Can you get Social Security disability for Depression?

Depression appears in the majority of the claims I handle. Some of my clients have depression alone; others develop it because of physical disabilities that have changed their lives. I am certain I am not alone in this, and the judges who preside over the hearings I attend routinely read records carrying a diagnosis of depression.

Depression may be one of the most misunderstood disabling conditions. A great many people do not realize how severely it can limit a person’s ability to function, or how difficult it is to overcome.

The obstacle nobody warns you about

Depression raises a problem in pursuing a disability claim that most conditions do not, and it is worth addressing before anything else.

Deadlines must be met. Appointments must be kept. Paperwork must be completed thoroughly and on time. But if you have depression, you may lack the energy to keep track of your mail, let alone open it. You may be isolated enough that you do not attend appointments or return telephone calls. You may find it hard to hold your attention long enough to complete a questionnaire about your symptoms and work history.

If those obligations are not met, your claim can be decided against you without anyone ever weighing how sick you are. At the application stage that means a denial for failure to cooperate, decided on whatever evidence happens to be in the file already. At the hearing stage it means your request for a hearing can be dismissed outright. Either way the outcome turns on paperwork rather than on the merits, and either way it is avoidable.

The single most useful thing you can do is let a family member or friend help you keep track of it. Give them permission to open your mail, remind you about appointments, and sit with you while forms get completed. There is no rule against it, and the symptoms that make this necessary are the same symptoms your claim is about.

Symptoms of depression

Symptoms vary between individuals, but some of the more common ones include:

• Loss of interest in activities you used to enjoy
• Lack of energy
• Sleep disturbance
• Appetite disturbance, with weight gain or loss
• Lack of concentration or focus
• Low self-esteem, guilt, or feelings of worthlessness
• Crying spells
• Thoughts of death or suicide

Not every symptom on this list appears in the legal test. The paragraph A criteria set out below are the ones Social Security actually applies.

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.

How Social Security evaluates depression

Social Security addresses depression in its Listing of Impairments at listing 12.04, Depressive, bipolar and related disorders.

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

Paragraph A: documenting the symptoms

You need medical documentation of five or more of the following:

• Depressed mood
• Diminished interest in almost all activities
• Appetite disturbance with change in weight
• Sleep disturbance
• Observable psychomotor agitation or retardation
• Decreased energy
• Feelings of guilt or worthlessness
• Difficulty concentrating or thinking
• Thoughts of death or suicide

Two details in that list matter more than they look.

The threshold is five. Older guidance, including a good deal that is still published, says four. That was the requirement before the listings were rewritten, and building a claim to the old threshold leaves it a symptom short.

The word observable in front of psychomotor agitation or retardation means a clinician needs to have recorded it on examination. Reporting that you feel slowed down is not the same thing, and this is one of the more commonly missed items in an otherwise strong file.

You will also notice what is not on this list. Hallucinations, delusions, and paranoid thinking used to appear in the depression criteria and no longer do. Where psychotic symptoms are present, they are evaluated under listing 12.03 instead.

Paragraph B: how much it limits you

Paragraph B measures four areas of mental functioning:

• Understand, remember, or apply information. Learning tasks, following instructions, solving problems.
• Interact with others. Cooperating with coworkers, accepting supervision, dealing with the public.
• Concentrate, persist, or maintain pace. Sustaining focus through a work period and completing tasks at an acceptable rate.
• Adapt or manage oneself. Responding to change, managing stress, maintaining hygiene and personal care.

You need an extreme limitation in one of these areas, or a marked limitation in two. Marked means seriously limited, more than moderate but less than extreme.

Note that repeated episodes of decompensation, which used to be the fourth item in this part of the listing, are no longer part of the test at all.

Paragraph C: when your symptoms are currently controlled

If your symptoms are under control because of medication and therapy, to the point where you would not currently be rated as markedly impaired, Social Security may still find you disabled through paragraph C.

