Applying for Mental Disability Benefits

One of the most challenging areas for both applicant and advocates is working through an application for disability based on mental impairment.   This is particularly true for the applicant who has managed to establish a significant work history while dealing with a mental disorder.

The evaluation of disability on the basis of a mental disorder requires documentation (a written history of medical treatment) of a medically determinable impairment (illness), consideration of the degree of limitation imposed on a person’s ability to work, and consideration of whether these limitations have lasted or are expected to last for at least 12 continuous months.  In other words, for your application to be successful you must have a record of medical treatment of an illness or disorder that causes major problems and those problems must have lasted at least 12 months.

The Social Security Listings for mental disorders are arranged in nine diagnostic or distinguishing categories: (1) organic mental disorders, (2) schizophrenic, paranoid and other psychotic disorders, (3) affective disorders, (4) intellectual disability, (5) anxiety-related disorder, (6) somatoform disorders, (7) personality disorders, (8)substance addiction disorders, and (9) autistic disorder and other pervasive developmental disorders.

According to the National Alliance on Mental Illness (NAMI), approximately 1 in 25 adults in the U.S, which is 10 million people or 4.2% of the population, in a given year experience a serious mental illness that substantially interferes with or limits one or more major life activities such as work. In a society where mental illness is so prevalent, how does a person who is being treated for mental illness but somehow managed to eventually receive a favorable decision from the Social Security Administration?

Building a Winning Case

The starting point for a winning case is always a consistent history of medical treatment or medical records. No applicant or advocate can build a winning case out of complaints of mental illness that does not have a list of treatment sources or at least a doctor’s notes to support the complaints or episodes that .

In most of the cases where the applicant has a substantial work history, the problems with a mental illness develop over time and result in a deteriorating condition that makes a return to full-time employment impossible.

With this in mind, how does an applicant develop the medical evidence necessary to get a favorable decision from the Social Security Administration?  When a person initially feels he or she is experiencing   emotional or mental difficulties that make if handling the responsibilities of work and home intolerable, this is the time to express the concerns to the applicant’s healthcare provider.  Tell your doctor in detail what thoughts, imaginations and feelings you are having and under what circumstances.  If you break out in a sweat at the thought of walking down a certain hallway or get a sense of floating during a certain time at your job, tell your doctor. Many well-meaning and truly deserving applicants are frequently reluctant to tell health-care providers and family members of the extent of the difficulties they face in controlling their emotions and dealing with the pressures of the work environment, but symptoms and incidents that are not documented are unlikely to be considered as having occurred by the Administrative Law Judge.

Damaging Your Case

Another vital aspect of the application for mental or emotional disability is being compliant with the prescribed medical treatment.  That includes not only taking medicine as prescribed but also keeping appointments.  Additionally, it is important to attend group and individual therapy and counseling sessions even when those sessions do not appear to result in significant improvement of your condition.

In years of representing claimants, little is more disheartening to the advocate than spending hours building a rock solid case only to have the all the questionnaires and memorandums and briefs be cancelled out by the fact the applicant has not been taking his medication.  Failure to follow a prescribed treatment regimen is cause in and itself for a denial of benefits in many cases.

Another point of concern for the advocate and the claimant is making certain that the testimony from the claimant and witness match up with the medical evidence of record.  For example, it does not help further the goal of getting a favorable decision if the claimant fills out questionnaires complaining of auditory and visual hallucinations but there is never a suggestion of those hallucinations to medical personnel.  When the oral testimony and written forms completed by the claimant are not supported by at least similar complaints to counselors or doctors, then the truthfulness of the claimant applying for mental disability will be called into question by the Administrative Law Judge.