Get Social Security Disability & SSI Benefits: Schizophrenia

Winning Your Case

Social Security's Reading Of Your Schizophrenia Medical Evidence Is Critical

Diagnosis. Schizophrenia is a severe mental health disorder, and if diagnosed properly, it is usually awarded by Social Security without a hearing. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) establishes five diagnostic criteria (you must meet all five):

1. Two or more of - delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms such as diminished emotional expression;
2. Reduced level of functioning;
3. Symptoms have lasted six months or more;
4. Schizoaffective disorder, schizophrenia, and bipolar have been ruled out; and
5. Substance abuse has been ruled out.

So what is a "proper diagnosis"? It is a diagnosis made by a psychologist or psychiatrist and includes the evaluation of the above noted five diagnostic criteria. If you don't have a proper diagnosis, you may still be found disabled. Because of the seriousness of the disorder, if your disability claim has been denied at the initial or reconsideration level(s), it is likely because Social Security did find the diagnosis adequate.

Evidence. Social Security is looking at your medical treatment records to ascertain the seriousness of your schizophrenia. Your records should include your diagnosis, ongoing counseling sessions, medication history, and any hospitalizations (ER visits, hospital stays, or in-patient psychiatric facilities). If you have a history of substance abuse, Social Security will inquire and determine whether your disabling mental health symptoms are the result of your schizophrenia or substance abuse. Incarceration and police records are common for those diagnosed with schizophrenia. If you have had encounters with law enforcement or the criminal legal system as a result of your schizophrenia, you should submit those as well since they demonstrate the severity of your schizophrenia and your inability to adhere to social norms because of your schizophrenia. You should also submit any records involving child protective services (CPS) or any civil court. Social Security generally agrees that if you have difficulty caring for your children and family, or abiding by social rules, you will have difficulty carrying out job duties. If you have suffered schizophrenic symptoms while being in school or at work, submit those records along with a statement from someone who knew you in that environment as your functioning in such a setting provides Social Security with strong evidence of your abilities to maintain a work/school schedule and demands.

Social Security Schizophrenia & SSI Listing

The Adult Listing 12.03 and the Child Listing 112.03 are both met by satisfying 1 and 2, or 1 and 3:

1. At least one of -
1. Problems understanding reality,
2. Disturbed thought-process,
3. Significantly unusual behavior; or
2. One extreme limitation of one or two marked limitations in handling two of -
1. Knowledge,
2. Society,
3. Work rate,
4. Yourself; or
3. The schizophrenia has lasted longer than two years, and -
1. You are obtaining medical therapy that is helpful to you, and
2. You have only a minor ability to respond to life requirements.

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