Post-traumatic stress disorder (PTSD) happens after seeing or going through a traumatic event involving injury, violence, or death, such as an accident, rape, abuse, killing, natural disaster (like a fire, earthquake, or hurricane), or even experiencing a heart attack. PTSD causes recurrent flashback episodes and nightmares that can disrupt day-to-day activity. Some cases of PTSD include extreme fear of the event recurring, hyper-vigilance, anger or irritability, and a tendency to be easily startled.
Diagnosis of PTSD is made by psychiatrists or psychologists based on mental status examinations and a patient’s history. While brain imaging and biochemical abnormalities have been observed in some studies, these findings are not reliable or specific enough for diagnosis.
Treatment for post-traumatic stress disorder can involve counseling, cognitive-behavioral therapy, psychotherapy, antidepressant drugs, antipsychotic medications, or a combination of one or more of these treatments. Also, sometimes eye movement desensitization and reprocessing (EMDR) may help to reduce the effect of traumatic events.
Disability claims for PTSD, or post-traumatic stress disorder, can be approved by disability claims examiners in two separate ways. The first route for approval is for individuals whose medical records satisfy the requirements of Social Security's new disability listing on trauma- and stressor-related disorders, added in 2017. The second means of approval is to get a "medical-vocational allowance." This may sound like it's an exception, but it's actually the manner in which the great majority of SSDI and SSI disability claims are approved.
The new disability listing for trauma- and stressor-related disorders, listing 12.15, first requires medical documentation of all five of the following:
Once a diagnosis of PTSD is made by a psychologist or psychiatrist under the above criteria, Social Security then determines if the applicant has the required level of functional limitations due to post-traumatic stress. An applicant must have either an extreme limitation in one of the following areas or a “marked” (severe) limitation in two of the following areas:
Some applicants won’t be experiencing the functional limitations above at the level necessary to satisfy the listing because they live in highly protected and supervised situations or they are undergoing intense therapy 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. In other words, their condition is marginal. In these cases, there must be documentation that the applicant’s PTSD has been serious and persistent over a period of at least two years and that the applicant has minimal capacity to adapt to changes or the demands of work.
Most cases of PTSD are not severe enough for a sufficiently long period of time to qualify under the listing, but some can qualify for a medical-vocational allowance. To be considered for a medical-vocational allowance, a mental consultant for Social Security must determine that an applicant’s symptoms are severe enough to prevent work even though the applicant’s condition doesn’t meet the listing for PTSD. For instance, individuals with PTSD often have trouble concentrating, memory problems, and fatigue from poor sleep patterns, all of which can interfere with the individual's ability to work and maintain a job. Applicants whose PTSD occurs alongside other mental disorders or physical problems will have a better chance of getting benefits. Multiple problems taken together can increase the chance of getting benefits, especially if an applicant is 55 or older, has little education, or no past history of skilled employment. For more information on how Social Security decides when symptoms are severe enough to prevent work, see our article on getting a medical-vocational allowance for a mental illness.
What is in your medical records means everything to the processing of a SSDI or SSI disability claim. Your medical records should contain at least one detailed description of a typical episode of PTSD, including the frequency and duration of any panic attacks and what brings on worsening symptoms. Your doctor should also include whether your description of your symptoms matches his opinion of your mental state. Most importantly, your medical records should include how your PTSD symptoms affect your ability to function, both at home and at work.