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My Step by Step Analysis of a Mental Health Disability Claim

Recently a young man wrote me to ask my opinion about whether he qualifies for some form of Social Security disability. In his very thoughtful email he asks a number of questions that I suspect a lot of folks are wondering about.

After practicing in this area of law for 20+ years I can generally sense fairly quickly whether someone has a viable case.  In my last blog post I discussed what I look for generally in a mental health disability claim.  So now I thought I would explain – step by step – how I analyze potential client inquiries using this case as an example.

Obviously I will not use this gentleman’s real name and I will change the facts a little to preserve his anonymity.

Potential Client with Mental Health Claim

My potential client writes to say that he is 23 years old and a full time college student who works part time. He states that he suffers from mental illness that includes anxiety, depression and possible schizophrenia as he experiences visual and audio hallucinations. He also experiences tremors in his hands but does not have a definitive diagnosis.

He states that his illnesses have caused attendance problems at work and at school. He wants to know if he might qualify for full or partial disability, whether Social Security will help find him a job that he can perform given his limitations, and whether the disability process is the same in every state.

I will start my claim evaluation by answering the last questions first. In the Social Security disability system there is no partial disability – either you are disabled or you are not. Social Security defines disability in terms of your capacity for work so another way to look at the definition of disability is to ask whether you could reliably perform the job duties of a simple, entry level job.

It is not enough to prove that you cannot perform your current or past jobs – you have to show that your medical issues prevent you from performing a simple, one-step, sit-down minimum wage job.

Second, Social Security disability is a federal program, meaning that the definitions and procedures are the same in every state. Some states have their own disability programs but if you are pursuing Social Security disability, there is one system.

Third, Social Security does not include any sort of jobs program. They will not help you find a job that would accommodate your medical limitations.

How I Analyze a Disability Claim

Now, let’s look at this young man’s case.

The negatives I see include:

  • he is currently working part time and attending school full time. Full time school or work would be considered substantial gainful activity by Social Security so at this point in time, he could not be found disabled because he is performing activities that equate to full time work.
  • my experience has also been that part time work will make your chances of winning Social Security disability smaller as many judges assume that if you can reliably work part time, you could probably work full time at an easier job or one where you were given more hours.
  • mental health claims are increasingly difficult to win in a Social Security disability claim. As I discuss in this video, the cases that tend to get approved are ones where the claimant has had two or more inpatient hospitalizations at a psychiatric hospital over the past 2 to 3 years, and cases where there have been one or more actual suicide attempts.
  • disability judges hear claimants on a daily basis claiming that they cannot work because of depression and anxiety. To convince a judge you have to show that your depression is life threatening or severe enough to interfere with activities of daily living.
  • this young man’s age – he is 23 years old – would also be a problem in a Social Security disability case. Social Security judges know that if they approve a 23 year old, he may very well collect benefits for the next 40+ years. As the Social Security disability trust fund is running out of money, judges will only approve a claimant in his 20’s if the medical evidence is overwhelming.
  • further, judges assume that a person in his 20’s will have more energy and capacity to work despite his medical or mental health issues. Judges also feel that additional therapies – in this case medicines – need to be given a chance to work before concluding that a young person has lost all capacity for employment. I have found that evidence of multiple failed work attempts and evidence of trials of multiple medications can help override this presumption.
  • as this individual is only in his 20’s I also wonder whether he would be insured for SSDI purposes. SSI claims are much less desirable for attorneys because of offsets which reduce any attorney’s fees that might be generated. Given that this claim would be a long shot anyway I would be reluctant to accept a case where I am not likely to be paid very much.

There are a few positives here as well.

  • this young man contends that he hears and sees things that are not there. Audio and visual hallucinations are usually the sign of schizophrenia or another serious mental health issue. A person whose reality is skewed would have a very difficult time working.
  • even though this young man is only 23 it is certainly possible that he has suffered from mental health issues for some or all of his life. If his medical record shows ongoing treatment from age 10 on, and a deterioration of his condition during that time, that would be compelling evidence.
  • the tremors he is experiencing may reflect an underlying neurological problem that could be permanent and very serious. Certainly a diagnosis of Parkinson’s disease or multiple sclerosis could change how a judge might look at this case.

My conclusion is that this young man most likely does not have a viable Social Security disability case. His status as a full time student and part time employee suggest that he is able to function acceptably even if he is uncomfortable. His young age is also a big red flag as even the strongest claims by people in their 20’s are often denied.

If he was to stop working, and if he had enough credits to pursue SSDI, and if the medical record contains evidence of in-patient psychiatric hospitalizations, suicide attempts and a definitive diagnosis of a serious neurological issue I might re-evaluate.

My gut reaction to this claim would be that the odds of winning are not high enough to justify my time investment.

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