Does Depression Qualify Me for SSDI?

Depression is one of the most common mental disorders affecting people in the United States. One recent study estimated that nearly 15 million Americans suffer from Major Depressive Disorder or clinical depression. That means that nearly 7% of Americans aged 18 and older are affected by depression during any given year. While most people can overcome the condition through therapy and/or medical treatment, many Americans are disabled by depression. In fact, according to the World Health Organization, depression is the leading cause of disability for Americans aged 15-44. So what can you do if depression had disabled you to the point that you are no longer able to work? For many, the answer is Social Security Disability benefits (SSD) – either Social Security Disability Insurance benefits (SSDI) or Supplemental Security Income (SSI). Social Security Disability benefits can provide a financial lifeline for those disabled by depression. However, not all people suffering from depression qualify for SSD benefits. In this post, I will review the criteria necessary to meet a medical listing for depression and, thus, qualify for SSDI benefits. It is important to note that you can still qualify for SSD benefits even if your depression does not meet the level of the medical listing. In that case you will have to demonstrate that your depression (and any other medical conditions) would prevent you from sustaining full time work – 8 hours a day, 5 days a week.

Medical Listing

As I mentioned in the post, a medical listing is a collection of medical criteria created by SSA. If your condition meets the criteria in the medical listing, you will meet the medical requirements necessary for receiving Social Security Disability benefits. In the case of depression, meeting a medical listing requires fulfilling two conditions. Lets look at these two requirements separately.

Condition 1: Does your condition meet the criteria for Depressive Syndrome?

When you apply for SSD benefits because of depression, the first step the SSA will take to determine if you meet the medical listing is to determine if your condition actually qualifies as a true Depressive Syndrome. After all, there is a big difference between just being depressed and having clinical Depression. The SSA provides very specific criteria to determine whether your condition qualifies. According to the SSA, a Depressive Syndrome is a medically documented condition (which is either constantly present or is intermittent) with at least four of the following characteristics:

Anhedonia: a persistent loss of interest in nearly all activities.
Loss of appetite with change in weight
Sleep disturbances: either lack of sleep or too much sleep
Psychomotor agitation or retardation:
Psychomotor agitation is characterized by repeated purposeless and unintentional activities that seem to stem from some sort of mental tension or disturbance. Examples of these include wringing hands repeatedly or pacing.
Psychomotor retardation is the noticeable slowdown of physical or mental activity also due to some mental disturbance.
Decreased energy
Feelings of guilt or worthlessness
Difficulty with concentration or thinking
Thoughts of suicide
Hallucination, delusions, or paranoid thinking: seeing visions, hearing voices, thinking that people are plotting against you, etc.
Condition 2: Does your condition cause severe functional limitations?

The second consideration is whether your condition is severe enough to limit you from working. You can satisfy this guideline in one of two ways:

1. Demonstrate that the condition is significantly limiting your ability to function by meeting two of the following criteria:

a. Marked restriction of activities of daily living: these are the activities that people do on a daily basis that allow them to independently live their lives. These activities include grooming and hygiene, using a telephone, cleaning your home, paying bills, and using public transportation. In evaluating your ability to perform activities of daily living, the SSA will also determine the extent to which you can perform them. In other words, the SSA will determine if you can perform these activities independently, appropriately, effectively, and for extended periods of time. Through this evaluation, the SSA will determine the extent to which your condition limits your ability to function on a daily basis.

b. Marked difficulties in maintaining social functioning: this describes your ability to interact effectively with other people. To determine this, the SSA will look for any history of altercations, evictions, termination of employment, avoidance of relationships and other signs that your condition prevents you from establishing and maintaining social interactions and relationships necessary for a functional role in both the workplace and society.

c. Marked difficulties in maintaining concentration, persistence, or pace: this describes the ability to maintain enough concentration to successfully complete tasks commonly performed in the workplace. Such limitations are usually demonstrated through psychological testing (mental status examination), prior work evaluations or both.

d. Repeated episodes of decompensation, each of extended duration: this describes periods of exacerbation in which your depression becomes so severe that you experience the marked functional limitations described above. These periods of decompensation are usually identified in the medical record as times when medications or treatments need to be significantly altered and/or documentation is present expressing the need for a more structured psychological support system (hospitalization, for example). The SSA defines the “repeated episodes of decompensation, each of extended duration” as three periods within 1 year (or an average of once every 4 months) , each lasting for at least 2 weeks.

OR

2. Demonstrate a medically documented history of depression that has lasted at least 2 years and caused more than a minimal limitation of ability to do basic work and that is currently controlled with medication or therapy but demonstrates 1 of the following:

a. Repeated episodes of decompensation, each of extended duration: see 1d, above.

b. The condition is so unstable that even a minimal increase in mental demand or a change in environment would predictably lead to a decompensation.

c. A history of 1 year or more in which the condition leads to an inability to function outside a “highly supportive living arrangement”: the condition only allows you to be functional in very select living environments such as a psychiatric hospital, halfway house, or a highly structured household.

The Importance of Documentation

In previous posts, I have mentioned the importance of documentation in submitting a claim for SSD benefits. While documentation is important for SSD claims for physical disabilities, it is even more vital for claims based on mental disabilities like depression. For physical disabilities, most documentation needs to come from the notes of a treating physician, imaging studies, and labs. For SSD claims based on mental disability due to conditions such as depression, however, the medical record is only part of the documentation necessary. While results of psychological testing and the impression of a medical professional are important, information from non-medical sources are also critical to a successful claim. For example, information from the claimant himself, family members, friends, and coworkers can substantially supplement the record and verify the findings of the medical record. Equally important is to present this evidence from various sources over as long a period of time as possible. Such longitudinal evidence will better establish the severity and extent of your functional impairment. Much of this information needs to be properly and effectively presented in the initial application. Many of my clients have come to me after being rejected for an SSD claim despite actually meeting a medical listing for depression solely because they did not include all the appropriate evidence in their applications. As I mentioned before, including all the appropriate evidence from the beginning can mean the difference between receiving SSD benefits and dealing with a frustrating rejection from the SSA. If you are not sure what to include in your application, seek the assistance of a knowledgeable, experienced attorney in your area.

Michelle Shvarts
www.disabilityadvocatesgroup.blogspot.com