Can I Qualify for Disability Benefits With a Mental Health Issue or Illness?

One of the key standards the SSA (Social Security Administration) evaluates when making disability determinations is the presence, type, and severity of a claimant’s disability. To help understand how SAA approves disability benefits, our disability attorneys wrote about how you can get approved for disability. In the past, we’ve covered obesity, cardiovascular disease, and rare illnesses. In this entry, our Philadelphia disability attorney from Young, Marr, Mallis & Associates will answer the question: can I qualify for benefits with a mental disorder?

Mental Health and Disability Benefits in Pennsylvania

According to the National Alliance on Mental Illness, or NAMI, approximately one in four Americans will experience the effects of a mental illness in an average year. That’s a massive chunk of the population, representing over 61 million people, or nearly 25% of the country. NAMI reports that the some of most common mental illnesses in the United States include:

• Schizophrenia (2.6 million people)
• Bipolar Disorder (6.1 million people)
• Depression (14.8 million people)
• Anxiety (42 million people)

Among the 61 million-plus who live with mental illness, about 13.6 million are classified as living with a serious mental illness (e.g. PTSD, schizophrenia, major depression). Among 18-44-year-olds, mood disorders are the third leading cause of hospitalizations in the United States.

Can a Mental Illness Qualify Me for Disability Benefits in Pennsylvania?

It is understood that when you have a broken back, you are simply physically unable to work. Unfortunately, many mental illnesses do not have the same “obvious” quality and are sometimes undermined and minimized due to ignorance and stigmatization. While no one questions the validity of a broken back, sufferers of depression are sometimes told to “cheer up,” while sufferers of anxiety may be told they “just need to relax.”

While the perception of mental illness by the general public is sometimes inaccurate, the SSA, fortunately, takes a more informed approach when considering the potential for debilitating side effects. Because of the wide range of conditions and disorders, including mental health issues, the SSA developed a comprehensive guide for their representatives and physicians to use to determine if an applicant’s condition qualifies for benefits. Known as the Blue Book, this guide features an entire section in its list of impairments, Section 12.00, which is devoted to mental disorders. So, what does Section 12.00 cover?

Schizophrenic, Paranoid, and Other Psychotic Disorders (Section 12.03)

Section 12.03 defines this group of disorders as being “characterized by the onset of psychotic features with deterioration from a previous level of functioning.” But while the SSA recognizes the medical validity of these disorders, they must meet additional requirements in order to be considered disabling “enough” to merit benefits.

For example, the SSA requires “medically documented persistence… of one or more of the following,” and goes on to cite hallucinations, catatonia, and emotional withdrawal among potential symptoms. Furthermore, these symptoms must lead to “marked difficulties” in various areas, including “daily living” and “social functioning.”

How Do Affective and Anxiety Disorders Qualify Me for Disability Benefits?

Each kind of disorder or mental condition is evaluated according to a specific set of criteria. For an applicant to be eligible for benefits, they must demonstrate that they meet the criteria for a listed condition or that the sum total of their disabling conditions is equivalent to a listed condition.

Affective Disorders (Section 12.04)

These disorders include depression and Bipolar Syndrome. As with psychotic disorders, affective disorders must meet several standards of severity. For example, a certain number of symptoms must be “medically documented,” including “appetite disturbance,” “sleep disturbance,” and “feelings of guilt or worthlessness.” Once again, these symptoms must result in various “marked difficulties.”

Anxiety Disorders (Section 12.06)

Include anxiety, Obsessive-Compulsive Disorder (OCD), and extreme phobias. Some of the symptoms which must be documented include “recurrent severe panic attacks,” “generalized persistent anxiety,” and “recurrent obsessions or compulsions,” depending upon the disorder. “Marked difficulties” must result.

Mental Health Issues That Qualify for Disability Benefits

There are a variety of other conditions and disorders that could qualify for disability benefits.

Autism and Related Disorders

If you suffer from autism or a similar pervasive development disorder, you will have to demonstrate that your condition limits your ability to communicate, engage in ordinary activities, and interact with others socially. More importantly, you will have to prove that these limitations result in an inability to perform your required functions at work.

