Review Your Disability File Before Appealing a Mental Disability Claim

If you applied for Social Security disability due to mental or emotional impairments, here's what to look for when you review your file.

If you applied for disability based in whole or part on a mental, psychological, emotional, or psychiatric problem, and were denied, you should review your disability file before you file an appeal. You'll want to read Social Security's forms to try to figure out if the DDS medical consultant or claims examiner assigned to your case made any errors.

First, read our article on reviewing your disability file before your appeal to find out how to get your file and how to review the main part of it. In addition to reviewing the Disability Determination Rationale, as discussed in that article, if you were denied benefits for a mental disability claim, there are two other forms you'll want to review carefully: the mental RFC and the PRTF.

Mental RFC

Your mental RFC ("residual functional capacity") is an assessment of the mental abilities you have available to you despite your mental, emotional, or psychological impairments. Ask the following questions as you review your mental RFC.

  • Did the medical consultant (MC) ignore symptoms and limitations for the type of mental disorder you have?
  • Did the MC attribute to you mental abilities you do not have—such as the ability to complete tasks in a timely manner?
  • Did the MC agree with your treating doctor’s evaluation? If not, the MC must provide an explanation on the RFC form explaining why your doctor’s recommendations were not used.

You can attempt to suss out problems with the mental RFC in this way, but the above analysis depends on knowing a good deal about how Social Security is required to evaluate mental impairments. If you notice anything suspect, you may want to consider contacting a disability lawyer to help you prepare your appeal.

Form SSA-2506-BK: Psychiatric Review Technique Form (PRTF)

If you have a mental condition of any severity, this PRTF form should be in your file. It is supposed to assure that the DDS psychiatrist or psychologist who gives an opinion on whether you are disabled considers all of the important information about your mental impairment.

Read this form carefully (or have someone read it for you) to see if the MC considered all of the pertinent information in your file.

About the PRTF

The PRTF contains the following:

• Dates covered by the assessment, the MC’s signature, and the date signed.

• Section I should contain a medical summary.

• Section II should include the MC’s record of pertinent signs, symptoms, findings, functional limitations, and effects of treatment that have a significant bearing on your case. This section should also include the MC’s reasoning about why you received a particular medical determination.

• Section III should include the MC’s record of signs, symptoms, and findings that show the presence of the categories of mental disorders in the Listing of Impairments.

• Section IV should include the MC’s rating of your functional limitations, which are relevant to your ability to work.

What to Look For

Look for errors on the PRTF such as:

  • incorrect dates
  • incorrect diagnosis of your mental condition, and
  • statements that contradict those of your treating psychiatrist or psychologist.

Also, did the MC state that you have had no episodes of worsening in your mental condition affecting your ability to work when in fact you did—for example, did you have to leave work or were you unable to work for certain periods of time because of worsening symptoms?

Who Made the Medical Determination?

It is important for you to establish that a medical consultant (and not just a claims examiner) reviewed your file and made the medical determination about what you can and cannot do. Here’s how to do that:

MC's review notes. Look for the medical consultant's review notes. An MC’s medical notes demonstrate his or her thinking, interpretation of test results, recommendations on medical development, and statements about medical severity. Does your file lack MC notes completely? If your file lacks MC notes showing that an MC came to the conclusion that you should be denied benefits, the fact that an MC signed the disability determination form is no assurance that the MC performed a review of your file. In such a situation, be highly suspicious: your denial may have been made by the DDS examiner, not the MC. It is your right to have your file reviewed by an MC.

RFC form. Look at the signature on the RFC form. Note the name of the MC who signed the form. Is the handwriting the same as on the other parts of the form—that is, did the doctor actually complete the form? If not, the MC may have simply signed an RFC completed by the examiner. Again, legally, you have the right to have a medical determination by an MC. An MC’s signature is supposed to assure that your file was medically reviewed, but in reality, this is not always the case. If there is any question that a medical consultant looked at your file, you can insist that an MC review your claim by contacting the DDS director or asking a disability lawyer for help.

For more guidance on preparing your argument for appeal, see Nolo's Guide to Social Security Disability: Getting and Keeping Your Benefits, by David Morton, M.D. You may also find that you need help reviewing your disaiblity file; it's difficult to decipher these forms and spot issues or errors in them. This is something a disability lawyer can help you with. For more information, read our article on how a disability lawyer can help you win a claim for mental illness.

By: David A. Morton III, M.D., former chief medical consultant for Social Security

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