Supplemental Security Income is awarded to the aged (65 years or older), blind or disabled who have not worked or who have not paid enough employment taxes and are not considered “insured” by the SSA but they need a monthly cash assistance to pay for their monthly expenses because they are unable to work for at least 12 continuous months. Not all claimants will qualify for SSI. It is a “needs” based program and is only provided to claimants who have VERY limited income and resources.
Winning SSI for Depression
Although most people struggle with feelings of sadness or a loss of self-esteem periodically, prolonged periods of depression with feelings such has helplessness, hopelessness, insomnia, fatigue or significant changes in appetite can be signs of clinical depression. Depression, which is the opposite of mania (elevated mood, euphoric, grandiose ideas), can have a severe impact on a claimant’s life and in the most severe cases can lead to attempts of suicide.
Meeting or Exceeding a Listing for Depression
The Social Security Administration has two methods they use to determine if a claimant is disabled and unable to work. First, they will evaluate the claimant’s condition and determine if it “meets or equals a listing” on their SSA Medical Listing of Impairments (also known as the Blue Book).
If the claimant’s condition is not listed or does not meet a listing in the Blue Book, the SSA will determine how much residual capacity the claimant has to perform substantial gainful activity. This is done through the medical vocational allowance process.
The Social Security Administration (SSA) will evaluate depression under the Listing 12.00 for Mental Disorders, specifically 12.04 Affective Disorders. The following information can be found in the SSA Blue Book under Affective Disorders.
12.04 Affective Disorders
According to the SSA, affective disorders are “characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome. Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation.”
First the SSA will be evaluating whether the claimant has at least four of the following symptoms (symptoms provided from the SSA Blue Book):
• Anhedonia or pervasive loss of interest in almost all activities; or
• Appetite disturbance with change in weight; or
• Sleep disturbance; or
• Psychomotor agitation or retardation; or
• Decreased energy; or
• Feelings of guilt or worthlessness; or
• Difficulty concentrating or thinking; or
• Thoughts of suicide; or
• Hallucinations, delusions, or paranoid thinking; or
2. Manic syndrome characterized by at least three of the following:
• Hyperactivity; or
• Pressure of speech; or
• Flight of ideas; or
• Inflated self-esteem; or
• Decreased need for sleep; or
• Easy distractibility; or
• Involvement in activities that have a high probability of painful consequences which are not recognized; or
• Hallucinations, delusions or paranoid thinking; or
3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently characterized by either or both syndromes);
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration;
C. Medically documented history of a chronic affective disorder of at least 2 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:
1. Repeated episodes of decompensation, each of extended duration; or
2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or
3. Current history of 1 or more years’ inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.
Proving Depression through Medical Records
The Social Security Administration will request copies of the claimant’s medical records. They will also assume that if the mental health disorder is severe, the claimant will be under the care of a psychiatrist or psychologist. Records from the claimant’s treating sources such as psychiatrists, psychologists, counselors, mental health clinics, hospitals, and family doctors will be reviewed. Additionally, the SSA will request information from the family and friends of the claimant.
The SSA is attempting to determine how depression affects their ability to perform substantial gainful activity. Can they carry out directions and maintain a persistent work pace, can they get along with a supervisor or coworkers, and can they maintain a consistent work schedule?
What if the claimant has not been seen by a doctor or they are not following their specified treatment plan? The SSA may deny SSI benefits, assuming that if they were following their medical treatment plan they may improve to such a degree that they could work.