About a quarter of applicants for Social Security disability list mental illnesses or disorders as their primary impairment. Depression (including bi-polar disorder) and anxiety disorders make up the majority of these claims. In addition, applicants make disability claims based on intellectual disability, dementia, schizophrenia, autism, and learning disabilities. 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. While almost half of all mental disability claims are denied at the initial application stage, 75% of those who go on to appeal are eventually approved after appeal.
Social Security will review your medical records to see if your mental illness meets the criteria of one of the mental illness listings in its "Listing of Impairments." The listings contain an entire section devoted to what the SSA describes as "Mental Disorders."
Here are some of the conditions included under the Mental Disorders listing:
Each category of conditions has a specific set of requirements that must be met. Not only must you have a diagnosis of a certain illness, but you must also 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 a mental disorder listing.
If your condition doesn't meet the listing requirements for your condition, the SSA will look at your symptoms to determine your "mental residual functional capacity" (MRFC). Your MRFC is the most you can do despite the mental (or emotional) limitations you have. If the SSA decides you don't have the MRFC to work on a regular and sustained basis, full time, you will be approved for benefits; 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 should 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 psychiatrist or licensed psychologist, and without a detailed report from the psychiatrist or psychologist about your mental limitations and how they limit you.
Social Security will look to see the extent of any limitations you have in the following areas:
The more limitations your mental condition causes, or more severe your limitations are, the more likely you are to get approved for benefits. (To learn specifically what types of limitations qualify you for disability, read Nolo's article about getting disability when you can't do a simple, unskilled job.)
If you have hired a disability attorney, he or she will make sure that your doctor has an MRFC form and that it is completed properly and submitted to the SSA on time.
Social Security will look at whether you are working, and if so, how much. Social Security can grant you disability benefits if you are unable to work at or over the "substantial gainful activity" level (called SGA) for at least one year. (SGA is defined as earning about $1,300 a month from working.) But if you are earning more than that, Social Security will deny your claim without even looking at your medical records.
All disability claims are decided almost solely on the content of the applicant's medical records. Make sure you include all medical records from providers that gave you care based on the condition. For example:
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 disability 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.
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 in treatment (or other inconsistencies) to the ALJ.
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.