How Does the SSA Decide if a Mental Disability Qualifies for Social Security?
The three ways your mental health condition can qualify for Social Security benefits are:
- Meeting a listing: Your condition matches one of the diagnoses listed in the Blue Book, as well as its disability criteria.
- Medical equivalence to a listing: Your condition is functionally similar to one listed in the Blue Book, even if your specific diagnosis or some of the symptoms don’t match exactly.
- Residual functional capacity, or RFC: If your condition doesn’t match a Blue Book listing, but still prevents you from substantially gainful employment, you may still qualify for benefits. The SSA will evaluate your capacity to work despite physical, mental, or environmental limitations caused by your condition.
The 11 Categories of Mental Disorders the SSA Recognizes
The SSA Blue Book’s Section 12.00 provides the criteria for the following 11 categories of mental health disorders that can qualify for disability benefits:
- Neurocognitive disorders – 12.02: These include conditions that impair one’s mental function, processing, and memory, such as dementia, traumatic brain injuries, and impacts from strokes.
- Schizophrenia spectrum and other psychotic disorders – 12.03: This listing includes conditions that cause delusions or hallucinations that prevent one from functioning normally.
- Depressive, bipolar, and related disorders – 12.04: This includes conditions that cause disruptive impacts on mood, pervasive loss of interest, and suicidal ideation.
- Intellectual disorder – 12.05: This category describes generally poor intellectual functioning that developed before age 22, excluding Autism spectrum disorders and learning disabilities.
- Anxiety and obsessive-compulsive disorders – 12.06: These include non-trauma-related conditions that cause extreme anxiety and fear symptoms, such as panic attacks.
- Somatic symptom and related disorders – 12.07: These include genuine physical symptoms that defy a specific medical explanation, such as somatic symptom disorder, illness anxiety disorder, and conversion disorder.
- Personality and impulse-control disorders – 12.08: These include conditions marked by maladaptive behaviors and extreme reactions, such as borderline personality disorder.
- Autism spectrum disorder – 12.10: Disabling conditions that fall under the Autism spectrum are included here.
- Neurodevelopmental disorders – 12.11: This includes conditions that affect mental processing or cause uncontrollable movements, such as learning disabilities, severe ADHD, and Tourette’s syndrome.
- Eating disorders – 12.13: Anorexia, bulimia, and other conditions marked by abnormal eating or self-image issues fall under this category.
- Trauma- and stressor-related disorders – 12.15: This includes post-traumatic stress disorder and other conditions caused by an intense, emotionally distressing experience.
Some conditions can overlap between more than one category, such as OCD and schizoaffective disorders. In that situation, the SSA will evaluate the disability under the criteria of each applicable section.
Do Children Qualify Differently?
Children have their own parallel collection of disability listings under Section 112.00 of the Blue Book. Section 112.00 includes an additional listing for developmental disorders in infants and toddlers with distinct qualifying criteria.
What Are the "Paragraph A, B, and C" Criteria?
- Paragraph A: The symptoms or diagnoses you must be able to show with medical documentation.
- Paragraph B: Extreme limitation in at least one of four types of functioning assessed by the SSA, or marked limitation in at least two:
a. The ability to understand, remember, or apply information
b. The ability to interact with others
c. The ability to concentrate, persist, or maintain pace
d. The ability to adapt or manage oneself - Paragraph C: Demonstrating that your disability is serious and persistent, meaning at least two years of medical evidence shows that you rely upon consistent treatment to manage your symptoms, but still have a limited ability to adapt to new environments or responsibilities.
What If My Condition Doesn't Exactly Match a Listing?
Social Security disability claims can be approved even if the condition doesn’t fully match a listing. Many conditions are found to be medically equivalent to a listed disability, meaning they have comparable symptoms and impacts on one’s ability to function.
In addition, a large number of disability claims are approved based on residual functional capacity. The SSA gives older applicants special consideration when evaluating their RFC, as it expects them to face more difficulty finding and adjusting to new full-time work.
What Evidence Do I Need for My Disability Benefits Application?
The SSA will consider a variety of information when evaluating your Social Security Disability application. Types of evidence to gather for your claim include the following:
- Your longitudinal medical record, which is your complete chronological patient history
- Doctor’s notes and statements from therapists and psychiatrists
- Statements from your friends and family verifying the impacts of your condition
Many physical disabilities are visibly apparent and can be objectively demonstrated through imaging and other tests. On the other hand, mental health conditions can be more difficult to establish through psychiatric evidence. Submitting a thorough body of information to support your claim gives you the best chance of approval.
Common Mistakes That Get Mental Health Claims Denied
Denials of initial Social Security Disability claims are relatively common. In fact, the majority of claims are denied at the initial stage. Rejection isn’t the end of the road, but there are also ways to avoid preventable mistakes that will lower your chances of approval. Common errors that applicants make include:
- Relying on listings: If you focus too much on demonstrating that your condition meets Blue Book criteria, you might not include enough supporting information showing your functional limitations, which is what the SSA truly cares about.
- Leaving gaps in treatment history: Showing two years of continuous treatment is helpful for approval in many categories, but it’s also key to avoiding evidentiary gaps that can weaken your overall argument for disability.
- Third-party issues: Double-check the supportive statements submitted by your friends and family to make sure their language doesn’t contradict your medical records, as the inconsistency can undermine your application.
- Overlooking secondary criteria: While having medical evidence to meet Paragraph A requirements is vital, many applicants fail to satisfy Paragraph B or C, leaving them with only half of the necessary qualifications.
Contact an SSDI Lawyer for Help With the Process Today
If you’re dealing with a mental health condition that prevents you from working, getting Social Security Disability benefits can feel like an uphill battle against yourself. Rob Levine Law is deeply experienced in handling SSDI cases involving mental illness, and we’re ready to help you secure the benefits you need to feel financially secure and better manage your symptoms.
Whether you are filing an initial application or your claim has already been denied, our Social Security Disability lawyers can help. We’re available 24/7 to answer your questions, and with our Fee Free Guarantee®, you won’t owe us anything unless you win.
Call (888) 791-9135 or contact us online today for a free consultation.
