Social Security Disability for Mental Disorders

There is a pervasive social stigma attached to mental disorders in America as well as the rest of the word. Many people do not consider mental disorders disabling at all. In fact, individuals with mental problems are often viewed as lazy or malingering. This, of course, is unsettling since, statistically, so many individuals suffer from mental illness worldwide. In the United States alone, millions suffer from severe mental disorders, syndromes, and diseases that make it all but impossible to function in a normal work environment.

From my experience as a former disability examiner, I found that most individuals who file for disability based upon mental conditions such as depression, bipolar disorder, anxiety, panic attacks, or schizophrenia have significant problems.

Generally, the individuals I came across had a lifetime of problems that culminated with an application for disability. Unfortunately, it is very difficult for individuals who apply for disability based upon a mental condition to win disability from Social Security at the initial claims level, and most will have to pursue the disability appeals process to win their benefits.

The criteria for evaluating most mental disorders tends to be more subjective than objective and there are very few tests (i.e. blood work, x-ray, imaging) to evaluate the severity of an individual’s mental condition. Disability examiners must base their decisions on the clinical notes of mental health professionals, third party questionnaires (all individuals who file for disability with Social Security are asked to list a third person who is familiar with their illness--this person will typically be contacted and asked about the claimant's condition and normal daily routine), and an ADL, or activities of daily living, questionnaire completed by the claimant (the information gathered from the third-party contact also regards activities of daily living).

Frankly, only mental conditions such as mental retardation, memory impairments, or other organic mental disorders can be tested objectively, (testing includes intelligence quotient (IQ) and memory impairment testing).

So do Social Security disability examiners make disability decisions based upon allegations of mental impairments fairly? That may not be possible to answer (for one thing, there are more than 50 DDS agencies and even the individual processing units within them may vary dramatically on how they decide claims), though from my own experience as an examiner I concluded that the answer was no--far too many times I saw cases denied for individuals with well-documented histories of mental impairment that, in my opinion, effectively ruled out the option to work.

Having said that, though, the Social Security disability handbook contains impairment listings for organic mental disorders, schizophrenic along with other paranoid and psychotic disorders, affective disorders (depression, bipolar), mental retardation, anxiety-related disorders, somatoform disorders, personality disorder, substance and addiction disorder, and autistic disorder along with other pervasive development disorders.

Social Security has established evaluation criteria for each of the above mentioned mental impairment listings and if an individual meets or equals the listing criteria they will be approved for disability.

Some individuals who do not meet or equal the criteria established for a mental impairment will still be able to qualify for disability, because their mental residual functional capacity has become so restricted that they are unable to function in a normal work environment. In other words, they will be granted a medical vocational allowance.

The number of initial disability approvals based upon mental impairments is small, and most individual have to pursue their disability allowance through the Social Security appeals process.











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Social Security Disability Deadlines

The topic of deadlines as they relate to social security disability comes up fairly often. Mainly, however, the subject is addressed due to false assumptions by applicants regarding the processing of initial disability applications.

Unlike various programs operated by state and local governments, SSD applications and SSI applications do not have processing deadlines. In other words, after you apply for disability, your claim may take one month to process...or five months to process. There is simply no time limit on how long a claim may inevitably take, though its safe to say that the averages quoted by the social security administration are fairly accurate. As a disability examiner, I found that most cases were usually decided within a three to four month time frame following the filing of a claim.

Of course, it bears mentioning that the one factor that accounts for the most processing time on a case, and the longest delays, is the wait for medical records. Social security makes every attempt to get a claimant's medical records so that a decision can be made as fast as possible. In fact, as soon as a case lands on a disability claim examiner's desk, the examiner's first primary task will be to send out requests for records to every medical treatment source listed by a claimant on their disability application.

However, in the end, however long it takes for a doctor's office or hospital to comply with the request and send records back...is entirely up to them.
As an examiner, I found that it was not unusual to have to make repeated calls to medical records departments and repeatedly fax over the same request for records multiple times. Working in representation, I found that the difficulties in obtaining records were no less, though some doctor's offices seemed to respond more quickly to followup calls from the office of a disability representative (not always the case, certainly).

So, back to the topic, are there deadlines for social security disability and SSI disability applications? No, there are not.

However, in an unofficial sense, there are deadlines of a type. And what I mean by that is this: each disability examiner who works on SSD and SSI claims is rated according to how fast they process cases. And the more cases they have that are "getting older" (often, not due to the examiner's fault), the worse it looks for the examiner's statistics.

