Will I qualify for New Jersey disability benefits due to a mental disorder?
Mental disorders are a commonly-cited impairment in New Jersey and Sussex County Social Security disability cases. And many people with physical impairments also develop psychological issues as a result. Unfortunately, chronic physical problems can often take a psychological toll.
If you are suffering from a mental disorder, you may be able to receive Social Security disability benefits. The Social Security Administration’s rules for assessing whether a claimant for New Jersey disability benefits qualifies due to a mental disorder are complex. This article provides an overview of how a person suffering from a mental disorder qualifies for Social Security disability benefits.
How the Social Security Administration evaluates mental disorders in New Jersey disability cases
For most common physical and mental impairments, including mental impairments such as anxiety disorder and depression, the Social Security Administration has developed a set of rules called the Listing of Impairments. The Listings are included in the Social Security Administration’s Disability Evaluation Under Social Security (also known as the Blue Book) located at http://www.ssa.gov/disability/professionals/bluebook/. The Listing for a particular impairment describes a degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work.
For physical impairments, the Listings are used only in adjudicating Step 3 of the Sequential Evaluation Process, that is, determining whether a claimant’s impairment meets or equals a Listed impairment. If a disability applicant meets or equals a Listing because of an impairment, he or she will be considered disabled and eligible for disability benefits.
However, for mental impairments, the Social Security Administration uses the Mental Disorders Listings to determine that the disability claimant, in fact, has a medically determinable mental impairment. This is the first requirement for the Social Security Administration’s evaluation of mental impairments. This is done by deciding whether certain medical findings are present using the Listing’s A criteria (discussed in greater detail below). Once this hurdle is crossed, the Social Security Administration moves on to an evaluation of whether or not the mental impairment is “severe,” Step 2 of the Sequential Evaluation Process.
At Step 2, the Mental Disorders Listings’ criteria are used to determine whether a mental impairment is severe. This is determined by evaluating not only the medical evidence pertaining to the mental impairment, but also by evaluating the degree of functional limitations caused by the impairment, addressed in most Mental Disorders Listings in the B criteria. These functional limitations are discussed in greater detail below under the heading “Is your mental disorder severe? The B criteria.” If the mental impairment is found to be severe, the Social Security Administration moves on to Step 3.
For Step 3, the Mental Disorders Listings are used in determining whether a claimant’s impairment meets or equals a Mental Disorders Listing. If a disability applicant meets or equals a Listing because of a mental impairment, he or she will be considered disabled and eligible for disability benefits. If a claimant’s mental disorder is not severe enough to equal or meet a Listing, the Social Security Administration assesses the claimant’s “residual functional capacity” (the work a claimant can still do, despite his or her affective disorder), to determine whether the claimant qualifies for disability benefits at Step 4 and Step 5 of the Sequential Evaluation Process.
What different types of mental disorders are recognized by the New Jersey Social Security Administration?
The Social Security Administration’s Listings for mental disorders are arranged in nine diagnostic categories, which are as follows:
12.02 Organic Mental Disorders – Psychological or behavioral abnormalities associated with a dysfunction of the brain. History and physical examination or laboratory tests demonstrate the presence of a specific organic factor judged to be etiologically related to the abnormal mental state and loss of previously acquired functional abilities.
12.03 Schizophrenic, Paranoid and Other Psychotic Disorders – Characterized by the onset of psychotic features with deterioration from a previous level of functioning.
12.04 Affective Disorders – 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.
12.05 Mental Retardation – Mental retardation refers to significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22.
12.06 Anxiety-Related Disorders – For these disorders, anxiety is either the predominant disturbance or it is experienced if the individual attempts to master symptoms. For example, confronting the dreaded object or situation in a phobic disorder or resisting the obsessions or compulsions in obsessive compulsive disorders.
12.07 Somatoform Disorders – Physical symptoms for which there are no demonstrable organic findings or known physiological mechanisms.
12.08 Personality Disorders – Exist when personality traits are inflexible and maladaptive and cause either significant impairment in social or occupational functioning or subjective distress. Characteristic features are typical of the individual’s long-term functioning and are not limited to discrete episodes of illness.
