Getting Disability Benefits for Bipolar Disorder

Bipolar disorder—sometimes referred to as manic depression—is a mental illness that causes extreme ups and downs in a person's mood, energy, and ability to function. Bipolar disorder is usually further classified into several subtypes, like bipolar I and bipolar II, but all are characterized by alternating episodes of mania (a state of elevated mood and hyperactivity) and depression (overwhelming sadness and fatigue).

Some people cycle rapidly between manic and depressive episodes, while others have episodes that last for weeks or months. The intensity of the episodes can vary as well. With bipolar I, the manic episodes are "full-blown" and last at least a week, with depressive episodes lasting two weeks. For bipolar II, symptoms of mania are milder (hypomania). In cyclothymia, both the depressive and manic symptoms are milder.

Is Bipolar a Disability?

The Social Security Administration (SSA) recognizes that symptoms from mental disorders like bipolar can significantly interfere with your daily routine and prevent you from working. If symptoms from your bipolar disorder are severe enough—even with proper medication—you could qualify for disability benefits for bipolar disorder.

The SSA can find you disabled in one of two ways:

• You meet the specific requirements for bipolar disorder that the SSA has identified in its impairment listing on mood disorders ("medically disabled"), or
• You can't function at a high enough and consistent enough level to hold a basic, unskilled job.

How Do You Qualify for Disability Benefits Based on the Bipolar Listing?

To qualify under the SSA's official listing for bipolar disorder, you must have a diagnosis of bipolar disorder and your medical records must show that you have at least three of the following symptoms:

• unnaturally fast, frenzied speech ("pressured speech")
• quickly changing ideas and thought patterns ("flight of ideas")
• inflated self-esteem (usually with false beliefs)
• decreased need for sleep
• distractibility
• involvement in risky activities with painful consequences that you don't recognize, and/or
• increase in physical agitation (such as pacing or restless busyness) or in "goal-directed activity" (such as taking on new projects).

You must also meet Social Security's "functional" criteria to show that you have a loss of abilities due to these symptoms. Just having a diagnosis isn't enough for the SSA to find you disabled—you'll need to show that your bipolar disorder causes an "extreme" (debilitating) limitation in one, or a "marked" (intense, but not debilitating) limitation in two, of the following areas:

• understanding, remembering, or using information (ability to understand instructions, learn new things, and apply new knowledge to tasks)
• interacting with others (ability to use socially appropriate behaviors)
• concentrating and maintaining pace in performing tasks (ability to complete tasks), and/or
• adapting or managing oneself (ability to control behavior, adapt to new situations, and have practical personal skills like paying bills, cooking, dressing).

Proving these limitations can be tricky because terms like "marked" and "extreme" are subjective and not well defined. To help the SSA understand how you meet these criteria, it's a good idea to ask your treating psychiatrist, psychologist, counselor, or therapist for a medical source statement. Having multiple providers who can provide evidence that your limitations are medically disabling strengthens your claim.

Most applicants whom Social Security finds medically disabled because of bipolar disorder do have evidence of marked or extreme limitations. But the SSA can find you medically disabled without those limitations if you can show that you're only able to function as well as you do because you get a lot of help. If you can't function without a support system, such as social workers, group homes, or family members who make sure that you're taking care of yourself, the SSA will take this into consideration.

How Do You Qualify for Disability Based on Reduced Functional Capacity?

Even if your bipolar symptoms don't cause marked or extreme functional limitations, they can still prevent you from working. If your medical records have the right evidence, Social Security can still find you disabled "vocationally" even when the agency doesn't think you're disabled under the medical listing for bipolar disorder.

To figure out whether you can work any jobs full-time, Social Security must consider to what extent your bipolar symptoms interfere with your ability to do certain work activities, like following directions and remembering details.

The SSA will review your medical records, your ADL questionnaire, and any medical source statements from your doctors to come up with your mental residual functional capacity (RFC). Your RFC is the SSA's assessment of what you can still do despite your mental limitations (and exertional limitations, if you have physical impairments as well).

A typical mental RFC will include the type of jobs Social Security thinks you can do (skilled, semi-skilled, or unskilled) as well as any restrictions you have in dealing with other people and handling stress.

If you're under the age of 50, the SSA will need to see that you can't do low-stress, unskilled work with little public contact—such as cleaning eyeglasses—before it can find you disabled vocationally. (For information on how the SSA evaluates claims when applicants are over 50, see our article on the medical-vocational grid rules).

Even the least demanding jobs still require employees to show up to work regularly and complete the job duties on time. But if you're too distracted during a manic episode to do simple tasks in a timely manner, or you're calling in sick for a lengthy depressive episode, it's unlikely that you'd hold even the easiest jobs for long. In your RFC, the SSA refers to this reduction in productivity as "off-task" behavior. If you spend more time off-task than employers will tolerate, Social Security can find you disabled.

What Medical Evidence Do You Need for Disability Based on Bipolar?

When you begin your disability application, the SSA will ask you to list the names, locations, and dates you've visited any doctors, hospitals, or mental health professionals. With your permission, the SSA will request medical records from the doctor and clinics where you've received treatment. Your psychiatric record should include:

• your medication history, including any mood-stabilizers, antipsychotics, and antidepressants that you've tried, such as lithium, Seroquel, or Zoloft
• your doctor's or counselor's observations about how you're feeling and acting during a visit
• mental status examinations showing any abnormalities in your thinking
• any hospitalizations for symptoms of bipolar disorder, and
• other treatments you may have tried, such as electroconvulsive therapy (ECT).

Because people respond differently to the medications used to treat bipolar disorder, your medical records should also include notes about whether your medications are effective at treating your symptoms, along with any side effects you might have. For example, one of the most common side effects of Depakote, a mood-stabilizer, is drowsiness. If you're taking Depakote successfully to manage your mood, but it's causing you to nap frequently, Social Security is required to take that into consideration when determining if you're disabled.

What to Do If Your Records Show Drug or Alcohol Abuse

Many people with bipolar disorder have struggled, or continue to struggle with, drug or alcohol abuse (DAA). During manic states, people with bipolar disorder are more inclined to engage in risky behavior, such as abusing drugs or alcohol.

If your medical file shows evidence of DAA, Social Security won't go straight to a denial. Instead, the agency will need to determine whether the DAA is "material" to the question of whether you're disabled. Basically, the agency needs to see that the limitations from your bipolar would still exist even if drugs or alcohol weren't in the picture.

The signs and symptoms of bipolar disorder can mimic or overlap those of DAA, so it's important to establish a period of sobriety or abstinence while you're receiving medical treatment. Having a period where you're not using drugs or alcohol gives Social Security an idea of your mental health "baseline" without interference from the effects of DAA.

Starting a Disability Claim for Bipolar Disorder

There are several easy ways you can begin your disability application:

• Go online at https://www.ssa.gov/applyfordisability/.
• Call 800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. If you're deaf or hard of hearing, you can call the TTY number at 800-325-0778.
• Go in person to your local Social Security field office. You can find your nearest SSA office here.

Applying for disability benefits is a time-consuming process, and can be intimidating if you're doing it without any help. Consider getting an experienced disability lawyer or advocate on your side. A lawyer or advocate will be able to sort through your medical records, strengthen any weaknesses in your application, and handle communications with Social Security.

_{Updated November 17, 2022}