According to the Social Security Administration, a 20-year-old worker has a 25% chance of becoming disabled before retirement age. Mental health conditions were the most common causes of disability for workers age 50 and younger.
Social Security administers two disability programs that provide benefits for mental illness when a person’s condition prevents them from earning a living by working. This guide explains the Social Security mental illness approval process, the mental health conditions, and the SSD for mental health benefits available through the Supplemental Security Income and Social Security Disability Insurance programs. When you need assistance, contact the Clauson Law Firm for answers to your questions and concerns about disability benefits for mental health conditions.
Approval of depression SSD claims and other mental health conditions relies on evidence establishing that they have a “disability” defined by federal law as the inability to engage in substantial gainful activity caused by a medically determinable physical or mental impairment expected to result in death or that has lasted or can be expected to last for not less than 12 continuous months.
Adults applying for SSI and all applicants for SSDI must have a disability meeting the federal definition. Applications for SSI benefits filed on behalf of children must conform to a different definition of disability requiring a medically determinable physical or mental impairment or a combination of impairments resulting in marked and severe functional limitations. The impairment or impairments must have lasted or be expected to last for at least 12 months or be expected to result in death.
The challenge to being approved for disability benefits with a mental illness comes from the nature of the condition. Unlike a physical condition that can be seen using diagnostic imaging or proven with blood test results, mental conditions are difficult for claimants to prove and for the Social Security Administration to evaluate.
Social Security maintains a list of impairments for each of 14 major body systems, including mental disorders, that it considers severe enough to prevent a person from working. A separate listing exists for the evaluation of claims for SSI filed on behalf of children. The childhood listings contain impairments considered severe enough to cause a child to experience functional limitations that are marked and severe.
The listing of impairments includes medical criteria needed to meet or medically equal a listed impairment. The SSA's five-step sequential evaluation process to determine whether a person has a disability relies on the listed impairments identified in step three.
Mental health conditions in section 12 of the adult listings include:
· Neurocognitive disorders
· Schizophrenia and other psychotic disorders
· Depressive disorders
· Bipolar disorder
· Intellectual disorder
· Anxiety and obsessive-compulsive disorders
· Personality and impulse-control disorders
· Autism spectrum disorder
· Neurodevelopmental disorders
· Eating disorders
· Trauma- and stressor-related disorders
Section 112.00 of the childhood listings includes conditions similar to the adult listings, except for the inclusion of listing 112.14, developmental disorders in infants and toddlers.
Medical documentation needed to prove a claim for SSDI or SSI based on a mental health condition depends on the condition. Each condition has symptoms and other medical criteria that must be met to be approved for benefits.
Examples of the evidence needed to support an anxiety disability application include:
· Medical records containing physical and psychological evaluation notes and findings.
· Results of psychological testing and laboratory testing.
· Records of medications and treatment plans prescribed by doctors.
· Statements from physicians, including specialists, such as psychiatrists and psychologists.
· Hospitalization records, including emergency room visits.Third-party statements from friends, family, employers, and co-workers about limitations observed in the ability of a person to function when doing daily and work activities.
An applicant for mental health disability benefits should keep a journal to record symptoms and limitations they experience from their mental health condition.
Documentation of prescribed drugs and therapy can be crucial to the process of approval of benefits for mental health conditions. The medication records should include side effects and any changes to the prescribed medication or dosage.
Therapy records should include notes of the healthcare provider that include observations about progress or setbacks during treatment. Notations about changes in a patient’s behavior and mood over time can be essential evidence to prove impairments limiting the person’s ability to work.
Medication and therapy records can be used as evidence of an ongoing course of treatment without any gaps. A claimant may be denied benefits where the records show a failure to take prescribed medications or missed appointments with physicians and therapists.
Two programs administered by the Social Security Administration offer disability benefits to individuals with a disabling mental health condition. SSDI provides benefits to individuals who worked at jobs or self-employment with Social Security payroll taxes paid on their earnings or income.
The work history for SSDI must be sufficiently long to meet the program's requirements. The age at which a person becomes disabled affects the length of the required work history. Workers disabled at a younger age require shorter work histories.
The SSI program does have a work history requirement. Instead, SSI pays benefits to people with disabilities who have limited income and resources. For example, the value of resources or assets available to an individual may not exceed $2,000, or $3,000 for couples.
The SSDI program provides a monthly cash payment and Medicare coverage to people with mental health disabilities. The amount of the monthly benefits depends on the individual’s average lifetime earnings.
The more money that a person earns and pays into the Social Security system through their federal payroll taxes, the greater their monthly SSDI benefit amount. SSDI benefits can increase annually due to cost-of-living adjustments.
Medicare coverage does not become available immediately. An applicant approved to receive benefits must wait 24 months from approval of their application before they are automatically enrolled for Medicare Part A and Part B coverages.
Part A, hospital coverage, does not require payment of a monthly premium when the person enrolled has been approved for SSDI. However, Part B medical coverage requires a premium payment. SSDI beneficiaries may opt out of Part B coverage.
Some medical conditions do not have a 24-month waiting period for Medicare enrollment. Individuals approved for SSDI benefits with a diagnosis of amyotrophic lateral sclerosis (ALS) can be enrolled immediately in Medicare.
Individuals approved for SSDI benefits with end-stage renal disease (ESRD) may have no waiting period or a four-month waiting period for Medicare enrollment. If you have been diagnosed with ESRD, talk to a disability lawyer at Clauson Law to determine when your Medicare coverage starts.
Most states treat an application for SSI benefits as a Medicaid application, so approval for SSI includes Medicaid. The Clauson Law disability team will assist you regardless of the state where you live.
If you live with a mental condition that impairs your ability to work, reach out to the disability benefits professionals at Clauson Law. Our disability attorneys are here to help you navigate the disability benefits process. Contact us today for a free case evaluation.
Sources: Probability of disability at age 20
