Approximately 1 in 25 (10 million) adults in America live with a serious mental illness that prevents them from engaging in one or more important life activities. In fact, serious mental illness cost the country 193.2 billion in lost earnings every year. Mental disorders permeate every aspect of a person’s life, and the lives of those around them.
Social Security Disability Insurance (SSDI) benefits from the Social Security Administration (SSA) are a lifeline for about nine million Americans today, 35 % of which were eligible for benefits because of mental disorders. If you (or the person you represent) suffers from a mental disorder that significantly inhibits your life, then you could be eligible for SSDI.
What Criteria Does the Social Security Administration Use to Evaluate Mental Disorders?
You are eligible for Social Security Disability Insurance benefits if:
- Your mental disability doesn’t allow you to work at a regular job.
- You can demonstrate that your mental disability has prevented or will prevent you from working at a job for at least 12 months.
- You have earned enough work credits in the Social Security system.
In most cases, there are also certain functional limitations you need to exhibit in addition to the diagnosis of your mental disorder:
- Significant limitations in daily activities.
- Significant limitations in social functioning.
- Difficulties in being able to concentrate, carry out functions, and speed of functions.
- Repeated episodes of worsening of symptoms (decompensation), each for extended periods.
What Documents Do I Need to Submit?
The SSA establishes whether or not you are eligible for SSDI based on:
- Psychological tests
- Medical evidence of symptoms
- Laboratory findings
- Records from psychiatrists, psychologists, therapists or counselors
- Records of any hospitalizations or emergency room visits made because of your condition
In case you do not have adequate medical records, the SSA may send you for a psychological evaluation.
What Mental Disorders Appear in the Blue Book?
A list of mental disorders eligible for SSDI benefits appear in Section 12 of the Blue Book. There are nine categories:
- Autistic Disorders and other Pervasive Developmental Disorders: Autism Spectrum Disorder (ASD) is a neuro-developmental disorder that has an effect on the way the human brain processes information. Autism, Asperger Syndrome (AS), and Pervasive Developmental Disorder (PDD-NOS) fall under autism. These are usually diagnosed by age three, but are sometimes also diagnosed in adolescence or adulthood.
Childhood Autism: Autism affects 1 in 68 children, and is one of the fastest-growing developmental disorders in the U.S, costing families $60,000 a year on an average. Childhood Autism is in Section 112.10 of the Social Security Administration’s (SSA) Impairment Listing Manual. Qualitative insufficiencies in social interaction, verbal, and non-verbal communication skills as well as imaginative activity are basic qualifying parameters. In addition, there are more requirements in Paragraph B that must be met before a child can qualify for disability benefits.
Adulthood Autism: Although there is no specific listing for adulthood autism, a claimant can apply based on the description of conditions for disability in Section 112. Presenting medical evidence is important, but a claimant must also be able to show inability to function well enough to meet the SSA conditions for gainful employment.
- Schizophrenic, Paranoid, and other Psychotic Disorders: Schizophrenia is characterized by the inability to distinguish between reality and delusion due to the breakdown of mental and emotional processes. There are four types of schizophrenia, and these are usually diagnosed by psychiatrists rather than medical doctors.
- Affective Disorders: Depressive syndrome, manic syndrome, and bipolar syndrome are listed under this category, each with its specific set of requirements and additional criteria.
- Intellectual Disability: This refers to mental incapacity reflected in dependence for basic personal needs such as bathing, using the toilet, dressing, and bathing. It could also mean an IQ score of 59 or less, an IQ score of 60-70 coupled with an additional mental or physical disability or significant disabilities.
- Anxiety-related Disorders: Claimants must have one of the following: Generalized persistent anxiety, persistent irrational fear, panic attacks, recurring obsessions or compulsions.
- Somatoform Disorders: Physical symptoms like constant disturbance in vision, hearing, speech, sensation, use of a limb, movement, and control of the body exist for no obvious reason and there is an unrealistic belief that one has a serious disease or injury based on an interpretation of physical symptoms.
- Personality Disorders: These are characterized by rigidity, unwillingness to adjust to the challenges of life and changes causing difficulty in social or occupational functioning. Schizoid personality disorder, obsessive compulsive disorder, borderline personality disorder, and antisocial personality disorder are some examples.
- Substance Addiction Disorders: Regular use of substances causes physical or behavioral changes that affect the central nervous system resulting in substance addiction disorders. According to the Blue Book, these are deemed severe when they meet the conditions for any one of the following: organic mental disorders, depressive syndrome, anxiety disorders, personality disorders, peripheral neuropathies, liver damage, gastritis, pancreatitis, or seizures.
- Organic Mental Disorders: Mental disorders caused due to a brain dysfunction are considered in this section. Medical tests and history of the applicant show that there is a presence of organic influence that directly impacts the abnormal mental condition, and it is not caused by psychiatric problems or substance abuse. Delirium, dementia, Alzheimer’s disease, and amnesia are examples.
What Happens When My Mental Disorder Is Not Listed in the Blue Book?
When the mental disorder you are suffering from is not listed in the Blue Book, the SSA will determine your Mental Residual Functional Capacity or MRFC. It is an assessment of the amount of mental and emotional aspects of a full-time job you are able to carry out. If you have sufficient MFRC, your application will not be considered for SSDI benefits.
MFRC also takes into account your medical records and opinions of psychiatrists and psychologists. It is essential to have a medical doctor complete an MFRC report for you. On the basis of your medical records, the MFRC report assesses some specific functional limitations: ability to follow basic instructions, memory, reliability, ability to handle stress and so on.
If you have a greater number of limitations that arise out of your mental condition, the more likely you are to be approved for SSDI benefits. When your medical condition does not fit a Blue Book listing but is equivalent to one, you may be approved for benefits through a medical vocational allowance.
How Can I Apply for SSDI Benefits Today?
Mental disorders can severely limit your life in every possible way. If you are suffering from a mental disorder that has prevented you from working for a year or more, you could be eligible for SSDI benefits. Your child could also be eligible for SSDI under the autism category, provided the requirements under the listing are fulfilled. Take our free disability evaluation to find out whether you’re eligible for SSDI benefits.
Applications for SSDI benefits under Section 12 of the Blue Book are generally scrutinized carefully and getting approved for benefits can be a complex and time-consuming process. A little help along the way in the form of a disability advocate can make this process easier. Our experienced Disability United advocates ensure your application is complete in every way, and help you at every stage of the process.
Request for a free disability evaluation or call us now to find out how you can receive the disability benefits you deserve.