Applicants for Social Security disability often base their claims on mental illnesses and disorders such as depression, anxiety, and bi-polar disorder. While these claims can be difficult to win, you are more likely to be approved if you learn how the Social Security Administration (SSA) reviews these types of claims and understand the evidence needed to support your claim.
Basic Requirements for Disability Benefits
To be eligible for disability, you must prove that your mental illness is so severe that it stops you from being able to sustain a full-time job.
Substantial Gainful Activity
Generally, being unable to work means you are unable to work at or over the substantial gainful activity level (called SGA) for at least one year. For 2014, SGA is defined as earning $1,070 a month from working. The SGA amount is usually adjusted each year to reflect the changing economy, so make sure you check with your attorney (if you have one) or the SSA website for the latest figure.
SSI vs. SSDI
Depending on your work history and financial situation, you may be eligible for either Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). SSI is for people who have very little work history and who have limited resources and income. SSDI is for people who have a qualifying work history with employers who paid taxes to the SSA.
How Social Security Evaluates Mental Illness Claims
If the basic requirements for disability above are met, Social Security will review your mental illness to see if it meets or equals one of the medical conditions discussed in its Listing of Impairments. The listings are a collection of conditions that the SSA has decided are so severe that they should be approved automatically for benefits. However, simply having a condition that appears in the listings won’t get you approved; your condition must also meet the specific criteria of that listing.
The listings contain an entire section devoted to what the SSA describes as “Mental Disorders.” Here are the some conditions included under the Mental Disorders listing:
- organic disorders (such as Alzheimer’s)
- personality disorders (like borderline personality disorder)
- affective disorders (like depression or bipolar disorder)
- substance abuse disorders
- anxiety-related disorders (like obsessive compulsive disorder or PTSD)
- somatoform disorders (disorders that cause physical pain without a known physiological cause)
- autism, and
- mental retardation (intellectual disability).
Each condition has a specific set of requirements that must be met. Not only must you have a diagnosis of a certain illness, you must show that the illness causes functional limitations that prevent you from working (discussed more below).
The listing criteria are fairly complicated; you should speak with your treating psychiatrist, psychologist, or therapist to determine whether you may qualify under any mental disorder listing. You can read about the specific mental conditions and their criteria in the mental disorders section of our partner website, Disability Secrets.
If You Don’t Meet a Listing
If your condition doesn’t meet the listing requirements, the SSA will look at your symptoms to determine your mental residual functional capacity (MRFC). Your MRFC is the most you can do of the mental (or emotional) aspects of a job on a full-time basis. If the SSA decides you don’t have the MRFC to work at a regular and sustained basis, you will be approved; otherwise you will be denied.
To determine what type of mental capacity you have, Social Security will look at your medical records and any opinions submitted by your psychiatrist or psychologist. You must have a doctor who specializes in mental conditions prepare an MRFC report for you. It is very hard to win a claim based on a mental condition without the support of a physician, and without a detailed report from your physician about your mental limitations and how they limit you.
If you have hired a disability attorney, he or she will make sure that your doctor has a MRFC form and that it is completed properly and submitted to the SSA on time.
Let's look at the type of functional limitations that will be included in developing your MRFC.
Functional limitations are limitations imposed on you by your mental illness that detract from the ability to live your life normally. Social Security will look to see the extent of any limitations you have in the following areas:
- your activities of daily living (paying bills, grocery shopping, bathing, and so on)
- social functioning (getting along with others)
- concentration, persistence, or pace (your ability to stay focused and get work done in an appropriate amount of time), and
- episodes of decompensation (disabling worsening of symptoms).
Whether you are trying to meet a listing or show that you don't have the mental capacity to work, you generally must demonstrate that your functional limitations are “marked” (severe) in at least two of the areas described above in order to win your claim.
The MRFC Report
To determine your mental residual functional capacity (MRFC), doctors who work for the SSA will use the records you have submitted to complete a report that addresses the seriousness of your limitations on certain work-related emotional and mental requirements.
Here are some specific examples of functional limitations that the SSA will evaluate:
- your ability to follow simple directions
- your memory
- your ability to work in a normal work environment without additional supervision
- your ability to get along with others in the workplace or with the general public
- your ability to keep your appearance socially acceptable
- your reliability
- your ability to tolerate stress, and
- whether you have behaviors that will distract others.
The more limitations your mental condition causes, the more likely you are to get approved.
Medical Records for a Mental Disability
All disability claims are decided (almost) solely on the content of the claimant’s medical records. For claims based on mental conditions, make sure you include all medical records from providers that gave you care based on the condition. For example:
- records from psychiatrists, psychologist, therapists, or counselors
- records from hospitalizations
- records from any emergency room visits that were the result of your condition, and
- pharmacy records (that detail your prescriptions related to your condition).
Do not include irrelevant records from providers who didn’t treat you for your mental condition (such as chiropractors or podiatrists.)
If you don't have sufficient medical records for Social Security to make a decision, the agency may send you for a psychological evaluation.
Subjective evidence is a large part of mental illness, which is why these claims can be difficult to win. Subjective evidence is based on a person’s individual experience; it cannot be documented by testing procedures or other clinical methods. This is why it can be extremely helpful to provide the SSA with a detailed description of how your life is impacted by your mental illness. Make sure that you speak openly and honestly with your doctors and caregivers as well, so that your records accurately reflect what you are experiencing. You may also consider having a close friend or former co-worker or supervisor write a letter that describes the effects of your mental illness on you. However, letters should be used sparingly. An experienced disability attorney will be able to help you decide if a letter written on your behalf would be helpful to your case.
The Importance of Credibility
One critical factor in disability cases, in particular those involving mental conditions, is the issue of credibility. If you appeal your claim to the hearing level, an Administrative Law Judge (ALJ) will hear your case and have the opportunity to question you about your disability. ALJs hear hundreds of cases a year and are well trained at identifying testimony that is exaggerated or untruthful. If an ALJ thinks you are being untruthful about your condition or exaggerating your symptoms, you will probably be denied benefits. Make sure your medical records don't contradict the testimony you give in court.
Many times there are inconsistencies in medical records that can make it appear as if your condition is not as bad as you claim. For example, disability claimants often go through periods of time without medical treatment due to financial hardship or lack of insurance. If this is true for you, be ready to explain these gaps (or other inconsistencies) in treatment to the ALJ.
Alcohol and Drug Abuse
Many people who suffer from mental illness also have drug or alcohol problems. You can still get approved for disability if you are currently abusing drugs or alcohol as long as your mental condition would still be disabling if you were sober. If the records indicate your mental condition would go away if you stopped abusing drugs or alcohol, you will be denied. For more information, see Nolo's article on how alcohol and drugs affect your disability claim.