“How Do I know I Qualify for Disability?” part 1 and part 2 covered the timing of filing and some of the medical stuff related with knowing if your impairments qualify for disability. Today we will talk about mental impairments and whether you can get disability with these impairments.
Level of Severity and Duration
The level of severity of your mental condition is key to know if you qualify for a mental disability. A great example is depression and anxiety.
99.99% of people in the world go through phases in life when they are sad or despondent. A big loss of an adored family member or a big trauma can certainly cause great anxiety and depression. Other times, you are anxious about money, a test, school, work, a job interview.
The question is then: How do you know if your level of anxiety and depression is severe enough to win disability?
What the decision maker wants to see is clear evidence from your doctors that despite treatment you are unable to function. They also want to know how long this condition has affected your ability to function (remember part 1 about 12 months or more?).
Disability Due to Anxiety
Anxiety is a very common alleged impairment in disability cases. To prove it, your anxiety must be such that you are literally paralyzed with fear. Getting out of the house makes you break in sweats. Even going to the psychiatrist is a task you can barely handle. Some will even need in-home therapy to comply with their treatment.
Your daily activities will also tell the decision maker how severe your anxiety is. If you are still able to go out and shop and do certain activities, the decision maker will not be so impressed. I had one case I did not accept to take because the person was going out on dates despite claiming disability. He was also able to go out and shop twice a week. Not so good.
Ability to Function
I’m not saying you can’t do these things. Some have no choice but to go out and buy groceries or they would never eat. But these activities may be evidence that it may not be as bad as you think or may be more temporary in nature. The decision maker CAN and WILL use those activities as a reason for their denial.
How Disabling Is That Anxiety?
Another example of an ability to function despite the anxiety: the person playing video games all day long “to cope with anxiety”. What you do in your private time is usually no one’s business but when it’s listed in your medical records, it’s a deal breaker!
They think, if you can play video games you can do some sort of work, even if at home and away from people.
Vocational options
The classic example Social Security vocational experts give as a possible job for these claimants is “envelope stuffer”. They can do physical work, but their doctors don’t recommend that the claimant be around people. As an envelope stuffer, the person can fold and fill envelopes all day but he/she doesn’t need to interact with anyone. They can just sit in the comfort of their kitchen table and do that all day for a living.
I know, it’s a funny name but it’s a real job!
I know it’s a harsh assessment but in some cases, the claimant’s activities do translate into jobs. He/she just doesn’t know it yet. Also remember that:
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Disability Due to Depression
Depression cases are also tricky to see if they are severe enough to win disability. A lot of people work while taking medication for depression. It’s tough but they do it. So when does depression become so severe that you can no longer work and now you qualify for disability?
You must show that it is interfering with your work. You are making mistakes because you can’t pay attention or concentrate. Testing is required to make sure that your skills are affected by the depression. You can’t follow instructions. You miss work because you can’t get out of bed for days on end.
Again, if you are able to do certain activities like shopping or dating, then it may not be as severe. You may be able to work in another type of work, less stressful, with less people around. Or work from home.
The idea is that the condition is not temporary. And that despite treatment these conditions continue to affect your ability to work and maintain a job.
Combination Cases
In a lot of physical cases (broken back, etc) you see people suffering from depression secondary to pain. That is, you would not be depressed if you didn’t have your physical impairments in the first place.
While those symptoms are usually acknowledged, in most cases, depression secondary to pain is not treated by Social Security as a major thing. This then becomes a combination case (we talked about that in part 2).
The physical impairment is so bad that it causes depression: either because you now feel worthless and unable to do the things you did before or because the medications you take cause depression.
Visual Mental Impairment
Can People tell you’re disabled just by looking at you?
Mental impairments have variations of conditions that may have a more visual effect and are therefore easier for an outsider to see that the person has a disorder. Eg.: Schizophrenia, Psychosis, if you were put on a psych hold for attempted suicide, or for being a danger to others.