This route requires a documented history of the disorder over at least two years, together with both of the following:

• Ongoing medical treatment, mental health therapy, psychosocial support, or a highly structured setting that diminishes your symptoms
• Marginal adjustment, meaning you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life

In practical terms, this is the route for someone who is holding together only because their circumstances are stable and supported, and who would deteriorate if that support were removed or if something changed. Both elements are now required; the older version of this paragraph allowed several alternatives and is still widely quoted.

Who is treating you matters

One of my biggest challenges is representing a client whose mental health diagnosis and treatment come entirely from a family physician.

Your family doctor can diagnose depression and prescribe medication for it, but is not a mental health specialist. One factor an Administrative Law Judge considers is whether you are being treated by a specialist. If you have heart problems, most judges expect records from a cardiologist. If you have back problems, they want to see an orthopedist. In the same way, most judges expect someone with depression to be seeing a psychiatrist and attending counseling with a psychologist, social worker, or other mental health professional.

I sometimes sit in a hearing listening to a client testify, think they are plainly clinically depressed, and realize at the same time that their medical records are thin and their treating source is not one Social Security is likely to find persuasive. Since 2017 the agency no longer gives an opinion extra weight simply because it comes from a provider who treats you. It looks at how well the opinion is supported and how consistent it is with the rest of the record, and specialization counts toward both. You can be genuinely disabled and still lose, which is why it is worth getting the right treatment in place rather than relying on the agency to work it out.

A well-documented course of ongoing therapy with detailed progress notes goes a long way. Hospitalizations for mental illness also count for a great deal, because they show you are not improving despite treatment and medication.

If depression is what is stopping you from getting treatment

There is a circularity here that deserves saying out loud. The symptoms that make a depression claim strong, including isolation, exhaustion, and difficulty leaving the house, are the same symptoms that make it hard to attend regular appointments. A file with gaps in treatment is read as evidence of improvement.

Social Security is required to consider your reasons before holding a gap against you. If you missed appointments because you could not face leaving the house, could not afford care, or lost your insurance, that reason should be recorded in your notes rather than left as a blank. Telehealth appointments are worth asking about, since they remove one of the obstacles entirely.

What actually limits work

For most of my clients with depression, the most disabling limitation is the inability to work consistently on a full-time basis.

Their symptoms prevent them from focusing and concentrating well enough to sustain an eight-hour day. The lack of energy and the sleep disturbance prevent them from getting to work on time, or at all, often enough to hold a job. Vocational experts routinely testify that employers will not tolerate more than about two absences a month, or a worker who is off task beyond a small share of the day.

Remember also that Social Security must consider all of your impairments, physical and mental, alone and in combination. When you apply, tell the agency about every problem affecting your ability to work, not only the one you think is most serious.

Evidence and medical source statements

It is not enough to explain to Social Security what your symptoms are and how they affect you. You need documentation from a medical provider supporting your description, and evidence that your symptoms have lasted or are expected to last at least twelve months.

A statement from your treating psychiatrist or therapist addressing your diagnosis, symptoms, and limitations can be decisive. I routinely ask treating providers to complete medical source statements setting out the severity of a client’s condition. A specialist can give an expert analysis of the nature and severity of the symptoms and a well-supported opinion on how they prevent you from working.

Some judges will find a claimant disabled on comprehensive medical records alone. Others will use a medical expert at the hearing to agree or disagree with the documents in the file. Those experts can be cross-examined by you or your representative, which is one of the practical reasons to have someone with you.

Counting on Social Security to find you disabled without any proactive effort on your part is usually a mistake. If the agency were going to find you disabled easily, your claim would probably not have been denied at the earlier stages.

The wait, and what happens if you win

The time between applying and getting a hearing can be very long. It is hard to be patient when you and your family are struggling financially, and it is tempting to give up.

If the judge finds you disabled at your hearing, you may be entitled to the benefits you would have received during that waiting period, typically paid as a lump sum. It is worth sticking with the claim, because the chances of success are better at the hearing level than at the earlier stages.

Talk with an Indiana disability attorney

I understand that this process is confusing and frustrating. Laws and regulations are not written in a way most people can readily follow.

I am paid on a contingency basis, which means you pay nothing unless you receive benefits. That levels the playing field, because it means you do not have to walk into a hearing room alone. Contact my office for a free consultation.

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.