How Does the Social Security Administration Assess Whether or Not Your Condition is Physical and/or Mental?

by May 17, 2018General

Home » Blog » Frequently Asked Questions (FAQs) » How Does the Social Security Administration Assess Whether or Not Your Condition is Physical and/or Mental?

You can qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) regardless of whether your condition is physical or mental.

The Social Security Administration (SSA) offers disability benefits to people who have medical conditions that render them entirely unable to work and earn a living for themselves. That said, the SSA’s determination of whether you have a physical or mental disability does affect the process by which it reviews and makes a decision on your claim.

How the SSA Determines Whether My Condition Is Physical and/or Mental

For the most part, the SSA makes this determination by the nature of your condition. Often, the distinction is obvious. For instance, a knee or lower back injury is apparently a physical impairment, while Post-Traumatic Stress Disorder and schizophrenia are undoubtedly mental afflictions.

If ambiguity exists as to whether your condition is physical or mental, the SSA might resolve it by determining the type of physician who would diagnose your case. If the answer is a traditional medical doctor, the SSA likely treats your claim as a physical disability. If it is a psychiatrist or mental health specialist, your claim probably gets reviewed and decided as one involving a psychological condition.

Why It Might Matter If My Condition Is Physical or Mental

On a grand scale, it does not make much of a difference whether you have a physical or mental condition that renders you disabled. As long as you meet the SSA’s definition of total disability, you qualify for benefits either way.

Where the nature of your condition can affect things is in the way the SSA reviews and decides on your claim. It has somewhat different processes for handling physical and mental disability claims.

How the SSA Evaluates Physical Disabilities

The SSA follows a fairly standard process when reviewing claims made by applicants with physical conditions. First, the Social Security Disability Examiner (DE), determines whether the applicant’s status meets the criteria for a Blue Book listing. The Blue Book is the SSA’s catalog of automatically approved conditions.

Each condition in the Blue Book has a list of criteria you must meet to receive automatic approval. If the condition does not satisfy a Blue Book listing, the DE next consults with a physician, known as a medical consultant, who helps the DE determine, based on your supporting medical evidence, your Residual Functional Capacity (RFC).

Residual functional capacity refers to the work capacity you still have left in spite of your condition:

  • Your ability to lift, bend and stand or sit for long periods
  • Eyesight
  • Hearing
  • Other senses

The question the DE and medical consultant seek to answer is, is your residual functional capacity enough to permit you to return to a job you have done in the past (within the previous 15 years) or that you would be capable of performing based on your skills and education? The answer to this question is what typically determines whether you receive an approval or a denial.

If, after reviewing your application, the SSA cannot confidently render a decision one way or the other, it will ask you to undergo a consultative physical exam by an independent physician. Typically, this exam is perfunctory, lasting no more than 20 minutes.

How the SSA Evaluates Mental Disabilities

For mental disabilities, the SSA’s review process is mostly the same as for physical limitations, but with a few extra details. Rather than merely consulting with a physician to review your medical records and occasionally prescribing a cursory physical exam, the SSA might order you to undergo a mental consultative exam before it decides on your claim.

The mental consultative exam is comprehensive, providing the SSA with significant details of your mental state, including but not limited to your:

  • Memory
  • I.Q.
  • Presence of any mental illnesses

In summary, the most significant difference in how the SSA evaluates physical and mental disabilities lies in the medical evaluation: a routine physical exam versus a more in-depth mental health screening.

Call 865-566-0800 to Schedule a Free Case Evaluation at the Disability Advantage Group

At the Disability Advantage Group, our attorneys want to help you win disability benefits.

It starts with a free case evaluation, where we:

  • Review your claim
  • Answer your questions, such as, “How does the Social Security Administration assess whether or not your condition is physical and/or mental?”
  • Offer free advice

To schedule an appointment today, call our office at 865-566-0800.