Of course, some of these can be temporary in nature and one can go back to “normal”. The point is, the person will have a documented history of “events” and a clear diagnosis that anyone can see.
If it’s “in your head” then medical records are key to prove your case
There are mental disorders (aside from anxiety and depression) that are hard to “see” from the outside. These can be complicated to prove.
Looking from the outside a lot of people just think you look normal. You may have a sad face or look like you just got up and have bags under your eyes. However, no one can tell you suffer from depression or anxiety or any other “silent” mental impairment just by looking at you.
Why? Because in most cases “it’s inside your head”.
“What?!! How could you say that?!!!”
Hear me out: Most mental illnesses, unless you are seeing “flying tomatoes”(sorry for the bluntness), are not quite visible to the naked eye, i.e., can a stranger tell you have a mental condition just by looking at you? If the answer is no, then it requires the proper documentation to prove that you have these conditions.
How many stories have you heard of a disabled person parking in a handicapped spot who got a nasty note by some self-righteous bystander who “couldn’t tell” that the person was disabled? Just because someone doesn’t use a wheelchair or a cane it doesn’t mean they are not disabled.
But you see what I’m getting at?
To prove these “in your head”-type conditions you MUST be seeing a psychiatrist and a psychologist. Don’t rely on just pills and a primary physician assessment once every 6 months. These will get you nowhere and the decision maker will think “it’s not that bad” since you’re not seeing a specialist and only sees a doctor every 6 months. I have seen these words in denial letter many times.
Of course, the same goes for the more visible mental impairments. These doctors’ notes and frequent visits will be very important to help you win your case.
Further, saying that the treatment just didn’t work and you decided to stop is not an excuse not to continue treatment. The reason is, you need to show that the treatment didn’t work.
Somatoform conditions
These conditions are “in your head” conditions on steroids. Why?
Because they are mental impairments that can turn into physical symptoms. And I don’t mean, sweats or fluttering. I mean, some will even cause seizures if the person faces a stressful situation. In these cases, not only medical records are key but you should also use a calendar.
If you suffer a seizure due to stress (somatoform) or even in a regular seizure case (clear diagnosis), you are not always going to call the doctor to report it. The same goes for Migraine cases. So use that calendar!
In these cases, you must, MUST create a calendar or notebook where you report everything that happened.
You should always list the duration of seizures (10 minutes, 15 minutes), how long you were “out” (it took 3 days to fully recover), if you fell and hurt yourself, what you ate that day, what you did just before, etc.
I know, you are not going to remember a lot of these. But if a family member or friend saw when it happened, or you can calculate the time based on when you “came back”, then you should write it down.
For migraines, list duration of a headache, how long you needed to be in a dark room, sounds, etc.
Take these notes to your doctor. These are very useful. Your doctor can tweak your medication and treatment based on frequency and size of your seizures or headaches, and other factors you wrote on your calendar.
Self-Reporting versus Objective Reporting
Because some of these impairments are not visible on MRI but are “in your head” (not visible), these calendars or diaries will turn a self-reported symptom into an objective and highly credible assessment by your doctor.
You should know that self-reported symptoms usually carry low credibility for the decision maker because it’s not visible in tests and it comes from you (I know, I’m not saying you’re lying but that’s the decision maker’s first thought since there are people that lie about their symptoms just to get benefits).
An objective assessment by your doctor carries a high credibility rate because it was observed by someone other than you and by none other than a doctor!
So in all of these cases, whether physical or mental you need, no, YOU WANT, you doctor to clearly state in his medical notes what he sees when he examines you.
Look for the words like “physical examination” or “Objective” in your medical records to see what your doctor is saying about you and what he “sees“ after examining you.
To Recap:
Severity and duration of your mental impairments are important to see if you qualify under a mental disability. Also, your doctor’s notes with objective observations are important because you doctor carries a higher credibility rate with the decision maker.
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