the past, it will be especially helpful to speak to an attorney about your case.
It can be hard to win a claim based on a mental condition. However, an experienced disability attorney can identify the best strategy to win your claim and greatly increase your chances of approval.