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If you have a condition (such as schizophrenia or Huntington’s disease), you may qualify for disability benefits. For you to be eligible, you need to meet the Social Security disability requirements for mental illness. For example, you should have a diagnosed medical condition (e.g., autism spectrum disorder). Additionally, you must show that your condition prevents you from working. Depending on your prior work history, you may qualify for benefits under the Social Security Disability Insurance or Supplemental Security Income systems. 

Since 1936, Krasno, Krasno & Onwudinjo has been fighting for people who cannot work because of a disability or job-related condition. Our Pennsylvania Social Security Disability lawyers know how important it is for people to get the support they need to sustain themselves. Social Security benefits are there to support people with a disability, but the application process is often confusing and overwhelming for folks. Our experienced team empowers individuals by fighting for their interests and connecting them to the resources they need. 

Can You Get Disability Benefits for a Mental Illness?

If you have a qualifying mental health disorder that keeps you from working, you may be eligible for disability benefits. Depending on your situation, you may be able to receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. There are different requirements you need to meet to qualify for these programs. For example, you may have had to work for a certain number of years first. 

What Mental Health Disorders Qualify for Social Security Disability?

The Social Security Administration (SSA) has a Blue Book that lists the mental health disorders that may qualify someone for SSDI or SSI. The SSA organizes these conditions by categories, such as the following:

• Neurocognitive (e.g., Alzheimer’s dementia, HIV dementia, or Huntington’s disease), 
• Intellectual disorders, 
• Anxiety and obsessive-compulsive (e.g., agoraphobia or panic disorder), 
• Trauma- or stress-induced (e.g., post-traumatic stress disorder), 
• Autism spectrum, and 
• Personality and impulse control (e.g., borderline personality disorder or schizophrenia). 

For each of these categories, there are different criteria the person must meet to show they qualify. For example, for personality and impulse control disorders, the person would need medical evidence showing they experience a pattern of thoughts and behaviors, such as distrust and suspiciousness of others. Additionally, they might need to establish that they have an extremely limited ability to interact with people. 

What Are the Social Security Disability Requirements for Mental Illnesses?

To qualify for disability benefits under SSDI or SSI, you need to show that you have a qualifying mental disorder. As part of this, you may have to present medical criteria (e.g., doctor’s diagnosis) and proof that your condition limits your ability to function. In some situations, the SSA also asks people to show that their condition has lasted or is expected to last for a certain amount of time (e.g., two years). A disability lawyer can help you figure out if you qualify for benefits. They can also assist you by gathering the necessary paperwork and medical records you must submit with your application. 

Medical Criteria

The SSA requires you to present medical evidence showing you have a mental condition. This might include a diagnosis from a trained physician. Additionally, you may need to meet other criteria, such as a pattern of thoughts or behavior or significant cognitive decline. Exactly what medical evidence you need depends on the category of mental disorder you have. 

Functional Limitations

The SSA also asks you to prove that you have functional limitations imposed on you by your mental condition. For you to qualify, they need to be severe or marked. If you have an extreme limitation, you only need to prove one area of impairment. Someone has an extreme limitation if they can’t function in this area or can’t do so effectively. For example, someone may satisfy this requirement if they have a severe panic disorder that causes them to have sudden panic attacks within moments of stepping outside their house. They might also have to prove that this occurs when they interact (or attempt to interact) with people virtually. 

If you have a marked limitation, you have to show that you have an impairment in at least two areas. Someone has a marked limitation if they have a seriously limited ability to do something. For example, someone may meet these criteria if they have extremely poor memory and experience sudden, violent outbursts during conversations.  

Durational Requirements

To qualify for benefits, you may need to prove that your disability is serious and persistent. In some cases, this may require you to establish that your disability has lasted or is expected to last at least two years. If the SSA thinks your mental health disorder is temporary, you may not qualify for benefits. Sometimes, you may have to meet either the functional limitation or the durational requirement. For example, someone with post-traumatic stress disorder may have to prove (a) that their condition limits their functioning as described above or (b) that it is serious and persistent. 

