Schizophrenia is a serious, psychotic mental disorder that may make it difficult to think logically, interact socially in a normal way, control behavior, and distinguish between reality and delusions/hallucinations. Schizophrenia is a “spectrum” disorder, meaning that the types and severity of symptoms may vary greatly between individuals, especially taking into account different responses to treatment. Although some people with schizophrenia respond well enough to medications to perform some type of work, there are many others who cannot.
While schizophrenia is a common psychotic disorder seen by Social Security, there are similar disorders involving different degrees of psychosis that may also quality for disability benefits, such as:
As with all mental impairments, Social Security is more interested in what functional limitations a disability applicant has, after trying medical treatment, than what specific psychotic diagnosis the applicant has been given.
A simple diagnosis of schizophrenia is not enough to get disability benefits; an individual suffering from schizophrenia must be able to prove that schizophrenic symptoms prevent him or her from working, despite taking anti-psychotic medication.
The disability criteria for schizophrenia are a reflection of the complexity of the medical condition itself. There are no biological tests that can be conducted to establish schizophrenia, but brain imaging shows distinctive changes and may soon be accurate enough to use. For now, diagnosis is still currently by mental status examination.
To help identify serious medical conditions, Social Security has a Listing of Impairments that list the criteria needed for each condition to qualify for disability. Schizophrenia is listed in the listing of impairments under heading 12.03, Schizophrenia spectrum and other psychotic disorders. This listing was updated significantly in early 2017.
In order to qualify for disability benefits based on schizophrenia, an individual must be able to demonstrate that he or she suffers from one of the following, on either a constant or intermittent basis:
Note that emotional isolation and withdrawal from social interaction is no longer part of the listing for schizophrenia or psychotic disorders.
Once a diagnosis of a psychotic disorder like schizophrenia is made by a psychologist or psychiatrist under the above criteria, Social Security then determines if the disorder qualifies under the listing by either of the two methods below.
In the first method, there must be an extreme limitation in at least one of the following areas, or a “marked” limitation in at least two of the following areas:
Note that Social Security defines “marked” as less than extreme, but worse than moderate. Marked and extreme are matters of professional judgment to be made by a Social Security psychiatrist or psychologist reviewing the medical evidence.
In the second method, the psychotic disorder must be medically documented as serious and persistent over a period of at least two years and the applicant must be receiving medical treatment and mental health therapy or be living in a highly structured setting that diminishes the symptoms and signs of the mental disorder. The person must also have minimal capacity to adapt to changes in their environment or to demands that are not already part of their daily life.
This second method recognizes that there are some people who don’t satisfy the listing because they live in highly protected and supervised situations that makes their functional abilities appear better than would be the case in real-life situations where the stress and demands on them would be greater.
Those who have schizophrenia or another psychotic disorder but are unable to meet the criteria of Social Security's listing may still be able to get SSDI/SSI benefits on the basis of a "medical-vocational allowance." There are applicants who suffer from schizophrenia who are not incoherent or completely disassociated from reality, but they still find themselves unable to hold down a job. While many people who are schizophrenic exhibit stereotypical symptoms such as hearing voices, thinking everyone is out to get them (paranoia), or catatonia, there are also those who are simply unable to make normal associations, participate in normal social interaction, and maintain an organized thought pattern.
The medical-vocational allowance allows those who suffer from a schizophrenic condition that doesn't meet the requirements of the listing to get benefits if they can prove that their impairment is severe and ongoing (expected to last for a period of not less than twelve months) and that it prevents the person from doing even unskilled work. It often takes a qualified disability attorney to make this argument, particularly when it comes to appearing before an administrative law judge (ALJ) at a disability hearing.
Although treatment responses vary, it is impossible for even the best treatment to restore a person with schizophrenia to complete normality. All people with this disorder should be considered to have at least some significant limitations regarding the ability to work, and so all applicants with schizophrenia have some chance for a medical-vocational allowance. However, Social Security does find some applicants with schizophrenia and other psychotic disorders to have the ability to do simple unskilled work.
At first glance, it might appear that the criteria for schizophrenia are so broad it would be easy to meet them, but this is not the case. Medical records are often specific as to an individual's symptoms and the resulting limitations, but they seldom describe exactly how a condition prevents one from working, a concept that is key to being awarded disability benefits. Even disability examiners and judges who are well schooled in the criteria that must be met to qualify for SSDI/SSI must refer to their manuals when it comes to conditions like schizophrenia—the definition is so broad as to be open to quite a bit of individual interpretation. Interpreting an applicant’s medical records in a way that will persuade a disability examiner or judge that one is unable to work can be difficult.
Although some schizophrenics get turned down after their initial disability application, the overall allowance rate is over 80% for individuals with schizophrenia. Those who are able to manage the process of appealing and wait for a hearing date are usually successful in getting disability benefits.
Disability applicants who have complex mental conditions like schizophrenia or other psychotic disorders should consider hiring an experienced disability attorney to represent them. Not only is schizophrenia a complicated disorder, but those who suffer from it are at a great disadvantage when they choose to represent themselves, particularly in light of the limitations this condition places on concentration, memory, and logical thinking. A disability lawyer can take over getting necessary medical records and doctors' opinions and can manage the hearing process for the applicant.