Social Security Disability Benefits for Schizophrenia

Schizophrenia refers to a group of common psychotic disorders (such as schizotypal, schizophreniform, and paranoid schizophrenia) that can cause delusions and hallucinations. People with schizophrenia may find it difficult to distinguish between reality and imagination, and can have "disorganized" thoughts that make it hard to concentrate or relate to other people.

Symptoms of schizophrenia typically start in late adolescence or young adulthood, with most diagnoses made in the late teens to early twenties for men and late twenties to early thirties for women. Schizophrenia is frequently diagnosed along with other mental health disorders, such as anxiety or depression (also, see our article on schizoaffective disorder, a related condition that involves depressed mood).

Is Schizophrenia a Disability?

With help from doctors and counselors, people with schizophrenia can live fulfilling, productive lives. Often, finding the right combination of medication and therapy can take time. In the meantime, if your schizophrenia symptoms have kept you from substantial work for at least one year, you might qualify for disability benefits.

Qualifying for Disability by Meeting or Equaling the Listing for Schizophrenia

The Social Security Administration (SSA) maintains a Listing of Impairments for certain disorders that the agency considers to be especially serious. When disability attorneys and SSA claims examiners talk about "meeting or equaling a listed impairment," they mean that your medical records contain evidence that the SSA can use to find you disabled without having to determine that you can't work.

Listing requirements. Schizophrenia is a listed impairment. If you meet or equal the requirements of listing 12.03, the SSA will find you "medically disabled" and you'll be awarded benefits. Establishing medical disability isn't easy, though. First, your records will have to show evidence of at least one of the following:

• delusions or hallucinations
• disorganized (illogical or incoherent) thoughts and speech, or
• grossly disorganized behavior or catatonia (moving abnormally fast or slow).

To find this evidence, Social Security will look at your doctor's treatment notes to see what medications you take, how you feel and act (for example, if you're crying or angry) during doctor's appointments or counseling sessions, and the results of your mental status examinations.

Listing limitations. If Social Security finds the evidence it needs in your record, the agency will then look to see how much symptoms from schizophrenia limit your mental abilities. Simply having a diagnosis isn't enough—you'll need to show that your 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 (learning new things, applying new knowledge to tasks, following instructions)
• interacting with others in socially appropriate ways
• being able to focus on tasks to complete them at a reasonable pace, and
• adapting or managing oneself (regulating emotions, handling changes, having practical personal skills like paying bills, shopping, hygiene).

Proving these limitations can be tricky because terms like "extreme" and "marked" are subjective and not very 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 to write a medical source statement. The agency values the opinions of medical professionals who can shed light on your condition, and a favorable statement can help your case.

Limitations that are in remission. Most applicants who are found medically disabled because of schizophrenia do have evidence of marked or extreme limitations in the above areas. But Social Security can find that you're medically disabled without those limitations if you can show that you're only able to function as well as you do because you have a lot of help. The agency will look for evidence of a support group that you can't get by without, such as social workers, group homes, or family members who make sure that you're taking care of yourself.

Qualifying for Disability by Showing That You Can't Work Full-Time

Your medical records might not contain the right evidence for Social Security to find you disabled under the listing for schizophrenia. But you can still qualify for disability benefits if you can show that your symptoms prevent you from working any job on a consistent basis.

To figure out whether you can work any jobs, the SSA will want to know all the ways that symptoms from your schizophrenia interfere with your activities of daily living (ADLs). The agency asks about your ADLs because it makes sense that something you have trouble doing at home would be something you'd struggle with at work.

For example, if you're too distracted from auditory hallucinations ("hearing voices") at home that you neglect basic chores like washing the dishes, you might have a hard time following even simple instructions from an employer. Or, if you have trouble communicating your thoughts to others, you probably won't do well in a job where you'd have to deal with other employees or the public.

Social Security will review your medical record and your ADLs to determine the most you're capable of doing mentally in a work setting, a process the agency calls assessing your residual functional capacity (RFC). For people with schizophrenia, a typical RFC will include limitations on working with other people, handling stress, and how long you can concentrate. If the SSA finds that no jobs exist that you can do with your limitations, the agency will award you benefits.

Continuing Disability Reviews and Closed Periods of Disability

Because schizophrenia typically responds well to treatment with antipsychotics (such as Haldol or risperidone), and because the onset is usually in early adulthood, many people with disorders on the schizophrenia spectrum are able to return to work eventually.

If you're awarded benefits for schizophrenia, Social Security will likely schedule you for frequent continuing disability reviews (CDRs). The agency sends out CDR forms about every three years to help determine if your condition has improved enough that you could return to work.

Some people who have already improved to the point where they've started working again since they applied for disability might qualify for a closed period of disability.

Applying for SSI with Schizophrenia or a Related Psychotic Disorder as a Child

Most young people aren't diagnosed with schizophrenia or related disorders until their late teens or early twenties, so Social Security doesn't evaluate too many applicants under the childhood listings for psychotic disorders. But your child may be able to get benefits for schizophrenia if they have a diagnosis from a licensed psychiatrist and very serious limitations in their daily functioning. (If you're unable to afford medical care, you can ask the SSA to send your child to a psychologist for a consultative examination.)

The most straightforward way for your child to receive disability benefits is by meeting the limitations described under listing 112.03, for schizophrenia spectrum and other psychotic disorders.

Your child can meet the listing if their medical records show that they have:

• delusional thoughts or hallucinations
• incoherent speech, random thoughts, or statements that don't make sense
• "grossly disorganized behavior" such as a decline in functioning or odd behavior, or
• a catatonic state (unaware or dazed level of consciousness).

The child also must have serious limitations in some of the following abilities:

• thinking or remembering
• social relationships and communication
• self-care and adjusting to changes, or
• concentrating and staying on task.

Here are some examples—based on actual Social Security cases—showing what evidence the agency needs in order to find a child disabled due to a psychotic disorder such as schizophrenia.

Social Security analyzes each child's disability application on a case-by-case basis. You can help by making sure your child's medical records and school records support your claim that your child's limitations are very serious.

Getting Help With Your Claim for Disability

Applying for disability benefits can be a frustrating and lengthy process. If you'd like help with your application, consider working with an experienced disability attorney. Your attorney can develop your medical records, handle communications with Social Security, and represent you at a disability hearing.