SSD claims involving mental disorders can introduce unique challenges

by Feb 28, 2017Frequently Asked Questions

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Documenting the disabling nature of mental disorders such as anxiety, depression or schizophrenia may be difficult for people seeking SSD benefits.

Many people in Knoxville struggle with depression, anxiety, schizophrenia or other serious mental disorders. In 2012, mental, behavioral or emotional disorders affected an estimated 43.7 million American adults, according to the National Institutes of Health. Sadly, it’s not uncommon for these disorders to prove disabling.

If a mental disorder prevents a person from working gainfully, the person may be eligible to receive Social Security Disability benefits. However, the evidentiary requirements that SSD applicants must meet are strict. Under Social Security’s standards, establishing the debilitating nature of a mental disorder can be especially challenging.

Evaluating mental disorders

Social Security has compiled a list of conditions that are considered disabling if they meet certain requirements. These conditions are listed in the “Blue Book.” Various disabling mental or emotional disorders, including anxiety, affective disorders and schizophrenia, are listed in the Blue Book. The book requires applicants who suffer from these disorders to document specific symptoms and functional limitations.

An applicant who does not meet these requirements may receive benefits if a claims examiner finds that the applicant cannot work. To make this determination, the examiner may consider all of the applicant’s impairments and adverse symptoms. For instance, someone afflicted with depression may experience issues with focusing, remembering things or making decisions. If a person’s impairments effectively preclude employment, the person might qualify for SSD benefits.

Providing adequate evidence

Proper documentation is essential for SSD claims involving mental disorders, since these disorders are not outwardly apparent. Applicants must provide medical evidence of the disorder and documentation of its disabling effects. The following evidence can corroborate an applicant’s self-reported symptoms and functional limitations:

  • A diagnosis from a licensed or certified psychologist
  • Medical records from all treating sources
  • Results of psychiatric or psychological testing
  • Statements from third parties, such as family members

Inadequate or inconsistent supporting evidence may provide grounds for claim denial. Unfortunately, this is not the only potential reason for an unfavorable decision in an SSD claim involving a mental disorder.

Potential complications

Claim approval may be less likely if an applicant has not established an ongoing record of medical treatment. Social Security can only award benefits if a condition is expected to preclude employment for at least 12 months, and gaps in medical treatment may suggest that a disorder cyclically improves or is not consistently disabling. Therefore, claimants may benefit from establishing a long-term treatment record before claiming SSD benefits.

Applicants who do not take prescribed medications also risk claim denial. Social Security won’t find a person disabled if treatment can manage the disabling condition. If the effects of medication aren’t known, a claims examiner may not be able to approve the claim. This makes it crucial for applicants to follow prescribed treatments or show valid reasons for failing to do so.

Finally, qualifying for SSD benefits may be difficult for people who suffer from substance use disorders. Social Security cannot award benefits for substance use disorders alone. Since substance use can contribute to many mental disorders, determining whether a disorder would be disabling without any substance use may be difficult. However, periods of sobriety can help claimants show that a mental disorder is disabling on its own.

Seeking assistance

People seeking SSD benefits for mental disorders often face unique challenges in proving their claims are legitimate. To reduce the risk of claim denial, applicants may benefit from partnering with an SSD attorney. An attorney may be able to offer advice on preparing a claim that meets Social Security’s strict standards.

Keywords: Social Security, disability, benefits