Not every type of mental illness requires a showing that it’s persistent. For example, someone on the autism spectrum would not have to present separate proof that their condition is persistent. Likewise, someone with schizophrenia may not need to prove that this is a lasting condition. For these and other similar disorders, the SSA only requires proof that you have this condition and meet the other criteria. 

What Benefits Can Someone Receive for a Mental Illness?

If you have a qualifying mental illness, you may be eligible for SSDI or SSI benefits. Each of these programs has different eligibility criteria. When you first apply for benefits, you need to meet the requirements for the particular program. If the SSA grants your application and you receive payments, you have to meet ongoing eligibility criteria as well. For example, you may be evaluated by a doctor periodically to see if your condition has improved or remains the same. 

Social Security Disability Insurance

SSDI is available to someone with a condition that meets the Social Security Administration’s definition of a disability. The person must also establish that they have enough work history to qualify. The idea is that the person paid into the SSDI system and is now collecting those benefits. How much someone gets depends on many factors, such as their work history and the average wage index that applies to their situation.  

Supplemental Security Income

SSI is available to people who have a qualifying disability (or are 65 or older) and are below a certain income threshold. The SSA considers someone’s income and assets to decide this. The income threshold they need to meet (or fall below) depends on their unique circumstances. If someone is 65 or older, they may qualify for SSI even if they do not have a disability. The SSA may also use the average wage index to compute someone’s total benefits. 

How Do I Apply for Social Security Benefits?

If you wish to apply for benefits, you need to submit an application to the SSA. On this application, the SSA may ask you for information about you, your mental health disorder, and your work history. For example, they may ask for your Social Security number and require you to turn in copies of relevant medical records. Additionally, they’ll probably want to know the name and contact information of the doctor who diagnosed your condition. You may also have to explain how your condition impacts your ability to work. 

When the SSA receives your information, they will review it and reach out if they need additional details. It’s common for the SSA to ask someone to send in more materials to support their initial application.  The SSA uses the materials provided to determine if you qualify for Social Security benefits. Finally, the SSA will make a decision and follow up with the applicant.

What Happens if My SSDI Claim Is Denied?

If the government denies your SSI or SSDI application, you can file an appeal. How you go about this depends on the specific situation. For example, to appeal an initial denial, you might file for reconsideration. If the SSA denies your application a second time, you may ask an administrative law judge for a hearing. During the appeals process, you would need to present evidence to prove your mental health condition prevents you from working. You might accomplish this by giving them copies of your medical and treatment records. You (or your attorney) may also submit forms and legal arguments that explain why you think you qualify for benefits. 

For the other part of the appeals process, the SSA may ask you to go to court to discuss your disability and present evidence. For example, you might ask a doctor or other medical expert to testify about your condition and how it prevents you from working. At the end of the hearing, the SSA reviews the materials given to them and makes their final decision. If you win your appeal, you may be eligible to receive retroactive benefits. 

Krasno, Krasno & Onwudinjo: Fierce Disability Lawyers Serving Pennsylvania

Receiving benefits can be a lifeline for many folks, equipping them with the funds they need to support themselves. However, the process of applying for benefits can be challenging. The SSA may ask you intrusive questions about your condition and require you to complete multiple forms and evaluations. If you’re struggling to obtain benefits for a mental health disorder or other condition, you may find it helpful to work with a seasoned Social Security Disability attorney. 

The attorneys at Krasno, Krasno & Onwudinjo have significant experience connecting people with Social Security benefits for mental health conditions. Eileen Pomento has over a decade of legal training and courtroom experience fighting for those whose conditions keep them from working. She respects the vulnerability of her clients and leaves no stone unturned when developing a strategy to help them thrive.

If you need help understanding the Social Security Disability requirements for mental illness, contact us today by calling 844-948-2338 to schedule a free, no-obligation consultation.