Individuals can qualify for benefits through the Social Security Disability Insurance Program (SSDI) as long as they meet the Social Security Administration (SSA)’s financial and medical eligibility requirements. An applicant in Massachusetts, or throughout the country, is medically eligible for SSDI if the applicant has an impairment or disability that prevents him or her from working a current or past job and would prevent the individual from being able to work another type of job available in the economy. Both mental disorders and physical impairments can form the basis for SSDI eligibility.
How the SSA Evaluates a Disability
A disability is typically measured in one of two ways. First, the applicant may qualify for benefits under SSA’s Listings of Impairments contained in their “Blue Book” of disability impairments. This book lists a wide variety of medical conditions, diseases, and disorders that qualify an individual for benefits, and it includes specific symptoms, test results, or other requirements that an individual must meet in order to qualify under a given listing. When an applicant meets a medical Listing of Impairment, he or she is presumed to meet the medical requirements necessary to be entitled to SSDI benefits.
Mental Conditions and the SSA’s Social Security’s Listings of Impairments
Social Security’s sequential evaluation process requires that the Agency first determine whether one has what is deemed to be a medical determinable impairment that is severe. Assuming this to be the case, the next step in the medical portion of the sequential evaluation process is to determine whether one meets what is called the medical listings of impairments. These listings are set forth in SSA’s Blue Book and include a vast array of physical conditions and diseases that can qualify an applicant for benefits, but it also includes an extensive list of mental health conditions that the SSA has determined can be disabling. The mental health listings categorize mental health conditions into the following categories:
- 12.01 Category of Impairments, Mental
- 12.02 Organic Mental Disorders
- 12.03 Schizophrenic, paranoid and other psychotic disorders
- 12.04 Affective disorders
- 12.05 Intellectual disability
- 12.06 Anxiety-related disorders
- 12.07 Somatoform disorders
- 12.08 Personality disorders
- 12.09 Substance addiction disorders
- 12.10 Autistic disorder and other pervasive developmental disorders
For each of these categories, the SSA has set forth precise requirements for benefits eligibility. Social Security’s rules provide, for each particular mental health listing, a set of A criteria, or medical findings which must be documented and met, along with B or C criteria (depending on the particular listing), which are defined levels of functional dysfunction. Assuming one meets both the A criteria of the medical findings set forth and the level of functional severity set forth in the particular listing, a finding of meeting a listing (and a finding of disability) would follow. The B criteria is divided into 4 areas: activities of daily living, social functioning, concentration, persistence or pace and episodes of decompensation. The C criteria (which is evaluated with respect to only four of the above listings: Listings 12.02, 12.03, 12.04 and 12.06) provide another set of functional limitations under which one may qualify as well, assuming the A criteria for the particular listing is met, and includes among other requirements that the individual be suffering from at least a 2 year history of a chronic, ongoing mental health impairment that poses more than a minimal limitation on one’s ability to undertake basic work activities. As most psychiatrists, psychologists and mental health practitioners are not concerned about whether their documentation appropriately addresses the issues of the listings of impairments and whether one might meet the criteria for a particular listing, it is important that one obtain the assistance of an experienced Social Security disability practitioner to help document such findings.
Qualifying for Disability Without a Blue Book Listing
While the most straightforward way for a Massachusetts resident, or any other individual, with a mental health condition to qualify for SSDI is through the Blue Book, many times an individual does not meet the criteria set forth by any of the listed mental health impairments. In fact, in most instances, individual claimants need to proceed to the next step in the sequential evaluation process, where they seek to qualify for SSDI by showing that they lack the functional capacity to perform their prior employment or other employment that may be available in either their local region or in other regions of the national economy. This step in the sequential evaluation process requires an assessment of the individual claimant’s residual functional capacity (RFC) assessment: that is to say, a determination as to the extent to which their ability to undertake mental health activities necessary for the performance of work activities in a competitive work environment (whether it be unskilled, semi-skilled or skilled work).
The RFC Process
A “functional capacity” assessment of one’s ability to undertake work is undertaken by the state agency with respect to one’s mental health abilities at the same time they undertake an assessment of one’s physical residual functional capacity. Examples of one’s mental health residual functional capacity include the ability to maintain attention for a 2 hour period of time, deal with normal work stress, maintain persistence and pace on tasks, be punctual and maintain regular attendance and interact appropriately with co-workers and supervisors in a work setting. During the course of SSA’s fact finding, they will look to see whether the claimant’s treatment providers have addressed a Mental Residual Functional Capacity form that address the extent to which one remains limited in terms of their ability to undertake mental health functioning in aptitudes necessary for unskilled, semi-skilled or skilled work; likewise, SSA may send a request for such information to one’s treating mental health practitioner if there is insufficient evidence in the file. In some circumstances, where the claimant is not treating with a specialist for their mental health concerns, SSA may send the individual for what is called a consultative examination with a doctor who specializes in treating mental health concerns so that an assessment of the severity of the condition can be undertaken. It is important that claimants who are seeking Social Security disability insurance as a result of a mental health impairment are receiving the advice of a skilled practitioner who can provide guidance as to whether their treatment remains appropriate and sufficient (both from a personal standpoint and a case standpoint), and so as to assist with the proper obtaining of evidence to support one’s claim.
Assuming SSA determines that you remain incapable of undertaking any of the past relevant work (that is to say, types of jobs you’ve undertaken in the 15 years prior to becoming disabled), and assuming they likewise determine you remain incapable of performing other work for which you’re reasonably suited by age, education and experience (and which exists in significant numbers in either one’s local region or other regions of the country) as a result of one’s severely impaired residual functional capacity, a finding of “disabled” under Social Security’s rules will follow.
If you would like more information about qualifying for SSDI benefits with a mental health condition, or are concerned about the application process, contact the Law Offices of Russell J. Goldsmith for a free and confidential consultation at 1-800-773-8622.
More Blog Posts
Requesting Reconsideration of an Application for SSDI in Maine and Elsewhere, Social Security Disability Lawyer Blog, August 2, 2015
Lawmakers Must Act to Prevent Depletion of SSDI Trust Fund in 2016, Social Security Disability Lawyer Blog, August 2, 2015
How to Apply for SSDI Benefits in Maine and Beyond, Social Security Disability Lawyer Blog, July 1, 2015