Mental Illness

Mental Illness —> Blue Book Criteria | Evidence Needed | Functioning Limits | Additional Criteria | Example | Disability Apply Can Help

Is mental illness a disability? Yes. If you or a loved one has a mental health impairment, you may be eligible for Social Security Disability benefits.

For the Social Security Administration (SSA) to consider you disabled based on mental illness, your condition must be diagnosed by a doctor and meet certain criteria. Whether you are applying for Social Security Disability Insurance (SSDI) or Supplement Security Insurance (SSI), the criteria will be the same.

Qualifying for benefits with a mental illness can be challenging, but working with a disability representative can help your case. To find out more about receiving benefits for a mental illness, call us at the number above to find answers to your questions about applying for Social Security Disability benefits.

Mental Illness And The SSA

The SSA can help with monthly income for people living with a mental health condition that prevents them from being able to sustain employment. Focusing on the qualifications for SSDI, your mental condition must prevent you from working for at least 12 months and you must have worked and paid into Social Security through payroll taxes. To qualify for benefits with a mental illness, you must be able to:

– Show that you meet the SSA criteria for a mental illness.
– The sum of all your disabling conditions is equivalent to the listed criteria.
– Your condition completely hinders you from working.

The SSA uses a Blue Book listing of disabling impairments that qualify an individual for disability benefits. The Blue Book lists specific criteria under each condition and you must be able to show that you meet the criteria to qualify for benefits.

Section 12 of the Blue Book focuses on mental disorders. It contains a list of different types of mental disorders and the medical criteria required to qualify for benefits. There are 11 categories of mental disorders covered in the Blue Book, including:

  • Neurocognitive disorders
  • Schizophrenia spectrum and other psychotic disorders
  • Depressive, bipolar, and related disorders
  • Intellectual disorder
  • Anxiety and obsessive-compulsive disorders
  • Somatic symptom and related disorders
  • Personality and impulse-control disorders
  • Autism spectrum disorder
  • Neurodevelopmental disorders
  • Eating disorders
  • Trauma- and stressor-related disorders

What Criteria Is In The Blue Book?

Each type of disorder has its own unique set of criteria. Your mental illness must satisfy the requirements stated. Each mental disorder has two to three detailed paragraphs with requirements:

  • Paragraph A: lists the medical criteria that must be present in your medical evidence.
  • Paragraph B: lists the SSA functional criteria that evaluate how your mental disorder limits your functioning.
  • Paragraph C: lists the SSA criteria of how serious and persistent a mental disorder is required to be.

Need help applying for Social Security Disability? Find out how to sign up!

Evidence Needed To Evaluate Your Mental Illness

To qualify for disability benefits because of mental illness, you will need to present medical evidence from your physician, psychologist, and other medical sources that establish that you have a mental disorder.

The SSA will need evidence to evaluate the severity of your mental disorder and if it affects your ability to work. Evidence should include:

  • Medical, psychiatric, and psychological history.
  • Psychological testing or results of mental examinations.
  • Medications you take and their side effects.
  • Type, frequency, and duration of therapy you receive.
  • Information about the sensory, motor, or speech abnormalities.
  • Expected duration of your symptoms and signs and their effects on your functioning.

Other evidence used to evaluate your mental disorder should include testimonies from family and friends or evidence from school or work-related programs.

How Your Mental Disorder Limits Your Functioning

Paragraph B draws attention to your mental function to perform work activities. In summary, the criteria highlight how your mental illness affects the four areas of mental functioning and your ability to function independently. This includes the ability to function independently appropriately, effectively, and on a sustained basis. The criteria include your ability to:

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

The SSA will use a rating scale to determine the degree of your limitations. The five-point rating consists of none, mild, moderate, marked, and extreme limitation. To satisfy the criteria, your mental illness must result in one extreme limitation or marked limitation of two.

The SSA will use all the medical and non-medical evidence you provided to evaluate symptoms and limitations in your activities to determine the rate and ultimately if you are eligible for benefits.

Additional Criteria

According to the Blue Book and Paragraph C, your mental disorder must be serious and persistent. This means you will need to provide the medical history of the existence of the disorder over a period of at least 2 years. You will need evidence of both ongoing medical treatment and marginal adjustment.

Mental Illness Example

The Blue Book lists depressive, bipolar, and related disorders under Section 12.04. Examples of disorders evaluated in this category include:

  • Bipolar disorders (i or ii).
  • Cyclothymic disorder.
  • Major depressive disorder.
  • Persistent depressive disorder (dysthymia).
  • Bipolar or depressive disorder due to another medical condition.

In Section 12.04(a), the Blue Book lists various symptoms for both depressive and bipolar disorder. A few of the symptoms listed under depressive disorder are depressed mood, difficulty concentrating, and thoughts of death or suicide.

Some of the symptoms listed under bipolar disorder include pressured speech, flight of ideas, and inflated self-esteem. From all the listed symptoms, the SSA requires that an applicant has a minimum of five symptoms if filing for depressive disorder. If filing for bipolar disorder, a minimum of three of the symptoms listed must be satisfied.

In addition to the symptoms, 12.04(b) requires that the applicant suffers extreme limitation of one, or marked limitation of two, of the listed areas of mental functioning. If you do not meet the criteria for limitations of mental functioning, you must meet the criteria of 12.04(c) and have a serious and persistent disorder. To meet the requirements of 12.04(c), you will need documented evidence of ongoing medical treatment and marginal adjustment.

Work With Our Experts To Help Your Mental Illness Case

If you are filing for disability benefits with a mental illness, it is recommended that you work with a disability representative to help navigate the complexity of your claim.

A Disability Apply representative can help you with the disability application, work with you to gather all required medical evidence, and prove to the SSA that you meet the necessary criteria of mental illness to receive disability. Do not risk missing out on your benefits.

Contact us today to review your case! We can be reached at the number above or you can complete this free evaluation form to get started.

Do You Qualify for Social Security Disability Benefits?

    1. Do you expect to be out of work for at least 12 months?

    2. Did you earn taxable income for 5 of the last 10 years?

    3. Are you currently receiving disability benefits?

    4. Have you seen a doctor within the last 12 months?

    5. Are you currently working with a disability advocate?

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