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SSA Disability - Mental Health Disorder Evaluation

How do I prove I have a mental health disorder?

The Social Security Administration outlines nine diagnostic categories for a mental health disorder including organic mental disorders, schizophrenic, paranoid and other psychotic disorders, affective disorders, mental retardation, anxiety-related disorders, somatoform disorders, personality disorders, substance addiction disorders and autistic disorder and other pervasive developmental disorders.

To win SSDI or SSI for a mental health disorder a claimant must be diagnosed with a medically determinable impairment which is expected to last for at least12 continuous months and which does not allow them to perform substantial gainful activities.

How does the SSA evaluate a mental health disorder?

The SSA will evaluate a claimant’s medical records and determine the severity of the condition, the limitations on the claimant’s ability to work and whether the condition will last for at least 12 continuous months. If a mental health disorder also causes physical dysfunction the SSA can also evaluate the physical condition under the appropriate physical health listing (i.e. eating disorders).

Medical evidence must consist of signs, symptoms and laboratory findings. The SSA will consider not only the claimant’s description of their condition but also appropriate psychiatric signs as described by a doctor. The SSA will expect to see symptoms which cluster together to “constitute recognizable mental disorders described in the listings. The symptoms and signs may be intermittent or continuous depending on the nature of the disorder.”

What happens at the Consultative Examination?

Many claimants mistakenly believe that they will automatically be sent to for a mental health evaluation if they apply for disability benefits. Generally, the SSA will only send you to an examination if they do not have enough medical evidence to determine if you have the mental health condition, you have not seen the appropriate doctors or your doctor fails to provide medical evidence to the SSA.

What will the Consultative Examiner evaluate?

The goal of the mental assessment is to help the SSA evaluate the functional limitations of the claimant. The SSA will determine if the claimant is not severely limited, moderately limited or markedly limited in the areas of activities of daily living (cleaning, shopping, cooking, paying bills), social functioning (getting along with others appropriately and on a sustained basis) and concentration, persistence, or pace (the ability to have sustained focused attention to complete tasks which may be evaluated through clinical examinations or testing). The SSA will also evaluate how many episodes of decompensation the claimant experiences (periods of increased signs and symptoms which lead to adaptive functioning which may exacerbate the need for increased treatment or intervention).

What will the Consultative Examiner give to the SSA?

The consultative examiner is not an SSA doctor. They are hired by the SSA to perform a mental health evaluation and present their findings back to the SSA. They will not be responsible for awarding disability benefits. but if you lack additional mental health evidence to support your SSDI case or SSI claim the information they provide to the SSA will be the main information used to support your case. The consultative examiner will complete a report and a Mental Residual Capacity Assessment Form (RFC Form) and give it to the SSA.

It is recommended that you get your own mental health doctor and begin to seek consistent treatment for your condition, taking care to follow your doctor’s prescribed treatment plan. This will give you the best possible chance to win SSDI or SSI benefits for a mental health disorder.
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