People living with chronic physical conditions frequently suffer from depression or anxiety in addition to their physical impairment. Ongoing illnesses, particularly those that cause pain, affect brain chemistry and sleep and cause mood fluctuations, all of which can lead to varying degrees of depression and anxiety. Even if your depression or anxiety is not severe enough to win claim for disability on its own, it can, when considered along with a severe physical impairment, play an important role in winning your claim for disability.
Telling Social Security About Your Anxiety and Depression
First, you need to tell the Social Security Administration (SSA) if you are receiving treatment for any mental illness, including anxiety and depression, even if your symptoms are moderate. This is because the SSA has to consider how your psychological symptoms affect your ability to work when combined with your physical impairment. If you are not receiving treatment but feel as though you may be anxious or depressed, seek help from a mental health professional as soon as you can.
It is also important that you provide the SSA with a complete list of the medications you take for your depression or anxiety. You must also tell the SSA who prescribed the medication, the dosages, and whether or not you experience any side effects. Keep in mind that it is more helpful to your claim if you are treated for your anxiety or depression by a mental health professional than by your family doctor. If you see a therapist, social worker, psychiatrist or psychologist, their names and contact information to the SSA as well.
The SSA will also ask you to describe how your impairments affect your daily life on an Activities of Daily Living (ADL) questionnaire. Many disability applicants do not take the time to complete the ADL in detail. However, this information is used throughout the disability process and is frequently referred to by the judge in a disability hearing. Therefore, you should explain in detail how your anxiety and depression affect the way you live -- in particular, whether you have trouble sleeping, difficulty staying motivated, or trouble with concentration.
If you didn't include any of this information regarding your depression or anxiety in your original application and questionnaire -- and you were denied benefits -- be sure to submit new reports and medical records documenting your symptoms to the hearing office before your hearing.
Anxiety and Depression Can Cause Non-Exertional Limitations
If you apply for disability for a physical condition that limits your strength or ability to walk, the SSA will decide what level of work you can do, as in heavy, medium, light, or sedentary work. If you have a moderate physical disability that limits your ability to lift heavy items, you might be restricted to medium or light work, but that's no guarantee of disabilty benefits.
But when considering whether you are actually able to work, the SSA must also evaluate any non-exertional impairments you have. Non-exertional impairments are those that relate to non-strength related work activities such as the ability to focus, concentrate, get along with others, and be reliable. Many people with moderate anxiety and depression experience these kinds of non-exertional impairments. For more information, see our article on how non-exertional impairments can help you win your claim.
Just because your mental health issues aren't considered severe doesn't mean that they can't affect your ability to do a wide range of jobs. Having non-severe mental health issues other than anxiety or depression can also increase the chances of winning a disability claim, when added to a physical impairment. For more information, see our article on when combining severe and non-severe impairments leads to disability benefits.
Proving You Can't Do Work With “Unique Features”
Some disability applicants have done past work that includes “unique features.” Even a non-severe impairment can sometimes affect an individual's ability to do a job with certain unique features. For example, jobs that require intense focus and concentration, such as heavy machinery operator positions, can be significantly affected by even moderate depression or anxiety. If you think your depression or anxiety interferes with key requirements of your job, you should hire a disability attorney to help you prove this.
For information on how you can prove that your depression and/or anxiety prevents you from doing a job with unique features, see our article on proving you can't do work due to a non-severe impairment.
Showing Reduced Productivity Due to Moderate Depression
Another way to win your claim for disability is to prove that your moderate depression or anxiety, when combined with your severe physical impairment, will result in a 20% reduction in your productivity in the workplace. (For more information, see our article on getting disability due to reduced productivity.)
You or your attorney can present this argument at the hearing level by discussing the combined side effects of your medications. For example, most anxiety and depression medications can cause fatigue, insomnia, headaches, or restlessness. Pain medication can likewise cause difficulty in thinking and concentration, along with excessive sleepiness. During your hearing, your attorney and the administrative law judge (ALJ) will ask you questions to determine the extent of how the medications affect you. Examples of these questions are:
- Do you watch television? If so, can you watch an entire one-hour show?
- Do you like to read? If so, do you read magazines or books?
- How many hours do you sleep at night?
- Do you sleep during the day?
- What time do you go to bed during the day? What time do you wake up?
- Are you able to drive when you take your medications?
- Have you tried any other medications?
- Do you pay your bills or does someone help you?
In addition to your testimony about the side effects, you must provide the SSA with objective medical evidence to support your statements. Therefore, be sure to inform your medical provider of any side effects you experience and make sure they are documented in your file. Also, it is helpful if your record demonstrates that you tried other medications in an attempt to alleviate the side effects.
The Effects of Depression and Anxiety on Pain Tolerance
Studies show that people who suffer from even moderate depression and anxiety have a decreased pain threshold. Anxiety and depression themselves can also be the source of physical pain. This is especially important for people whose primary impairment results in significant pain. Some examples of these impairments are:
- back and spinal disorders
- irritable bowel syndrome
- chronic fatigue
- renal disease
- certain neurological disorders, and
- somatoform disorders (a psychiatric disorder where pain or other symptoms cannot be explained by a medical disorder).
If constant or recurring pain hampers your ability to concentrate on tasks, remember facts and instructions, and get along with others, Social Security must consider this in determining whether there is work you can do. (For more information, see our article on how Social Security evaluates chronic pain.) A disability attorney can help prove that, because of your combined impairments -- your painful physical impairment together with depression or anxiety -- you experience more pain and are more limited than someone with the physical impairment alone.
Getting Your Doctor's Support
Make sure that you have your treating physician prepare a mental residual functional capacity (RFC) form on your behalf. A mental RFC is a detailed report that discusses how your anxiety and depression affect your pain thresholds and your ability to do certain job functions. Your attorney will use the mental RFC to create hypothetical questions designed to counter the VE's testimony.
Although any doctor can prepare a mental RFC for you, the SSA will give more weight to a doctor who specializes in treating mental illness. Therefore, you should make sure to seek the help of a psychiatrist or psychologist in the treatment of your anxiety or depression.
Getting a Lawyer's Help
It is rare for an unrepresented disability applicant to be able to employ the above strategies without the help of an attorney with a good deal of experience in representing clients at disability hearings. If your hearing date is approaching, consider contacting a disability lawyer about your claim, and of course, mention the fact that you also have moderate depression and/or anxiety in addition to your physical impairment.