Can you get Social Security disability for Mental Health Conditions?
Written by: Scott D. Lewis, disability attorney
Short Answer: Yes, and mental health conditions account for a large share of the claims we handle. Social Security evaluates them under Section 12.00, which covers eleven categories including depressive and bipolar disorders, anxiety and obsessive-compulsive disorders, trauma and stressor-related disorders such as PTSD, schizophrenia spectrum disorders, personality disorders, autism, and eating disorders. Nearly every listing works the same way: you need a documented diagnosis with specific clinical findings, and then either an extreme limitation in one of four areas of mental functioning or a marked limitation in two of them. Those four areas are understanding, remembering and applying information; interacting with others; concentrating, persisting and maintaining pace; and adapting or managing yourself. Most claims are won on evidence of how you function over time rather than on the diagnosis itself.
Mental health issues have really come to light in recent decades, and my practice reflects that.
Many of the disability claims we handle are for mental health conditions, and it is worth setting out how these claims actually work: which conditions qualify, how Social Security measures them, what evidence wins, and what to do if you have already been denied.
Which mental health conditions qualify for disability?
We see a wide range of diagnoses, and in most cases people are not dealing with a single condition but a combination of two or more.
Social Security evaluates mental health conditions in the Listing of Impairments at Section 12.00, Mental Disorders. There are eleven categories:
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- 12.02 Neurocognitive disorders, including dementia and the lasting cognitive effects of brain injury
- 12.03 Schizophrenia spectrum and other psychotic disorders, including schizophrenia and schizoaffective disorder
- 12.04 Depressive, bipolar and related disorders, including major depressive disorder and bipolar disorder
- 12.05 Intellectual disorder
- 12.06 Anxiety and obsessive-compulsive disorders, including generalized anxiety disorder, panic disorder, agoraphobia, and OCD
- 12.07 Somatic symptom and related disorders
- 12.08 Personality and impulse-control disorders, including borderline personality disorder
- 12.10 Autism spectrum disorder
- 12.11 Neurodevelopmental disorders, including ADHD, learning disorders, and tic disorders
- 12.13 Eating disorders
- 12.15 Trauma and stressor-related disorders, including PTSD
If your diagnosis is not named above, that does not mean you cannot qualify. What matters is the effect on your functioning, not the label, and most diagnoses fall within one of these categories even when the name differs.
One note on substance use: Social Security removed the separate listing for substance addiction disorders in 2017. Substance use is now handled as a question of whether it is material to the disability, meaning whether you would still be disabled if you stopped. If your mental health condition would remain disabling regardless, it is generally not material.
How Social Security decides a mental health claim
Social Security’s evaluation rests on three things: documentation of a medically determinable impairment, the degree of limitation that impairment places on your ability to work, and whether those limitations have lasted or are expected to last at least twelve continuous months.
Nearly every listing in Section 12.00 is structured the same way, and understanding that structure tells you what your records need to show.
Paragraph A is the diagnostic part. It asks whether the medical evidence documents your condition with specific clinical findings. For depressive disorder, for example, that means documented depressed mood along with several other specified symptoms such as appetite disturbance, sleep disturbance, decreased energy, feelings of guilt or worthlessness, difficulty concentrating, or thoughts of death or suicide. The diagnosis alone is not enough; the symptoms have to appear in the record.
Paragraph B is where most claims are decided. It asks how much your condition limits four areas of mental functioning, which are the areas a person uses in a work setting:
- Understand, remember, or apply information. Learning new tasks, following multi-step instructions, solving problems.
- Interact with others. Cooperating with coworkers, accepting supervision, dealing with the public.
- Concentrate, persist, or maintain pace. Sustaining focus through a normal work period and completing tasks at an acceptable rate.
- Adapt or manage oneself. Responding to changes at work, managing stress, maintaining hygiene and personal care.
Each area is rated on a scale from none through mild, moderate, marked, and extreme. To satisfy paragraph B you need an extreme limitation in one of the four areas, or a marked limitation in two of them.
Paragraph C is an alternative route for some listings, intended for conditions that are serious and persistent. It requires a documented history of the disorder over at least two years, together with evidence of ongoing treatment, therapy, or a highly structured setting that reduces your symptoms, and evidence of marginal adjustment, meaning you have minimal capacity to adapt to changes or to demands that are not already part of your daily life.
That last route matters more than people realize. Someone whose symptoms are reasonably controlled precisely because their life is highly structured, and who would decompensate if that structure were removed, may meet paragraph C even though they look stable on a given day.
What we need to argue a mental health disability claim
Mental health impairments are very different from physical impairments. A claimant cannot be sent out for objective testing like an MRI, X-ray, or blood work. So what can be done to show the limitations your condition causes?
An official diagnosis is usually required. Alongside that, the following supports a claim.
Medical Records:
Detailed notes from a psychiatrist or other mental health provider are crucial, along with records showing ongoing treatment such as medication, therapy, and vocational support. Social Security looks for this, and without it the agency may assume your condition is not severe enough to be disabling.
Hospitalizations and Psychiatric Holds:
Mental illness can lead to hospitalization, whether for a severe depressive episode, a manic episode, a psychotic episode, or an acute crisis. Those hospital records go a long way toward showing the severity and history of your illness.
