The majority of people who apply for disability for a mental illness or emotional condition are granted benefits.
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% are eventually approved after appeal.
How Social Security Evaluates Mental Illness Claims
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,” which was updated extensively in January of 2017.
Mental Disorders Listing
Here are the some 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, you must 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 You Don’t Meet a Listing
If your condition doesn’t meet the listing requirements for you 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:
your ability to understand and remember information
your ability to follow directions and control your behavior
your ability to get along with others)
your ability to tolerate stress
your ability to concentrate, complete tasks, and get work done in an appropriate amount of time
your ability to adapt to changes, and
your activities of daily living (paying bills, grocery shopping, bathing, and so on)
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 a MRFC form and that it is completed properly and submitted to the SSA on time.
Whether You Are Working
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. (For 2017, SGA is defined as earning $1,170 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.
Medical Records for a Mental Disability
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:
records from psychiatrists, psychologist, therapists, counselors, or social workers
records from hospitalizations or emergency room visits that were the result of your condition, and
pharmacy records (that detail your prescriptions related to your condition).
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.
The Importance of Credibility
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.
A Note on Alcohol and Drug Abuse
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.
John is a Jacksonville native who grew up on the First Coast. He graduated from Bishop Kenny High School in 1975 and went to college at Florida State University where he completed a 4-year program in 3 years. John graduated from the Florida State University College of Business in 1978 and went straight into Florida State University College of Law. While in law school, John earned a position on the prestigious Law Review Board serving as its Business Editor. As a law student, John studied in the Oxford program. He also interned with the Florida Legislature working in the Florida House of Representatives Criminal Justice Committee. John was admitted to the Florida Bar in 1981.
John began his legal career as a law school intern in the State Attorney's Office in Jacksonville in 1981. After his internship, legendary State Attorney Ed Austin hired John as a full-time Assistant State Attorney for the Fourth Judicial Circuit (Clay, Duval, and Nassau Counties). As a prosecutor, John tried jury and non-jury trial on charges ranging from DUI to Murder.
In 1983, John moved from the State Attorney's Office to begin his career in private practice. He has practiced law for 30 years on the First Coast. For the last 20 years, John and his family have made Clay County their home.
John limits his practice to personal injury and disability cases. While there are many fine attorneys in Clay County, John is one of only a few Clay County attorneys who limit their practice to personal injury and disability cases. John takes pride in helping clients resolve injury claims in ways that avoid the stress, uncertainty, and the expense of unnecessary litigation.
John is the past President of the Clay County Bar Association and has served on the Board of the Clay County Bar Association from 2009-2013. He is an active member of the Florida Bar, and the Federal Bar of the Middle and Southern Districts of Florida. He is also a member of the American Association of Justice, the Florida Association of Justice, the National Organization of Social Security Claimants' Representatives, and the National Organization of Veterans' Advocates.
Service to the Community
John is involved in the Clay County Community serving as a member and Director of the Rotary Club of Orange Park, of the Clay County Bar Association, and the Putnam County Bar Association.
The information provided on this web site is provided for general informational purposes only and should not be interpreted as legal advice. Every case is different and requires individual attention before such advice can be given. Neither the transmission nor receipt of general advice to or from our website will constitute an attorney-client relationship.