Therefore, disability examiners have every clear incentive to get decisions made as quickly as possible. So, while there are no official deadlines on the the processing of disability claims, each disability examiner is expending effort to get cases off their desk ASAP.

This brings up, of course, the subject of what a claimant can do to help speed their case along. And that's fairly simple:

1. Always respond to correspondence related to a disability case. This includes letters from the social security office and letters from the disability examiner who is attempting to make a decision on the claim. Sometimes, failing to respond to a request for information can add significant time to the processing of a case.

2. Always report new information regarding treatment sources, diagnoses, and work activity to social security.

3. Always go to scheduled social security medical exams. Failing to do so can, at the very least, add significant amounts of processing time to a case. And, typically, for no good reason (failing to have transportation to a consultative exam is not the best reason for missing an appointment considering how long claimants are notified in advance that they have a medical exam scheduled).

4. Supply complete and detailed information when initially filing for disability.

It's extraordinary to think about it, but many claimants file an application for disability with only the barest details about their work history and medical treatment history. It's almost as if they seem to think that the social security administration has a crystal ball into which it can look and glean all the information that is required. However, that's not the case and if you give incomplete information when you apply for disability, you only disadvantage your claim by doing so.








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Effective New Therapy for Alzheimer’s Disease

There is an effective new therapy being studied for Alzheimer’s disease. The therapy is called BDNF, which stands for brain-derived neurotrophic factor. BDNF is a protein that occurs naturally in the body. Researchers at California University, led by Mark Tuszynski, have been treating laboratory mice with this protein with much success. Not only are they finding that BDNF can prevent memory loss in the mice, but they are also finding that it can repair and reverse memory loss, restoring function to the parts of the brain that are treated.

In the study, BDNF was targeted to brain memory circuits in the mice, which was determined to quicken cell functioning, while preventing cell death. Researchers are saying that BDNF is showing protection of memory and restoration of memory in the mice. BDNF treatment either slowed the progression of Alzheimer’s or stopped Alzheimer’s altogether in the mice, which was a large contrast to the mice not treated.

Since Alzheimer’s disease has no cure, this is a very promising treatment for the disease. Of course, human trials and studies will need to be done, but until then hopes are high for this new, potentially effective treatment. The study was published in the journal Nature Medicine.














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How Long Must I Wait For a Social Security Disability Hearing?

Most individuals, unless they've had a friend or relative who has become disabled, never even realize that there is such a thing as "social security disability" or "SSI disability". Even I, who had previously worked as a caseworker in nearly every federally mandated program, knew practically nothing about the disability benefit programs administered by SSA (social security administration) until I applied for a job as a disability examiner. For most individuals, an awareness of social security disability or SSI only comes when they begin to have serious medical or mental health programs and are forced to investigate their available options for financial survival. But in a nation that, statistically, is becoming older, this prospect is increasingly more likely.

Each year, approximately two and a half million individuals file for Social Security disability, not knowing at all what's in store for them. This is what they find out: Two thirds of all initial disability claims are denied; unfortunately, due to a variety of reasons (including, I believe, a failure of SSA to properly educate claimants regarding their appeal options), many individuals decide not to continue their disability claim at this juncture. In other words, they don't appeal.

However, according to one estimate, roughly six hundred thousand individuals do go on to utilize the Social Security disability appeals process. In most states, this means filing something known as a request for reconsideration. And at this stage of the process, things can seem even more dismal: though the numbers vary, depending on the state in which you live, about 80 percent of all reconsideration appeals are denied.

How much time has been consumed at this point? SSA has no way of knowing just how long it will take an individual to go through the disability process, nor is there any set amount of time in which Social Security is required to move a case along at the initial claim level, reconsideration level, or, later in the process, to set a hearing date with an administrative law judge.

Most disability claimants receive their initial disability decision in roughly three to four months (SSA typically quotes an average and expected processing time of "one hundred and twenty days") though there are plenty of exceptions that drag on for longer periods of time. Often, those involve situations in which medical records are difficult to obtain, claimants repeatedly miss appointments for consultative medical exams (sometimes due to valid and extenuating circumstances and sometimes not), or where surgical procedures have been performed at the same time that a disability case is pending (such as subsequent heart procedures that require a case to be put on hold for an three extra months so social security can evaluate a claimant's medical response, i.e. did they get better or worse?).

However, the wait for a hearing is easily the largest component of the social security disability waiting game. The national average wait time for a Social Security disability hearing was over five hundred days in 2008, which meant that some hearing offices had longer wait times.

As you might well imagine, many individuals experience extreme financial hardship while waiting for a Social Security disability hearing. For most, there is very little that can be done to speed up their wait time.

