You probably know that getting approved for Social Security disability benefits (SSDI) can be a challenge. That can be especially true when the basis for your claim is a mental disorder. If you’re pursuing a disability claim due to mental health issues, it’s especially important to fully understand what will be required to prove your claim.
It’s also in your best interest to consult an experienced Florida Social Security disability lawyer as soon as possible if your claim is denied.
SSDI Bluebook Mental Disorders
The Social Security Administration (SSA) provides a listing of covered SSDI conditions known as the “Bluebook.” The Bluebook also sets forth the criteria used to determine whether someone suffering from a listed condition medically qualifies for benefits.
The types of mental disorders listed in the SSDI Bluebook include:
- Neurocognitive disorders: common examples include Alzheimer’s-type dementia, neurological disease, and progressive brain tumor
- Schizophrenia spectrum and other psychotic disorders: common examples include schizophrenia, schizoaffective disorder, and delusional disorder
- Depressive, bipolar and related disorders: common examples include major depressive disorder, bipolar disorders I and II, and persistent depressive disorder
- Intellectual disorder: intellectual disability not included under another category
- Anxiety and obsessive-compulsive disorders: common examples include panic disorder, social anxiety disorder, agoraphobia, and obsessive-compulsive disorder
- Somatic symptom and related disorders: common examples include somatic symptom disorder, illness anxiety disorder, and conversion disorder
- Personality and impulse-control disorders: common examples include borderline personality disorder, paranoid personality disorder, and intermittent explosive disorder
- Autism spectrum disorder: includes autism spectrum disorder with or without accompanying intellectual impairment and with or without accompanying language impairment
- Neurodevelopmental disorders: common examples include specific learning disorders, borderline intellectual functioning, and tic disorders
- Eating disorders: common examples include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food disorder
- Trauma- and stressor-related disorders: includes post-traumatic stress disorder and other stress-related disorders
Looking at the list, it’s easy to see why the SSA sets forth specific criteria that must be met in order to medically qualify for disability benefits. Many people live with mental health conditions such as anxiety, depression, stress-related disorders and other conditions and are able to work and support themselves. Whether or not the condition is disabling will depend on the nature, severity, and frequency of symptoms.
How is SSDI Eligibility Determined?
Anyone applying for Social Security disability is subject to technical qualifications, such as having accrued a sufficient number of work credits and providing all requested information. Each must also be found “medically qualified.”
For mental disorders listed in the Bluebook, there are three different approaches to determining medical eligibility.
Both Paragraph A and Paragraph B
For somatic symptoms and related disorders, personality and impulse-control disorders, autism spectrum disorders and neurodevelopmental disorders, applicants are assessed against two sets of criteria. The first (known as “paragraph A”) involves medical factors. The second (known as “paragraph B”) involves functional criteria.
The paragraph B assessment involves four areas of mental functioning:
- Understanding, remembering, and applying information
- Interacting with others
- Concentrating, persisting, or maintaining pace
- Adapting and managing oneself
Each of these areas is assessed on a five-point scale, ranging from no limitation to extreme limitation. To qualify, the applicant must show either extreme limitation in one area or marked limitation in at least two areas.
This is a holistic assessment that takes into account information from medical providers and non-medical evidence such as questionnaires completed by people familiar with your daily activities. If you’re unfamiliar with the disability application process, it can be difficult to know how the SSA will view your medical records and the additional evidence you submit, and even to know exactly what information you should provide.
Paragraph A and Either Paragraph B or C
For neurocognitive disorders, schizophrenia spectrum and other psychotic disorders, depressive, bipolar and related disorders anxiety and obsessive-compulsive disorders and trauma- and stressor-related disorders, paragraph A criteria must be met. But, for these conditions, either paragraph B (as described above) or an additional paragraph C will suffice.
Paragraph C is used for “serious and persistent” disorders, and requires a showing that:
- The applicant is reliant on medical treatment, therapy, psychosocial supports, or a highly structured environment on an ongoing basis, and
- Despite diminishment in signs and symptoms, has achieved only “marginal adjustment,” meaning that the adaptation to daily life is fragile and the applicant has limited ability to adapt to changes in environment or new demands
The assessment for intellectual disorders is specific to that condition.
What if My Mental Health Condition Isn’t Listed?
The Bluebook is not an exhaustive list of conditions and combinations of conditions that can qualify a person for SSDI benefits. Someone who is suffering from a mental health condition that is “equivalent” to a listed condition in severity and the limitations it creates, or who has a combination of conditions that work together to create such limitations, may still be eligible.
Talk to an Experienced Social Security Disability Lawyer
Most SSDI claims for mental health conditions are denied at the initial application stage. The process can be daunting for any Social Security disability applicant. That’s especially true for some people whose claims are based on mental health disorders, since the very conditions triggering the application can make it difficult to manage the application process.
It’s important not to get discouraged and not to give up. Many claims that are initially denied are approved at a later stage in the process. One reason claims are more often approved at the hearing stage is that applicants are more likely to get lawyers for Social Security disability appeals than to work with a professional at an earlier stage of the process.
An attorney who is experienced with SSDI mental health claims will know what type of evidence the SSA is looking for and how to arrange and present that evidence in a way that makes a clear and compelling case.
At Harrell & Harrell, we offer free consultations to people who have been denied Social Security disability benefits. You can speak with a Social Security disability lawyer at no charge and with no obligation, to learn more about your rights and options. But, you may need to act quickly. The time to appeal an SSDI denial is limited. Call 904-251-1111 right now to schedule your free consultation.