12.09 Substance Addiction Disorders – Behavioral changes or physical changes associated with the regular use of substances that affect the central nervous system.
12.10 Autistic Disorder and Other Pervasive Developmental Disorders – Characterized by qualitative deficits in the development of reciprocal social interaction, in the development of verbal and nonverbal communication skills, and in imaginative activity. Often, there is a markedly restricted repertoire of activities and interests, which frequently are stereotyped and repetitive.
The Mental Disorders Listings can be found at http://www.ssa.gov/disability /professionals/bluebook/12.00-MentalDisorders-Adult.htm.
Applying the A, B, C, and D criteria to each of the Mental Disorder Listings
Each of the Mental Disorder Listings, except Listings 12.05 (Mental Retardation) and 12.09 (Substance Addiction Disorders), consists of a set of medical findings used to determine if a disability claimant has a particular mental impairment, the A criteria, and the B criteria, a set of impairment-related functional limitations.
For Listings 12.02 (Organic Mental Disorders), 12.03 (Schizophrenic, Paranoid and Other Psychotic Disorders), 12.04 (Affective Disorders), and 12.06 (Anxiety-Related Disorders), there are additional functional criteria assessed when the B criteria are not satisfied, the C criteria. To meet one of the Listings (except Listings 12.05 and 12.09), a claimant must meet the A and B criteria or the A and C criteria, when appropriate.
To meet the requirements of Listing 12.05 (Mental Retardation), one must satisfy the description in the introductory paragraph and meet any one of the four sets of criteria, A, B, C, or D.
Listing 12.09 (Substance Addiction Disorders) is structured as a reference Listing. That is, it indicates which of the other mental or physical Listings must be used to evaluate the behavioral or physical changes resulting from regular use of addictive substances. But if alcohol or other drug abuse is “a contributing factor material” to the finding of disability, the claim must be denied.
Do you have a medically determinable mental impairment? The A criteria
As discussed above, the first step the New Jersey Social Security Administration takes in evaluating a mental impairment is to determine that the claimant, in fact, has a medically determinable mental impairment. This is done by deciding whether diagnostic criteria in the Mental Disorders Listings, known as the A criteria, are met.
Each of the Mental Disorders Listings has its own separate A criteria. The A criteria substantiate medically to the Social Security Administration the presence of a mental disorder.
Is your mental disorder severe? The B criteria
If the A criteria are met, the New Jersey Social Security Administration moves on to the B criteria and, in some cases, the C criteria, which are used to assess the degree of your mental impairment. The B and C criteria describe impairment-related functional limitations that are incompatible with the ability to do any gainful activity. The functional limitations set forth in the B and C criteria must be the result of the mental disorder, and as manifested by the A criteria’s medical findings.
Under the B criteria, a New Jersey disability claimant’s functional limitations are evaluated in four areas:
Area 1: Activities of daily living – Examples include cooking, taking public transportation, paying bills, shopping, maintaining a residence, caring appropriately for grooming and hygiene, and using telephones and directories.
Area 2: Social functioning – An individual’s capacity to interact independently, appropriately, effectively, and on a sustained basis with other individuals.
Area 3: Concentration, persistence, or pace – An individual’s ability to sustain focused attention and concentration long enough to permit the timely and appropriate completion of tasks commonly found in work settings.
Area 4: Episodes of decompensation – Exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning, as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace.
A claimant’s functional limitations in each of the first three areas are rated as “none,” “slight,” “moderate,” “marked,” and “extreme.” For the fourth area, the scale is “never,” “one or two,” “three,” and “four or more” for the fourth area (episodes of decompensation).
A rating of “none” or “mild” indicates a degree of limitation that is generally not considered severe by the Social Security Administration, unless the evidence otherwise indicates there is more than a minimal limitation of the claimant’s ability to do basic work activities.
Are you disabled under the B criteria listing?
If you meet the A criteria, you will meet the Listing for a mental disorder and be considered disabled if:
Any one of the B criteria is rated “extreme” (a degree of limitation that is incompatible with the ability to do any gainful activity); or
Two of the B criteria are rated “marked” and, in the case of episodes of decompensation, three episodes of decompensation have occurred.
