Considerations When Applying for Social Security Disability for PTSD

We frequently represent individuals in Social Security disability claims who are suffering from the effects of Post Traumatic Stress Disorder (PTSD), in circumstances that many times involve military Veterans who have served our country.  This may result from involvement in armed conflict or as a result of military sexual assault.  Just as likely is the circumstance where an individual is suffering from PTSD as a result of trauma that they may have experienced from physical or emotional abuse during childhood, in a domestic violence situation or as a result of a crime of violence.

The effects of PTSD can be significant and crippling in terms of one’s ability to function from day to day at home (nonetheless in a work setting).   And yet, understanding the type of treatment and proof required to satisfy the requirements of the Social Security regulations may not be so obvious.

Just as with every manner of Social Security disability claim, it’s important to show that one is suffering from a severe medically determinable impairment which, despite prescribed treatment, has caused one to remain disabled from any manner of gainful employment for what has been, or will be, a year or longer.

As a Massachusetts Social Security disability lawyer licensed in Maine, Massachusetts and New Hampshire, we frequently see individuals who choose to insulate themselves from triggers of the PTSD to the point where the isolation causes them to avoid seeking help.  This means that sufficient evidence can be a major concern as clients may be unwilling to seek treatment in the form of counseling and/or psychiatric care .   Ultimately, without such treatment, we find that proving the condition exists and meets the criteria of the both the medical literature and the Social Security regulations may be lacking.

The American Psychiatric Association revised the diagnostic criteria for PTSD in 2013 in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM-V.  First and foremost, there must exist evidence that the individual was exposed to actual or threatened serious injury, sexual violence or death in one of the following ways: direct exposure, witnessing the trauma, learning that a close relative or friend was exposed to such a trauma , or indirect exposure to horrible details of such a trauma (such as is the case with first responders).  Likewise, there must be a re-experiencing of the event through one of the following: intrusive thoughts, nightmares, flashbacks, or emotional distress or physical reactions following exposure to traumatic reminders.  An example of some of the additional categories that must be addressed in order to satisfy the criteria include evidence of the need to avoid trauma-related stimulus after the trauma, the experience of negative thoughts or feeling following the trauma (that may include, for example, such issues as a sad or depressed emotional state, decreased interest in activities, feelings of isolation) and trauma-related reactions following  experience of the trauma (such as, irritability or aggression, hypervigilance, an increased startle reaction and difficulty concentrating or sleeping).

The Social Security Administration (SSA) set forth a new mental health listing of impairment with respect to PTSD that went into effect on January 17, 2017, entitled “Listing 12.15 Trauma and stressor-related disorders.”   The criteria required in section A appears very much tailored to match the DSM-V criteria, requiring that one show medical documentation of all of the following: 1) exposure to actual or threatened death, serious injury or violence, 2) subsequent involuntary re-experiencing of the traumatic event (for example, intrusive memories, dreams or flashbacks), 3) avoidance of external reminders of the event, 4) disturbances in mood and behavior; and 5) increases in arousal and reactivity (for exampled, exaggerated startle response, sleep disturbance).

Section B or C must likewise be met.  Section B requires a showing of either an extreme limitation in one category or marked limitation in two of the following categories: 1) understanding, remembering or applying information, 2) interacting with others, 3) concentrating, persisting and maintaining pace and/or 4) adapting or managing oneself.  Section C requires a showing that the condition has remained “serious and persistent” which is defined as a medically documented history of the disorder over a period of 2 years with evidence of both: 1) medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting (s) that is ongoing and that diminishes the symptoms and signs of your mental disorder and 2) that you have marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life.

Needless to say, in both establishing that one meets the diagnostic criteria and that the condition remains severe and disabling such that either mental health listing 12.15 is met or one remains incapable of undertaking gainful employment, consistent ongoing treatment with mental health specialists remains critical to establishing entitlement to Social Security disability benefits.  If you, or someone you know, is suffering from severe mental health trauma and remains unable to return to work, suggest they contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622 to see how we might be able to assist.