Some individuals may be able to expedite their hearing, by providing Social Security with a dire need request. Your dire need letter should furnish enough information to explain the severity of your situation; and it doesn't hurt to attach late notices from your utility companies, mortgage Company, or landlords. Sometimes a dire need letter may result in your hearing being scheduled sooner, however there are no guarantees and, unfortunately, financial ruin often goes hand in had with the Social Security disability process.

If you continue the Social Security disability process to the administrative law judge hearing, statistically you are more likely to be approved for disability benefits than not.

In fact, national statistics suggest that as many as two thirds of all disability claims that go before an administrative law judge are approved for benefits.

For this reason, then, more than any other, it should never enter the mind of an applicant for disability benefits to ever give up on their claim. Of course, as the title of this post suggests, the wait for a hearing (the second appeal in the process, following the denial of a reconsideration appeal) can be considerable. Currently, it can take up to two years, depending on where you live in the country and how backlogged the hearing office that has jurisdiction for your area is. And in some cases, it can take longer. But, by the same token, not all hearing requests will take so long.

Regardless, though, of whether a request for a hearing takes six months or two years-plus, this fact (the interminable wait) highlights the importance of maximizing one's chances of winning a claim early on, if at all possible.

Can you, the claimant, actually do anything to improve your chances of winning your claim at the initial claim or reconsideration appeal level? Actually, the best way to approach the topic is to say that there are a number of mistakes a claimant can avoid that may disadvantage their claim and slow down the processing of their case.

In a future post, I will discuss this more at length. In the meantime, here's a link to a section on www.disabilitysecrets.com that discusses various mistakes for disability claimants to avoid.

Social Security Disability Mistakes








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Don’t Miss Your Social Security Medical Exam Appointment

It is not uncommon for social security to schedule a disability claimant for a social security medical exam, or consultative exam. The doctors who perform these exams are in private practice and are not employees of the social security administration, although the SSA does pay the bill. Consultative exams are usually quite brief (most last no more than 15 minutes) and have little influence on a disability examiner’s final decision.

However, if you miss your appointment for a social security medical exam, a decision in your case will most certainly be delayed, and repeated no-shows are grounds for a disability examiner to deny benefits altogether based on a claimant’s “non-compliance.” Of course, if you have a good reason for missing your exam it can be rescheduled, but putting it off indefinitely is not an option, and missing these appointments only hurts your chances of approval.

It makes no difference if your claim is filed under social security disability (SSD) or supplemental security income (SSI), nor does it matter if your impairment is physical or mental; a disability examiner may require a consultative exam at any time, and even if you feel it is unnecessary, you must attend.

Why do disability examiners ask for consultative exams? Typically claimants are scheduled for consultative exams if they have something lacking in their medical records. Some people file for disability claiming to suffer from conditions for which they have never received any medical diagnosis or treatment. Others may have quite a lot of medical records in their file, but none that are current (dated within the past 2 to 3 months). Still others may have records that list symptoms or a diagnosis, but no real explanation as to how these affect their ability to function; i.e., perform work.

A disability examiner will schedule a consultative exam to address any gaps in a claimant’s medical records, because without recent medical information regarding the claimant’s current condition, no decision can be made. Some people have pointed out that consultative examinations offer little in the way of a real “objective” opinion regarding impairment, because they are so brief and are often performed by doctors who do not specialize in treating the medical condition in question. One newspaper even reported that a man with back trouble was sent to a social security medical exam only to find it would be performed by a gynecologist—stories like these support what many claimants and people who work in the disability system have said, which is that a consultative exam is no more than a formality that must be satisfied in order to close a case.

Still, if you are scheduled for a social security medical exam, do not miss your appointment unless you have a valid explanation. Acceptable reasons, such as car trouble, getting directions mixed up, illness, or family emergency are allowable, but only up to a point. Never forget that missing an appointment for a medical exam can provide a disability examiner with an excuse to dismiss your claim for benefits.







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Pregnant Women with Migraines More Likely to Develop High Blood Pressure

Pregnant women who suffer from migraine headaches are almost three times more likely to develop gestational hypertension (high blood pressure) than pregnant women who do not have migraines, according to a study performed at the University of Modena, Italy.

While there has been other research regarding the onset of high blood pressure and migraines in pregnant women, this is the first study to show a definite link between the two. The study also established that there is an increased risk of developing preeclampsia, a condition that causes high blood pressure, fluid retention and protein in the urine during pregnancy, in women who had migraines.

