The Social Security Administration (SSA) recognizes that living with pain from a physical illness can affect your mental health in ways that contribute to your inability to work. Chronic pain from physical conditions such as arthritis, chronic fatigue syndrome, or renal (kidney) disorders can make people irritable, withdrawn, and moody. Having a mental illness can even lower your pain tolerance, reinforcing the important connection between chronic pain and mental disorders.
Many aspects of living with a physical illness can cause an increased risk in mental illnesses such as depression, anxiety, or dysthymia. For example, people with arthritis often deal with ongoing, daily pain. Their pain can prevent them from enjoying fulfilling hobbies, engaging in full-time work, and even being self-sufficient at home.
The loss of autonomy can be very difficult to deal with, resulting in symptoms of mental disorders such as feeling hopeless, worrying constantly, or foggy thinking. These symptoms can vary in intensity, but Social Security is required to consider how even mild or moderate symptoms of mental disorders interact with your physical condition to prevent you from working. Your physical condition or mental disorders alone might not be enough for the SSA to find you disabled, but, when taken together, they can add up to a finding of disability.
Even when the main reason you're applying for disability benefits is because of a physical impairment, if you're receiving treatment for mental illness, you need to let the SSA know. Give the agency the names and dates of any mental health professionals you've seen, as well as the names of any medications you're taking for mental disorders.
If you aren't receiving treatment yet for your symptoms, try to seek help from a psychologist, psychiatrist, counselor, or therapist as soon as you can. Lots of people struggling with chronic pain have been taught to just deal with moderate symptoms of mental illness, and are reluctant to seek needed treatment.
When you visit your doctor or therapist, be sure to describe any feelings of sadness, anger, confusion, or frustration you feel. If you're feeling embarrassed about how limited your daily activities have become, especially if you were previously very physically active, take heart—many people in your situation feel the same way.
Resist the temptation to minimize your symptoms to your doctors. The doctor will add to your medical record only what you share, and if your record doesn't contain symptoms of mental disorders, the SSA could think that your chronic physical conditions don't have much of an impact on your mental health. Depending on what the rest of your record says, the SSA might then find that you can work.
The SSA will ask you to describe how your impairments affect your daily life on an Activities of Daily Living (ADL) questionnaire. Many disability applicants don't take the time to complete this important form in detail, but it's the best way for you to let the SSA know what you can and can't do on a regular basis.
The ADL form gives you the opportunity to explain in depth how your mental illness affects the way you live. If your sleep cycle is irregular, if you have trouble completing basic chores like cleaning, or if you frequently lose your train of thought, be sure to mention these limitations in the questionnaire.
Social Security doesn't expect you to do a job that's beyond your capabilities, physically and mentally. The agency will look at your medical records and your activities of daily living to determine your residual functional capacity (RFC). Your RFC is what the SSA thinks is the most you're able to do after they take your physical and mental limitations into account.
A typical RFC will include physical ("exertional") limitations on:
Your RFC will also include mental ("non-exertional") limitations, such as:
The SSA will consult the Dictionary of Occupational Titles, which classifies jobs according to how demanding they are, physically and mentally. The SSA will look at the exertional and non-exertional duties of your past work, compare this with your RFC, and determine whether you can still do the work. If you can't, the agency will do one of two things, depending on your age.
Having even moderate mental limitations in your RFC along with your physical limitations can make it much easier for Social Security to find you disabled, especially if you're older than 50.
If you gained work-related knowledge at your past job that you can bring with you to a different job, the SSA will find that you have acquired transferable skills. Examples of transferable skills include:
Having a moderate mental illness that impairs your concentration even slightly can prevent you from using any transferable skills you have acquired, or prevent you from learning skills at another job.
In the above instance, Social Security would likely find that Irving is disabled under the medical-vocational grid rules, a special set of circumstances where the SSA can find applicants over 50 disabled, even when they can do other work. While Irving was able to perform a less physically demanding job, his mental illness prevented him from picking up the new skills he needed to do the job. When that happens, the SSA will conclude that no employer would hire Irving to perform full-time work.
Even the easiest, least stressful jobs require that you be able to show up to work and complete the job tasks on time. If your moderate mental illness interferes with your concentration, persistence, and pace to a degree that employers won't tolerate, the SSA will find that you're disabled.
In this case, the SSA can find Casey disabled because she is unable to perform the demands of unskilled sedentary work, which is the Social Security term for the jobs that take the least toll on your body and your mind. For applicants under 50, showing that you can't do those jobs is the most common way the SSA will find you disabled.
Social Security values the opinions of medical professionals who've seen your ups and downs over time, and who can shed light on how your mental limitations interact with your physical conditions (and vice versa). If you have doctors or counselors whom you've seen consistently for a long time—say, over a year—it can be very helpful to your disability claim to ask one or more of them to submit a medical source statement (MSS) to the SSA.
The best medical source statements are ones written by providers who treat you in their area of expertise and that point to the diagnostic criteria they used to arrive at their opinion. Ask your doctors to refer to examples from your progress notes when writing their statements. Make sure that their opinions are about your limitations, such as how long you can concentrate for or how much weight you can lift, and not simply a statement that you are disabled.
If your doctors agree to write a medical source statement, it's important to make sure that they address only the medical conditions in their areas of practice. For example, if your psychologist writes an MSS stating that you can lift only five pounds, the SSA isn't going to take that as seriously as an MSS saying the same thing but written by your orthopedic doctor. Likewise, your neurologist isn't usually the best person to write an MSS about your mental health limitations.
Proving a claim for disability due to moderate mental illness along with physical disorders can be challenging if you're doing it on your own. Consider contacting an experienced disability attorney to help you with your application. Your attorney can help with obtaining your medical documents, getting favorable statements from your doctors, and advocating for you at a disability hearing.
Updated May 25, 2022