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Depression: Meeting Social Security’s Benefits Requirements

Depression is one of the most common disabilities effecting Claimants in 2017. Anxiety and depression effect 15 million Americans over the age of 18 according to the Anxiety and Depression Association of America. This account for almost seven percent of the adult population. Often depression is a co-morbid disability that pairs itself with bipolar disorder or schizophrenia. In those circumstances, a Claimant and their attorney will be trying to meet the more severe listing. But what should we do when Depression is the only diagnosis?

When diagnosed alone, depression can be a very difficult disability to prove when trying to get Social Security Disability Insurance Benefits (SSDI). However, with the right psychiatric medical treatment, and cooperation from your doctor, it is possible to obtain benefits.

Depression is categorized under Social Security Disability Listing 12.04. The Social Security Administration defines depression as, “a disturbance in mood, accompanied by a full or partial manic or depressive syndrome.” Mood refers to a prolonged emotion that colors the whole psychic life, generally involving depression or elation. As with most disabilities, the Social Security Administration has instituted a very high bar for the Claimant to meet when it comes to the severity necessary to gain a favorable decision. Symptoms are broken down into categories A, B and C.

To win, the Claimant must meet A and B together, or C separately.

A. Medically Documented Persistence of one of the following:

  1. Depressive syndrome characterized by at least four of the following:
    -Pervasive loss of interest in almost all activities, appetite disturbance with change of weight, sleep disturbance, impairment of motor function, decreased energy, feelings of guilt and worthlessness, difficulty concentrating and/or thinking, suicidal thoughts, hallucinations, delusions, extreme paranoia.
  2. Manic Syndrome characterized by at least three of the following:
    -Hyperactivity, inflated self-esteem, decreased need for sleep, easy distractibility, involvement of activities that have a high probability of painful consequences without the knowledge of these consequences, flight of ideas, pressure of speech.
  3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive symptoms.

B. Two of the following:
-marked restriction of activities of daily living, marked difficulties in maintaining social functioning, marked difficulties in maintaining concentration, persistence and pace or repeated episodes of decompensation of extended duration.

C. Medically documented history of a chronic affective disorder of at least two years duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support and one of the following: Repeated episodes of decompensation of extended duration OR a residual disease process that has resulted in such a marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to compensate OR Current history of one or more years inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.

We’ll want to talk about the various symptoms we’ve mentioned above. However, now is a good time to make the most important point of all if you are a Claimant trying to obtain Social Security Disability (SSDI) benefits based on depression. And that point is this…you must have medical documentation to support what you will be telling the Judge. You can tell the Judge you have ALL of the above symptoms but if you do not have consistent documentation from specialists confirming these diagnoses, it will fall on deaf ears. These medical specialists should ideally include psychiatrists, psychologists, neurologists and even social workers. It should be noted that a social worker’s opinion will be given significantly less weight with the Administrative Law Judge.

The symptoms listed in Part A, detailed above, should be relatively easy for a Claimant to meet if they are truly clinically depressed. These are the classic signs of even moderate depression, including the lack of appetite, difficulty sleeping, decreased energy and difficulty concentrating and thinking. It’s the requirement that the “B” symptoms be met along with the “A” symptoms that makes this listing so difficult to meet.

The “B” symptoms required a “marked” restriction of daily activities, social functioning or concentration and persistence or repeated episodes of decompensation. Let’s define a couple of these terms. “Marked” is a term used often by the Social Security Administration. It is considered the second-highest level of psychiatric dysfunction behind only “extreme”. A “marked” impairment is one when your impairment(s) interferes seriously with your ability to independently initiate, sustain, or complete activities. Your day-to-day functioning may be seriously limited when your impairment(s) limits only one activity or when the interactive and cumulative effects of your impairment(s) limit several activities.

The other term we need to define is decompensation. An episode of decompensation requires documentation showing that the SSDI Claimant’s symptoms worsened over a period of time, that the Claimant was unable to adapt or respond adequately to the stress of normal changes and that the Claimant was severely limited during the episode and was therefore unable to perform normal activities of daily living like completing tasks or remaining social and/or communicative with others.

These episodes of documentation must be accurately represented in your health professional’s records. This is one of the biggest difficulties for those suffering from depression when trying to get Social Security Disability benefits. Depression is, by its nature, an affliction that discourages those suffering from it from seeking medical attention. The idea that life is hopeless and that the depression is untreatable, keeps many sufferers from seeking the treatment they need. That, in turn, leads to incomplete or non-existent medical records that need to be in place documenting the debilitating effects of the disease. And while many Administrative Law Judges in the Social Security system are indeed sympathetic to the plight of those suffering with depression, the rules and procedures they must follow leave them no space to grant SSDI benefits to a Claimant who does not have medical documentation.

If you are suffering from depression and, the people at ADA hope you get the help you need, most importantly for your own well-being but also so that it can be documented for your disability claim. If you have further questions about this or any other Disability issue, please feel free to call us here at ADA. We can be of assistance in avoiding some of the pitfalls you just read about so that your claim makes its way towards a favorable decision.

A Note from American Disability Alliance

American Disability Alliance is dedicated to helping you through this difficult time. No one expects to have to apply for Social Security Disability benefits. But now that you are, we will guide you through the process knowing how difficult your circumstances have become. ADA gives you access to a dedicated team of disability lawyers, advocates and other professionals that know the Social Security Disability process and are on the cutting edge of new ideas and SSDI information.

You deserve access to your disability attorney and regular updates on your claim. We at ADA hope to start a partnership with all of our clients with you. We’ve found this to be the way to achieve the best results for our clients. We will share information, strategy and goals in order to make the SSDI process efficient, reassuring and, of course, successful.

ADA will never forget that it is a privilege to do the work that gets honest, working people back on their feet with disability benefits. This is our mission and guides every decision we make, from how we assist our clients to who we hire.