Mental Illness and Social Security Disability

Claimants filing for social security disability (SSD) or SSI benefits based on a psychiatric or psychological medical condition should become familiar with the term decompensation, because the concept of decompensation plays a very important part in a disability examiner’s decision-making process when it comes to claims filed for mental impairments.

Decompensation is actually included in the social security impairment book (blue book) in a number of separate listings. For example, listing 12.03, “Schizophrenic, paranoid, and other psychotic disorders.” The term refers to the deterioration of an individual’s mental health to the point that it prevents him or her from performing daily living activities.

It doesn’t matter if the decompensation is continuous or episodic in nature, so long as it can be demonstrated, through medical records, that the periods of decompensation are severe enough to prevent the claimant from getting (or keeping) gainful employment, and are likely to continue over the next 12 months.

All SSD and supplemental security income (SSI) claims are decided based on what the medical records say about the claimant’s condition. This can be tricky when it comes to mental impairments, because oftentimes periods of decompensation occur outside of the psychiatrist’s (or psychologist’s) office, and therefore they will not be noted in your medical record unless you make sure to tell your doctor about them.

If you have had a decompensation episode, it is a big mistake to either A) keep it from your doctor because you are embarrassed or don’t think it is relevant, or B) play down the incident to your doctor or try to make it sound less severe than it actually was.

For the purposes of winning SSD or SSI benefits, mental conditions, just like physical conditions, must be documented in the applicant’s medical records before a disability examiner will give any credence to the claim. Reporting all periods of decompensation to your physician is the only way to ensure that the severity of your mental illness and its associated symptoms will be known to the disability examiner deciding your case.

Many, if not the majority, of mentally ill patients have times when, even with the intervention of medication and therapy, they are no longer able to “hold it together.” They may completely lose their ability to cope, or even their grasp on reality—this is decompensation. Report all of these types of incidents to your physician or mental health professional.

Those filing for disability based on mental conditions must learn to view their mental illness in terms of periods of decompensation, for it is in documenting those periods that a solid case for disability (inability to work at any job) is formed.







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