More than 700 women participated in the study, and all had normal blood pressure before their pregnancy. Thirty-eight percent of the participants suffered from migraines, and 9 percent of these women went on to develop high blood pressure or hypertension during their pregnancy, compared to just 3 percent of the women who did not have migraines. In addition, more low-birth-rate babies were born to women who had migraines than to those who did not.

The authors of the study warn that "Women with migraine are to be considered at increased risk of developing hypertensive disorders in pregnancy."











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What Will Happen If I Draw Disability Benefits, Work, and do not tell Social Security?

Depending on an individual's circumstances, it may seem worth it at first glance, but Social Security will eventually find out about all work that you are performing whether or not you “tell” them about your job. At the very least, you may find yourself in the situation of owing Social Security money (an overpayment), and at the worst you may find yourself being charged with Social Security fraud. Social Security is cracking down on individuals who knowingly do not report work activity.

So, just how does Social Security know if an individual is working and how much they have earned? Social Security earnings records are provided through information reported to the Internal Revenue Service each year. If your social security number has reported earnings from employers, Social Security will access those earnings and your employers. Other times, Social Security becomes aware of an individual’s work activity through a tip from someone (generally Social Security finds individuals working for cash from individual reports). Often, individuals are reported by friends, family members, ex or estranged spouses, co-workers, supervisors, or even neighbors.

Social Security has to investigate each of these reports to ascertain if an individual is indeed working. Even if an individual is working on a cash basis, those earnings count for Social Security disability purposes. There are many ways that Social Security can find out about employment, so for anyone wondering about the possibility of shielding earnings from discovery, the truth is that it is really useless to think that they will not find out about work activity.

So what will happen when Social Security finds unreported work activity? There are times that Social Security finds work activity during a routine disability review or other times an individual’s work activity triggers a "work review".

What is a work review? Social Security work reviews involve Social Security contacting all of your employers for a monthly breakdown of your earnings. Once all employment information is received, Social Security will complete monthly totals for all months worked and determine which months you were not entitled to receive a benefit check.

For example, your monthly earnings determine when your trial work months--the nine months in any five year period that you can earn over the substantial gainful activity monthly amount without it affecting your disability--come to an end (The important thing to remember about trial work months is that they do not have to be consecutive, can occur anytime during a five year period, establish when your extended period of eligibility (EPE) begins and ends, and what your termination month will be).

As you can see, work activity "touches" a lot. And not reporting it can cause an overpayment (which for many claimants can become a truly awful situation). However, it can cause more than a simple overpayment; failing to report income can lead to benefit suspensions and terminations.

What happens if you receive money from social security that you were not actually entitled to receive and incur an overpayment? If you have an overpayment with Social Security, your benefits may be suspended until they collect all the money owed, or you may be allowed to make a payment arrangement with Social Security to pay back any money owed.

Reporting all work activity, by contrast, will prevent overpayments and will allow you to receive information that may prevent your disability benefits from being suspended or terminated.









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I Never Hear From my Disability Lawyer - Should I Get a New One?

Once you have completed your new client paperwork with your disability representative or disability lawyer, you may not hear from them again until a decision has been made on your disability claim. Of course, if your initial disability claim or reconsideration appeal is denied, your representative may contact you (typically to inquire about recent medical treatment) prior to filing your next disability appeal.

In many cases, however, if you hear from your disability lawyer or representative prior to a decision being made, it may be with regard to either an information request from Social Security, or a reminder that you need to attend a consultative exam that has been scheduled for you.

This is because Social Security disability examiners usually contact a claimant’s lawyer or representative when they are unable to reach the claimant through the normal lines of communication. Therefore, if you have a pending disability claim and you move or change your phone number, you should always notify Social Security and your disability lawyer. Disability examiners can actually deny your disability claim based upon your failure to cooperate if they are unable to obtain necessary information, schedule a consultative examination, or locate you.

If your disability claim is pending the scheduling of an administrative law judge hearing, it is likely that you will hear nothing from your disability lawyer or representative until you have a hearing date scheduled.

Many disability lawyers and non-attorney claimant's representatives do not make routine inquiries as to the status of a disability claim. But this is no reason to change your disability lawyer. If you are wondering about the status of your disability claim, call your local Social Security office or ask your representative's office to check the status of your claim.

Of course, if you have important information to give your disability lawyer, or have questions that need to be answered, or issues that need to be addressed, and you are repeatedly unable to get a response to attempts to contact your representative, you may wish to consider finding a new one.

However, if you do decide to change your representation, you need to keep in mind that you have signed a legally binding fee agreement with your current lawyer. As such your disability lawyer can demand payment for any expenses agreed upon in the fee agreement, so be mindful of what you agree to pay your representative.









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