Proving a mental disability claim

by Tim Moore, Disability Representative in North Carolina

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How do you prove your disability case with a mental condition?

All Social Security Disability and SSI cases are approved on the basis of medical records and what medical record documentation has to say about the claimant’s condition. Medical record documentation can include records from mental health facilities, treating psychiatrists and psychologists, and even a claimant’s own family physician in cases where the claimant is not actually treated by a mental health professional but, instead, is given a recurring prescription by their personal doctor.

(Read if you live in North Carolina)

What do mental records need to say about your condition to prove your disability case?

Ideally, they should provide some level of detail regarding a disability claimant’s ability to engage in normal daily activities. An inability to engage in normal daily activities, or a reduced ability to persist in them, may be indicative of a claimant’s inability to engage in work activity.

What Social Security looks for in mental claims

In cases involving cognitive impairments (low IQ, memory loss), anxiety related impairments (panic attacks, agoraphobia, anxiety disorder), and affective impairments (such as bipolar disorder and depression), the social security administration, through the disability examiner reviewing the case, will be looking for evidence of characteristics such as a reduced ability to concentrate, learn instructions, follow instructions, and retain instructions. The disability examiner reviewing the case will note evidence of social impairment such as the claimant’s ability or inability to get along with both managers and co-workers.

Mental claims and Decompensation

Something, however, that both the disability examiner and the examiner’s unit psychological consultant (disability examiners work in processing units to which both a unit medical consultant, and M.D. and a unit psychological consultant, a Ph.D.-level psychologist are attached) will be particularly attentive to will be evidence of episodes of decompensation.

Decompensation is typically defined as the deterioration of something that was previously functioning at an adequate level. For Social Security Disability and SSI purposes, decompensation, which may be the result of prolonged stress, fatigue, or psychiatric illness, stands as strong evidence of one’s inability to consistently engage in work activity.

After all, employees who repeatedly suffer from episodes of decompensation will find it difficult to perform their job functions to the levels at which an employer will expect, and extended and repetitive decompensatory episodes may result in termination of employment. In fact, it is for this reason that many mental conditions that are actually listed in the Social Security Disability list of impairments will refer to episodes of decompensation that are repeated over time and which are of extended duration.

What if you have a mental condition that does not result in extended episodes of decompensation?

In such cases, can you still be approved for disability benefits? Yes, many applicants are approved because the totality of their medical evidence indicates that they lack the ability to maintain attention and concentration while on the job, or have memory deficits that significantly impair the ability to remember tasks and receive new training. And, in most cases, claimants who file claims for disability will list multiple conditions versus just one condition.

In other words, the social security administration will consider all the limitations that result from all the various impairments that a claimant has. For example, a claimant may have back problems, depression, and carpal tunnel syndrome, and may possess age and vocational factors that make it improbable for them to engage in substantial gainful work activity. And, in fact, this is the reason why many applicants are sent to multiple consultative medical exams (examinations that social security both schedules and pays for) that are both physical and mental in nature.