Getting Social Security Disability Benefits for Neurocognitive Disorders

The Social Security Administration (SSA) awards disability benefits to people who have a medically determinable, severe impairment that keeps them from working full-time for at least one year. Severe impairments can be physical or mental in nature. If you've been diagnosed with a neurocognitive disorder, you may qualify for disability depending on whether your cognitive impairment causes mild or major limitations in your functioning.

What Are Neurocognitive Disorders?

Neurocognitive disorders are abnormalities of the brain that affect the thought process. Unlike mood disorders such as depression and anxiety—which often have a cognitive component—declines in memory, concentration, and reasoning are the defining characteristics of neurocognitive disorders.

Neurocognitive disorders are generally classified as "mild" or "major" based on how severe the symptoms are. Common causes of neurocognitive impairments include brain damage (by infection, injury, or stroke), dementias like Alzheimer's disease, genetic defects, a compromised immune system, or extensive substance abuse. These impairments are usually permanent and often progressive, but some early, easily treatable infections are short-term.

Are Neurocognitive Disorders Disabling?

Social Security decides whether your neurocognitive disorder is disabling by looking at the extent that your symptoms interfere with your ability to work. Major cognitive disorders can rule out even simple, unskilled work, while a mild cognitive impairment might impact your ability to learn a new job. In order to determine how severe your neurocognitive disorder is, the SSA will need to review your medical records for evidence of difficulty in thinking and understanding.

Evidence Needed to Show Disability for Neurocognitive Disorders

Neurocognitive disorders are usually diagnosed following a mental status examination. Mental status exams are typically administered by psychologists or psychiatrists. They involve completing very basic tasks, like spelling a word backwards, adding small numbers, or drawing shapes. The SSA reviews the results of your exam to help determine whether your cognitive abilities are mildly or severely impaired. If you've received brain imaging studies (such as an MRI or CT scan), the agency will look at those as well.

Clinical notes from your regular doctor showing treatment for a neurocognitive disorder are key. The notes should include your doctor's observations of any unusual thought patterns, memory deficits, or abnormal behaviors that you display. If your doctor agrees to write a letter describing your cognitive impairments, the SSA will take that into consideration when determining whether you're disabled—as long as the opinion isn't at odds with the rest of the medical record.

Social Security can ask you to see a doctor on their dime—called a consultative examination—if the agency doesn't think there's enough information in your medical records to make a disability decision. The SSA may also seek information from friends, family members, or caregivers who know you well and can provide insight into your cognitive limitations.

Getting Disability by Meeting Social Security's Listing for Neurocognitive Disorders

Social Security maintains a "Blue Book" of medical conditions that the agency considers especially serious. You can qualify for disability if you have evidence of specific symptoms described by a listed impairment. Getting benefits this way is called "meeting a listing."

The SSA evaluates neurocognitive disorders under listing 12.02. To meet the requirements of the listing, you'll have to show that you have a worsening cognitive impairment that's causing specific functional limitations in your mental abilities.

Significant Cognitive Decline

The first step towards meeting listing 12.02 is showing that you have "significant cognitive decline from a prior level of functioning." Basically, this means that you'll need to prove that your mental abilities have gotten worse since the onset (beginning) of your neurocognitive disorder.

Social Security accepts evidence of a decline in the following cognitive areas for the purposes of meeting the neurocognitive disorders listing:

• complex attention (being able to divide focus)
• executive function (controlling your thoughts and actions)
• learning and memory (retaining and using information)
• language (communicating without errors in grammar or word choice)
• perceptual-motor (coordinating your movements with your environment), or
• social cognition (understanding the behavior of others).

While a low IQ score on one test isn't enough to establish a neurocognitive disorder on its own, if you've taken multiple IQ tests and your score has dramatically decreased between them, that's strong evidence of significant cognitive decline due to a neurocognitive impairment.

Functional Limitations In Your Mental Abilities

It's not enough just to show that you have a significant cognitive decline from your previous level of functioning to meet listing 12.02. You'll also need to show that you have either an "extreme" limitation in one, or a "marked" limitation in two, of the following work-related areas of mental functioning:

• Understanding, remembering, or using information. This includes the ability to plan, follow instructions, correct mistakes, solve problems, and make decisions.
• Interacting with others. This includes cooperating with others, asking for help when needed, responding appropriately to social cues, and handling conflicts.
• Concentrating, persisting, or maintaining pace. This includes finishing tasks on time, avoiding distractions, and switching activities without being disruptive.
• Adapting and managing oneself. This includes being appropriately dressed and groomed, avoiding dangers, setting realistic goals, and responding to demands.

"Extreme" is more limiting than "marked." Limitations are marked when you can complete them independently, but with significant difficulty. If you have an extreme limitation, you can't function in that area on your own for any meaningful time. Somebody who is unable to leave their house alone is likely to have an extreme limitation in interacting with others, for example, while another person who can leave their house occasionally may have only a marked limitation in that area.

Most people who get benefits under 12.02 are able to show that they have marked or extreme limitations in mental functioning. But you can meet the listing without those limitations if you can show that you're only able to function as well as you do because you get a lot of help. If you've been managing your neurocognitive disorders within a "highly structured setting" (like a group home) and you're only marginally adjusted to routine changes, you'll meet the listing.

Getting Disability for Neurocognitive Disorders Based on a Reduced Functional Capacity

Typically, only applicants with major cognitive disorders will qualify for disability benefits under the neurocognitive listing. People with mild cognitive impairments can still be found disabled if mental limitations in their residual functional capacity (RFC) rule out all work.

Your RFC is a set of restrictions on the kinds of job duties you can perform. Common restrictions for people with neurocognitive disorders include:

• no complex or detailed tasks
• no more than occasional interaction with coworkers or supervisors
• no public contact, and
• a 10-20% reduction in concentration, persistence, and pace.

The limitations in your RFC are a reflection of how severe your mental symptoms are. If your symptoms are mild, you might not be able to perform your past skilled work, but Social Security could find that you could still do jobs involving simple, routine, and repetitive tasks. Moderate or major symptoms could erode your productivity to the point that you couldn't do any job.

All medically documented limitations, mental or physical, should be contained in your RFC, and the SSA is required to consider how your combined conditions affect your ability to work. Be sure to let the agency know about treatment you're receiving for other medical conditions besides your neurocognitive disorder. Even a mild cognitive impairment combined with physical limitations can eliminate full-time work (and qualify you for disability), especially if you're at least 50 years old and unable to return to your past jobs.

Applying for Social Security Disability Benefits

You can start your disability application in several ways:

• File online at the Social Security website.
• Call 800-772-1213 (TTY 800-325-0778) between 8 a.m. and 7 p.m., Monday through Friday, to speak with a representative.
• Go in-person to your local Social Security field office.

Whether you're filing an initial application or appealing a denial, consider contacting an experienced disability attorney. People with neurocognitive disorders often struggle to meet important deadlines, gather necessary documents, and keep up with correspondence from the SSA. Your lawyer can stay on top of your disability case and help explain the process in terms that you can understand.

_{Updated February 8, 2024}