How To Get Social Security Disability & SSI Benefits: PTSD

Winning Your PTSD Disability Case

Video

How Social Security Assesses Your PTSD Medical File

PTSD is one of the most common mental health conditions in America. It is therefore a very common disability case adjudicated by Social Security. PTSD is a psychiatric disorder that results from the experience of a traumatic event. PTSD is most common with veterans and victims of physical, emotional, or sexual trauma. Social Security will need evidence showing a diagnosis by a mental health specialist (not a primary doctor), and regular mental health therapy (individual or group). Therapy records are important in your disability case because they show what symptoms you report to your provider - what they are and how severe they are to you, your provider's opinion about the severity of your symptoms (how severe they are to your provider), and your provider's assessment of your mental health functioning. There are many PTSD symptoms that are the basis of disability, and they generally include the following:

1. Anxiety,
2. Nightmares,
3. Intrusive thoughts,
4. Flashbacks,
5. Hypervigilance,
6. Hyperstartle,
7. Anger,
8. Fear,
9. Detachment,
10. Hopelessness,
11. Being easily triggered,
12. Isolation, and
13. Avoidance of others.

Your provider will usually assess your functioning in three broad categories - cognition (concentration and memory), social interactions, and carrying out activities of daily living (schedules and responsibilities). Medications are usually prescribed, and they are a good indicator to Social Security that you require regulation of your PTSD symptoms.

There are five special considerations with PTSD that arise in a Social Security and SSI disability case. First, it is common that PTSD sufferers do not develop PTSD symptoms until long after the traumatic event. This called delayed-onset PTSD. This is often a challenge in a Social Security disability case. It is important to explain to Social Security that this most often occurs because of the combination of the original trauma and trigger of the original trauma by a newly experienced trauma.

Second, many PTSD sufferers do not want to acknowledge the trauma that is the root cause of PTSD. There are a variety of reasons for this: stigma, denial, shame, and an unwillingness to address symptoms and unhealthy life choices to name a few. The failure to acknowledge the trauma often results in a lack of treatment, a failure to engage in treatment once it begins, and a failure to meaningfully understand of nature of their PTSD. If this issue arises in your Social Security disability case, it is important you understand it will affect how well Social Security can understand and evaluates your case.

Third, Social Security usually finds that a diagnosis, treatment, and an opinion of your functioning by a psychiatrist or a psychologist to be more credible than from a counselor or social worker. Sometimes who treats you is out of your control, but attempt to see a psychiatrist or psychologist if you can, or have them review and sign off on your treatment.

Fourth, the psychiatric community and Social Security are split on the relevance of a global assessment functioning (GAF) score which is a part of your diagnosis and an assessment of your overall mental health functioning. If your mental health provider does diagnose you with a GAF score, a score of 50 or less is considered consistent with the inability to work. If your provider has not diagnosed you with a GAF score, ask them to do so.

Fifth, substance abuse, called drug and alcohol abuse or "DAA" by Social Security, is common with PTSD sufferers. If you engage in substance abuse, it is important to understand Social Security's DAA evaluation because Social Security can find you disabled and then not pay benefits because of your drug or alcohol use. Essentially, you must show your DAA is not a significant cause of your severe symptoms.

PTSD Social Security & SSI Listings

Adult Listing 12.15 and Child Listing 112.15 can be met by satisfying sections 1 and 2, or 1 and 3:

1. All five of -
1. Experience of trauma,
2. Distressing responses to the trauma,
3. Shunning reminders of the trauma,
4. Emotional disorder, and
5. Heightened response as a result of the trauma; and
2. You are extremely restrained in one or markedly restrained in performing two of these areas of life -
1. Knowing and carrying out work procedures,
2. Social dealings,
3. Completing work activities, or
4. Maintaining correct behavior; or
3. Your PTSD has existed for two years or longer and both -
1. Helpful mental health treatment, and
2. Poor capability in adjust to life issues.

Resources

1. PTSD Medical Information - National Institute of Health
2. PTSD Medical Information - American Psychiatric Association

A Success Story

Mr. Miller was a veteran from Tucson, AZ. He served two tours in the Iraq War. He began suffering PTSD symptoms while serving in the military and was discharged from the military because of his symptoms. After his discharge, his PTSD slightly worsened. He was denied at the Social Security initial and reconsideration levels. He had applied for Social Security Disability disability benefits. He did not qualify for SSI benefits. and counsel began representing him just after his reconsideration denial. He had a VA disability rating of 50% at the time of his Social Security denials. At the time he contacted counsel, he had not sought ongoing mental health treatment which was the primary reason his claim had been denied. He did have a few evaluations upon his discharge from the military and shortly thereafter. But, he did not seek regular treatment. He had not taken any medications for his PTSD. He was an intermittent heavy drinker.

Counsel convinced Mr. Miller to obtain ongoing counseling at the VA which he did. He attended regular group and individual therapy at the VA. We waited a little less than two years for his hearing to be scheduled. During this time, he had been inconsistent with both counseling attendance and adhering to his medication regimen. Counsel ordered his medical records from the VA, both his ratings decisions (he received a rating increase from 50% to 90% while we were awaiting his hearing), and an emergency room visit for a panic attack. Mr. Miller's VA doctors and counselors were not willing to provide an opinion about his condition (this is nearly always the case with the VA). Mr. Miller was unwilling to pay for an independent psychological evaluation. However, we were able to obtain statements from several friends and family members. All wrote about Mr. Miller's isolation, hypervigilance, anger, paranoia, and volatile and fractured relationships with those close to him. Counsel asked each to specifically address his alcohol use and whether Mr. Miller's PTSD symptoms were independent of his alcohol use or directly related to his use. All wrote that Mr. Miller had long periods when he drank and then long periods of sobriety, and his mental health symptoms were no different whether drinking or sober.

Mr. Miller had been difficult to communicate with prior to the hearing, and I was concerned about how he would testify. However, he was very emotional and likable. We spent considerable time addressing his isolation, problematic relationships, his intermittent mental health treatment, and his alcohol abuse.

About two months after the hearing, the ALJ issued a fully favorable decision primarily basing his opinion on the fact that Mr. Miller would be unable to maintain regular attendance at a workplace and successfully interact with others. The ALJ found Mr. Miller's alcohol use not material, in other words, alcohol use was not the cause of Mr. Miller's disability. About a year after his Social Security disability hearing, he was awarded 100% disability by the VA (one can simultaneously receive both benefits).