Mental Retardation

For you or a loved one to qualify for disability benefits based on mental retardation, you will need to provide documentation proving at least one of the conditions listed below.

• The applicant depends on others for their personal needs, including eating, getting dressed, bathing, and using the toilet.
• The applicant has an IQ of less than 60.
• The applicant has an IQ of less than 70 combined with other mental or physical conditions that limit their ability to work.

Substance Abuse

Substance abuse, either drugs or alcohol, is a widespread problem throughout the county and Pennsylvania. You could qualify for disability benefits if you suffer from substance abuse issues. However, you will have to provide medical evidence that your abuse issues result in symptoms or conditions that meet the requirements for another mental or neurological disorder.

Some other common conditions also include:

• Somatoform Disorders (Section 12.07)
• Personality Disorders (Section 12.08)
• Intellectual Disability (Section 12.05)
• Organic Mental Disorders (Section 12.02)

Depending upon the nature of your disorder, the SSA may look at your medical records, interview you, or subject you to psychological testing or IQ testing.

Proving You Have a Qualifying Mental Condition

If you are going to be approved for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, you will have to provide medical documentation and proof of your condition. The SSA will base its determination on the medical records you provide, including medical statements from your treating physicians. In addition to meeting the required criteria, you will have to demonstrate that your condition is expected to last at least twelve months or end in your death. Furthermore, your mental impairment must limit your ability to engage in a substantial gainful activity (SGA).

Medical Documentation

Medical documentation could include records from mental health facilities, treating psychologists or psychiatrists, and an applicant’s personal doctor if they are not receiving treatment from a mental health specialist. Evidence of prescription medication is also helpful in demonstrating a person is suffering from a debilitating mental condition or illness.

The medical records and documentation provided should demonstrate, in detail, the exact ways a mental condition is impacting and limiting an applicant’s ability to engage in ordinary daily activities. Proving that a person cannot engage in everyday activities or is only able to engage in a limited and reduced capacity could be an indication that the applicant is unable to engage in work activity.

SSA Disability Examiner

When a disability claim is based on cognitive impairments, anxiety-related disorders, or affective impairments, the SSA’s disability examiner will be looking for evidence that the applicant has a reduced capacity to understand directions, concentrate, and retain instructions. These impairments will impact a person’s ability to work and engage with supervisors and co-workers.

One thing the SSA examiner will be looking for is evidence of episodes of decompensation. Decompensation is usually defined as a deterioration of previously functioning ability and could be caused by fatigue, prolonged stress, or psychiatric illness. When decompensation is evident, it could indicate an individual’s inability to consistently engage in ordinary work-related tasks.

Substantial Gainful Activity

Providing medical evidence of your mental illness or disorder is only part of the equation. No matter your condition, to qualify for disability benefits, you must prove that you are unable to engage in substantial gainful activity. SGA refers to the amount a person is capable of earning despite their impairment. Therefore, if you are earning a specific amount of money each month, you are considered to be engaging in SGA.

The SGA thresholds chance periodically. As of 2021, the monthly amount for blind individuals is $2,190. If you are suffering from a mental disorder or illness and are not statutorily blind, the threshold income is $1,310 a month.

Because the inability to engage in SGA is a crucial component in the application process, your medical records must demonstrate that your mental condition impairs your ability to work. While test results, hospital records, and prescription medication are valid indications of your condition, a written medical statement by a treating psychologist or psychiatrist will help tie the medical evidence together. This statement should be more than “the patient is suffering from a mental disability.” Your treating doctor will have to explain how your condition specifically impairs your ability to work. One of the primary reasons disability claims are denied is a lack of adequate medical evidence. Our disability attorney will work with you and your healthcare providers to help ensure that the medical documentation submitted is sufficient.

Our Pennsylvania Disability Attorneys Can Help if You are Battling a Mental Health Issue

If you are trying to qualify for benefits in Pennsylvania or New Jersey, Young, Marr, Mallis & Associates can help. Applying for disability benefits is intimidating and is often an uphill battle. This is especially the case if you or a loved one suffers from a mental illness or disorder. Our experienced attorneys and staff will advocate for your interests and work to present the best evidence possible. To speak with a Bucks County disability attorney, call our law offices at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania, or contact us online today.

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