Medical Compliance:
For most mental health claims, treatment and medication matter. Social Security wants to see that you are trying to get better and making an effort to control your symptoms. If we cannot show that, the claim becomes harder. Where cost, side effects, or lack of insurance have gotten in the way, say so, because Social Security is required to consider your reasons before holding a gap against you.
Medical Source Statements:
At Lewis Disability Law we have developed questionnaires specifically for mental health impairments, and we work with you to get them to your providers. A provider who sees you weekly or monthly has documented your difficulties and can give a professional opinion on how they prevent you from working. Completed properly, these are often the strongest evidence in the file.
Who should be treating you, and can a therapist fill out disability paperwork?
This comes up constantly, and the answer has two parts.
Social Security does not treat every provider you see the same way. Certain professionals are what the agency calls acceptable medical sources, and only they can establish that you have a mental health condition in the first place. For mental health claims, that generally means a licensed physician, including a psychiatrist, or a licensed psychologist.
A counselor, licensed clinical social worker, or therapist who is not a licensed psychologist is not an acceptable medical source. That does not make their evidence worthless. Social Security will still consider what they say about the severity of your symptoms and how you function, and a therapist who has seen you weekly for two years may describe your limitations better than anyone. But their opinion alone cannot establish the diagnosis, so it needs to sit alongside evidence from a psychiatrist or psychologist rather than in place of it.
In my experience, many of my clients are not receiving the type of care they need to win their claim. Your family doctor can diagnose a mental health condition and those records do count. But a file containing only a general practitioner’s notes is usually thinner on the questions a claim turns on, and a psychiatrist’s or psychologist’s assessment of your symptoms and limitations tends to be more persuasive on exactly those points. It can be as simple as asking for a referral.
Administrative Law Judges also like to see an ongoing treatment relationship that documents how the illness has progressed. There is usually no substitute for consistent records when you walk into a hearing.
How mental health conditions keep people from working
While mental health conditions may not affect your ability to walk, stand, or lift, they may still affect your ability to get to work, maintain focus on the job, and perform as expected.
Examples
Focus:
Maintaining concentration, staying on task, or working through anxiety attacks may interfere with your ability to complete assigned work.
Social Interactions:
Getting along with others, picking up on social cues, collaborating with peers, or following a supervisor’s instructions may be difficult for someone with anxiety, PTSD, or a personality disorder.
Attendance:
Sometimes just getting to work is the problem. Anxiety, trauma, and other stress-related conditions may impede your ability to leave the house or drive safely. Depression can be severe enough that you lack the motivation to get out of bed. Vocational experts routinely testify that employers will not tolerate more than about two absences a month, or a worker who is off task more than a small percentage of the day.
Adapting to Change:
A change in shift, a new supervisor, or an unexpected task can be enough to trigger symptoms. Where that happens repeatedly, a job that looks manageable on paper turns out to be one nobody could hold.
Beyond any single symptom, there is the overall pressure to perform at work, which frequently makes mental illness worse rather than better.
The good news is that Social Security does recognize these limitations when evaluating a claim. With proper documentation and medical records, it is possible to win a disability claim for a mental health condition.
How to give your mental health claim the best chance
Drawing the above together, these are the things that most often make the difference:
- Get treatment from a psychiatrist or psychologist, not only a general practitioner, and keep going consistently.
- Be honest about your worst days, not your best ones. Many people understate their symptoms in appointments. Social Security decides whether you could sustain work over a full week, not whether you managed one good afternoon.
- Make sure the record describes function, not just mood. “Patient reports feeling low” tells a judge nothing. “Patient has not left the house in three weeks and cannot follow a two-step instruction” tells them a great deal.
- Get a medical source statement completed by the provider who knows you best.
- Report every condition you have, mental and physical. Social Security must consider the combined effect, and mental and physical conditions together often carry a claim that neither would alone.
- Do not stop treatment because you feel it is not helping. A gap in the record is read as improvement.
If you have been denied disability for mental illness
Most initial applications are denied, including strong ones, and mental health claims are denied more often than most because the evidence is harder to quantify.
A denial is not a judgment that your condition is not disabling. Appeal rather than filing a new application, because appealing protects your original filing date and the back pay attached to it, and you generally have sixty days from the date on the denial notice to do it.
In my experience, the hearing before an Administrative Law Judge is where mental health claims have the best chance, because it is the first point at which someone hears directly from you and from the provider who treats you.
A note on short-term disability
People often arrive here looking for short-term disability for mental health, which is a different thing. Short-term disability comes from an employer’s policy or a private insurer, and it covers weeks or months.
Social Security disability requires that your condition has lasted, or is expected to last, at least twelve months. If you need help for a shorter period, your employer’s plan or a private policy is the route to take, not Social Security. If your condition has already gone beyond a year, or clearly will, then Social Security is worth pursuing.
Talk with an Indiana disability attorney about your mental health claim
I represent Indiana residents with a wide range of conditions including depression, anxiety, PTSD, bipolar disorder, and schizophrenia. If you or someone you know is struggling with the disability process, or simply has questions about it, contact my office for a free case evaluation at (866) 950-5116.
If you are struggling with thoughts of suicide or self-harm, help is available now. In the United States you can call or text 988 to reach the Suicide and Crisis Lifeline, at any hour.
Related Conditions: Mental disorders
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