Will I Qualify for Disability Benefits Due to A Mental Disorder?

If a disability caused by a mental impairment prevents you from working, you may be entitled to benefits through the Social Security Administration. Social Security has two programs, Social Security disability insurance or SSD and Supplemental Security Income or SSI. Both programs offer monthly payments for people unable to work because of physical or mental conditions.

Obtaining disability benefits can be an arduous process that takes patience and perseverance, but it becomes even more of a challenge when the impairment causing your disability is mental rather than physical. Mental impairments may not be as obvious as those that are physical in nature, but they are just as real and can be equally disabling.

The information in this article offers an overview of the process used by Social Security to evaluate a disability claim based on mental impairment. Understanding the process will help when meeting with a New Jersey disability lawyer to prepare a strong application for disability benefits that meets the criteria to qualify under Social Security rules and regulations.

Qualifying for benefits through SSD and SSI

Although similar criteria are used to decide whether a mental disorder qualifies an adult to receive benefits through SSD and SSI, the programs are quite different as far as nonmedical qualifying criteria. To qualify for SSD benefits, you must have a work history that is long enough and sufficiently recent. You also must have paid Social Security payroll taxes from your earnings.

The length of the duration of your work history needed to qualify for SSD depends upon your age at the onset of the disability. Social Security uses work credits that you earn based on annual earnings. The earnings you need for one work credit in 2021 is $1,470, and you can earn up to four credits each year. For example, a person who becomes disabled before 24 years of age needs six work credits earned within three years of the onset of the disability, but a person whose onset of disability was at 31 years of age needs at least 20 credits earned within 10 years of becoming disabled.

SSI, on the other hand, does not require a work history to qualify; however, the financial resources available to you must be extremely limited and cannot exceed $2,000 for an individual and $3,000 for a couple. Resources include the following:

• Real property, except a home you own and use as your primary residence.
• Motor vehicles, except for the value of one vehicle you or another member of your household use for transportation.
• Cash on hand and money in accounts at banks and other financial institutions.

Unless you qualify under one of the exceptions, you must be a citizen and reside in the United States or the Northern Mariana Islands to qualify for SSI.

Qualifying mental impairment

Social Security considers a person to be disabled when a medically determinable physical or mental impairment causes them to be unable to engage in any substantial gainful activity, which is referred to as SGA for short. The impairment must have lasted or be expected to last for a continuous period of at least 12 months or be expected to cause the person to die.

Although children do not qualify for SSD benefits, they may be eligible for SSI, but a different definition of disability applies to them. A child younger than 18 years of age is disabled if a medically determinable physical or mental impairment or combination of impairments results in a marked and severe functional limitation expected to last or has lasted for at least 12 continuous months or may be expected to cause the death of the child.

The mental impairment evaluation process

A claimant’s nonmedical requirements for eligibility are reviewed at a Social Security field office. This would include the individual’s work history on applications for SSD and available resources and income for SSI applications. Once those requirements are verified as being met, the application goes to a Disability Determination Services office for an evaluation to decide if the medical evidence supports the applicant’s claim of being disabled.

DDS, which are state agencies, review a claimant’s medical records to determine if they contain sufficient evidence of a disability caused by a mental impairment. If the medical records of the claimant are unavailable or do not provide sufficient evidence for a decision to be made, DDS may request a consultative examination from one of the claimant’s health care providers or an independent source.

When a claim involves a mental impairment, the DDS uses a psychological consultant and a disability examiner working as a team to review the medical evidence. The team decides if the evidence shows a disability within the Social Security definition.

The process of review from receipt of the application by Social Security until the final determination can be broken down into five steps:

• Review of nonmedical criteria: Claims that do not meet the nonmedical guidelines will be denied. This includes individuals who are working and earning more than $1,310, which shows the person to be capable of engaging in substantial gainful activity. Applications that pass this step in the process move on to the next step.
• The severity of the condition: The mental disorder must be severe enough to prevent you from engaging in normal work-related activities, such as severe memory impairment. If it is not severe, the claim will be denied. A severe condition moves the application to the next step.
• Meets or equals a mental impairment on the Listing of Impairments: If your mental disorder appears on the Listing of Impairments compiled by Social Security or is equal to one on the list, you are disabled. The application moves forward to the next step without the necessity of further review of the medical evidence.
• Capacity to engage in past work: Even though a decision has been made that you are disabled, the ability to engage in the type of work you did in the past, as shown in your work history, will disqualify you from receiving disability benefits. If you cannot do the work you did in the past, the application moves to the final step.
• Capacity for other types of work: A claim will be denied at this step if you have the capacity even with the mental disorder to do a different type of work than you did in the past. This would include work that may require you to undergo vocational training. Factors taken into consideration include how old you are, your work experience, your education, and any transferrable skills you may possess. If you cannot do other types of work, the claim will be approved.

You have the right to appeal adverse decisions made at any of the five steps in the process. A consultation with a New Jersey disability lawyer can offer options when a claim for benefits is denied.

Listing of Impairments

The Listing of Impairments, which had been referred to as the “Bluebook,” describes impairments or disorders for each of the major systems of the body that are severe and prevent a person from engaging in any substantial gainful activity. As it pertains to children applying for SSI, a listed impairment is severe enough to cause a child to have marked and severe functional limitations.

Included in the Listing of Impairments are criteria to be used in the evaluation of medical and mental impairments in adults. A second part of the listings provides criteria for evaluating impairments in children younger than 18 years of age.

There is a section of the Listing of Impairments dedicated to mental disorders that includes a broad range of mental health conditions, including:

• Alzheimer’s disease.
• Parkinsonian syndrome.
• Traumatic brain injury.
• Substance-induced cognitive disorder.
• Depressive and bipolar disorders.
• Intellectual disorders, including intellectual disability and intellectual developmental disorder.
• Obsessive-compulsive disorder.
• Post-traumatic stress disorder.
• Eating disorders.

The list of mental disorders is quite extensive, but the fact that a condition may not be on the listing does not mean that you are not disabled. It only means that your claim for benefits must be reviewed to determine if your medical records show evaluations, treatment, and diagnostic testing to support it.

Working with a New Jersey disability lawyer

The assistance of a New Jersey disability lawyer can prove to be invaluable. For example, too many people focus on how a mental impairment affects them at work, but an experienced lawyer knows that its impact on your day-to-day activities outside of the workplace can be equally as important in support of your claim for SSI or SSD benefits.