Can you get Social Security disability for Anxiety and Panic Attacks?

Many of my clients diagnosed with an anxiety disorder have panic attacks. Because of the severity, frequency, and unexpected onset of these attacks, it can be difficult or even impossible to secure and keep a full-time job.

If you still have disabling panic attacks even after therapy and medication, it may be in your best interest to file for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.

I represent many people with mental disorders, and anxiety is no exception. The diagnosis can stand alone, or it may come alongside other mental and physical conditions. Some of my clients’ symptoms are severe enough that they cannot interact with friends or family, or leave the house for routine activities. With symptoms at that level, the thought of dealing with the public, coworkers, and supervisors is difficult if not impossible.

Symptoms of panic attacks and anxiety

A panic attack is an intense, sudden fear that brings physical reactions with it. The unpredictable nature of these attacks can leave people afraid to leave their homes at all.

Symptoms of a panic attack can include, but are not limited to:

• Racing heartbeat
• Chest pain
• Shortness of breath
• Sweating
• Nausea
• Dizziness or weakness
• Trembling
• Fear of impending doom
• Racing thoughts and inability to concentrate

Anxiety more broadly causes problems with maintaining focus. My clients often report racing thoughts, trouble concentrating, increased phobias, difficulty with any change in routine, and trouble sleeping. Physical symptoms are common too, including muscle tension, increased heart rate, sweating, and shaking.

An anxiety disorder differs from ordinary nervousness. The symptoms often occur for no apparent reason and do not go away, which can turn everyday experiences into sources of genuine fear.

Panic attacks vary in frequency, duration, and severity, and they can be severe enough to lead to emergency medical treatment. Some of my clients also describe a fear of leaving home, known as agoraphobia.

Which anxiety conditions qualify

Social Security evaluates these conditions in the Listing of Impairments at listing 12.06, Anxiety and obsessive-compulsive disorders. The agency describes this category as covering conditions characterized by excessive anxiety, worry, apprehension and fear, or by avoidance of feelings, thoughts, activities, objects, places, or people.

Examples Social Security evaluates under 12.06 include:

• Generalized anxiety disorder
• Panic disorder
• Agoraphobia
• Social anxiety disorder
• Obsessive-compulsive disorder

Two conditions people often expect to find here are evaluated elsewhere. Post-traumatic stress disorder is no longer treated as an anxiety disorder by Social Security; since 2017 it has been evaluated under listing 12.15, trauma and stressor-related disorders. Avoidant personality disorder and other personality disorders fall under listing 12.08. The framework is the same in each case, but the diagnostic criteria differ, so it matters which listing your claim is argued under.

What listing 12.06 requires

The listing is satisfied by paragraph A together with either paragraph B or paragraph C.

Paragraph A, documenting the condition

You need medical documentation of the following three:

• Anxiety disorder, characterized by three or more of: restlessness; being easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance.
• Panic disorder or agoraphobia, characterized by one or both of: panic attacks followed by a persistent concern or worry about additional panic attacks or their consequences; or disproportionate fear or anxiety about at least two different situations, for example using public transportation, being in a crowd, standing in a line, being outside your home, or being in open spaces.
• Obsessive-compulsive disorder, characterized by one or both of: involuntary, time-consuming preoccupation with intrusive, unwanted thoughts; or repetitive behaviors aimed at reducing anxiety.

Note what the panic disorder criterion actually asks for. It is not simply that you have attacks. It is the attacks together with persistent worry about further attacks or their consequences. That anticipatory anxiety, the part that shapes your whole week around avoiding a trigger, is what the listing is looking for, and it is frequently missing from treatment notes because nobody thought to write it down.

Paragraph B, how much it limits you

Paragraph B measures four areas of mental functioning, which are the areas a person uses in a work setting:

• Understand, remember, or apply information
• Interact with others
• Concentrate, persist, or maintain pace
• Adapt or manage oneself

To satisfy paragraph B you need an extreme limitation in one of these areas, or a marked limitation in two.

Anxiety claims most often turn on interacting with others and on adapting or managing oneself, because severe anxiety affects social functioning and self-regulation directly. Agoraphobia frequently supports marked findings in both. Where panic attacks are frequent, they can also produce a marked limitation in concentrating, persisting, or maintaining pace, because each attack interrupts sustained work.

Paragraph C, serious and persistent

There is an alternative route that matters a great deal for anxiety and is often overlooked. Paragraph C applies where your disorder is serious and persistent: a documented history over at least two years, 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 demands that are not already part of your daily life.

This is worth understanding if your anxiety appears controlled. Someone who functions reasonably only because they have narrowed their life to a small, predictable routine, and who would decompensate if that routine were disturbed, may meet paragraph C even though they seem stable at an appointment.

If you do not meet the listing

It can be difficult to meet or equal a listing, and not meeting one does not end your claim. Social Security will then assess your residual functional capacity, which is what you can still do on a sustained basis despite your impairments. That assessment has to weigh all of your conditions together, mental and physical, rather than your anxiety on its own. If the result is that you could not perform even unskilled work on a full-time basis, you can be found disabled at this stage without ever meeting a listing.

Many jobs require interaction with coworkers, supervisors, or the public, so limitations in getting along with others affect a wide range of work. If your symptoms would cause you to miss days or be off task during the day, Social Security may agree that you could not keep a job. Vocational experts routinely testify that employers will not tolerate more than about two absences a month.

The evidence these claims need

There is no MRI for anxiety. Because there is no objective test, well-documented progress notes from a mental health professional are frequently the key to a favorable outcome.

To win an SSDI or SSI claim, information from a treating, qualified mental health professional is generally essential. Cases involving anxiety are more easily won with complete records from a psychologist or psychiatrist. Useful evidence includes:

• Progress notes documenting the frequency and severity of attacks over time
• Records of any hospitalizations or emergency treatment
• A medication history, including what has been tried and what happened
• A medical source statement from your mental health provider
• Notes describing what you can no longer do, not only how you feel

I try to get my clients to take a medical source statement to their mental health provider, because a provider who sees you regularly can substantiate the symptoms you experience and explain how they prevent you from working.

The treatment trap in anxiety claims

Compliance with treatment is a significant factor. If you are not taking medication as prescribed, and not seeing a therapist regularly, it can be very difficult to win at the initial level or before an Administrative Law Judge. Consistent treatment also shows that your symptoms persist despite proper care, which is exactly what the listing asks.

There is a real problem hiding in that, and it is specific to this condition. Severe anxiety and agoraphobia make it hard to attend appointments. The very symptom that would prove your claim is the thing preventing you from building the record that proves it. Social Security then reads the gap as improvement.

If this is your situation, say so explicitly rather than letting the gap stand unexplained. Social Security is required to consider your reasons before holding missed treatment against you, and an inability to leave the house is a reason. Ask about telehealth appointments, which many providers now offer, and make sure the reason for any missed sessions is recorded in your notes rather than left blank.

Talk with an Indiana disability attorney

Many people who have not experienced a severe mental health condition do not understand its impact. My office tries to be patient and understanding with every client.

Sometimes medication and therapy do not produce results that let a person manage a full-time work schedule. Social Security disability may provide the financial relief those individuals need. If you have questions, contact my office for a free consultation.