A rating of “moderate” indicates a severe impairment, but one that does not meet or equal a listed impairment and therefore requires a “residual functional capacity” assessment. For more information regarding residual functional capacity, see below.
Establishing that you meet the B criteria
I let my New Jersey and Sussex County disability clients know that the best sources of information and testimony about the B criteria are usually a claimant’s family, friends, and neighbors. Sometimes a claimant may be able to provide useful information, but often in mental impairment cases, claimants have insufficient insight into their limitations. A claimant’s view of his or her mental disorder and those who know the claimant well may diverge widely. This problem in itself can turn out to be a major issue in a mental impairment case.
Sometimes denial decisions in mental impairment cases are based on little more than the New Jersey Social Security Administration’s uncritical acceptance of a claimant’s statements about daily activities, social functioning, and ability to get things done on time. This may be one significant reason why a number of mental disorder cases are denied and ultimately reach the hearing level. Mental disorders frequently rob claimants of the ability to realistically assess their limitations. In these cases, it is extremely important to have a competent New Jersey Social Security lawyer who can look beyond what the claimant says about his or her level of functioning.
If you do not meet the B criteria, move on to the C criteria
If you do not meet the B criteria, the New Jersey Social Security Administration moves on to evaluate the C criteria when your mental disorder is one of the following:
An organic mental disorder,
A schizophrenic, paranoid, or other psychotic disorder,
An affective disorder, or
An anxiety-related disorder.
The C criteria for organic disorders, psychotic disorders, and affective disorders are identical. The criteria requires a two-year history of a chronic mental impairment with more than minimal limitation in the ability to do basic work activities. In addition, the C criteria require at least one of the following:
Repeated episodes of decompensation, each of extended duration.
A current history of one or more years’ inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.
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.
The single C criterion for anxiety-related disorders is an anxiety disorder resulting in complete inability to function independently outside the area of one’s home.
As a rule, the C criteria must be assessed when you appear to function too well to meet the B criteria.
Establishing that your mental impairment meets the C criteria
More than the B criteria, deciding whether your mental impairment meets the C criteria may depend on expert opinion, particularly from your treating doctors. A single mental status examination may be insufficient. Claimants with long histories of repeated hospitalizations or prolonged outpatient care with supportive therapy and medication often have structured their lives to minimize stress and reduce symptoms. These claimants may be much more impaired for work than their symptoms and signs would indicate.
If you meet the B or C criteria, but not the A criteria
According to the Social Security Administration, the A criteria of the mental disorders Listings:
are only examples of common mental disorders that are considered severe enough to prevent an individual from doing any gainful activity. When [a claimant has] a medically determinable severe mental impairment that does not satisfy the diagnostic description or the requirements of the paragraph A criteria of the relevant listing, the assessment of the paragraph B and C criteria is critical to a determination of equivalence.
This means that a claimant who meets the B or C criteria, but not the A criteria may nonetheless be considered disabled.
Residual functional capacity assessment
If your mental disorder causes only moderate functional limitations (i.e., the B or C criteria are not met), you may or may not have the residual functional capacity to do substantial gainful activity. The Social Security Administration must do a residual functional capacity assessment – it will determine whether you can do skilled, semiskilled, or unskilled work in spite of mental impairments, or whether you cannot even do unskilled work. Claimants with a marked impairment in any of the abilities required for unskilled work will be awarded New Jersey disability benefits even in the absence of any physical impairment.
This assessment of mental residual functional capacity is crucial when your impairment does not meet the B or C criteria, but is nevertheless severe.
The New Jersey Social Security Administration requires a lot of information to make an accurate residual functional capacity assessment. This is another important area in which information from others about how you behave at home, work, and in social situations can help.
More information about mental disorders available on this website
My disability website provides more information about applying for Social Security disability benefits when you are suffering from a mental disorder. Whether you are just thinking about applying for New Jersey disability benefits, waiting for a decision, or have received a denial letter, you will find the articles and videos on this site helpful.
For more information, take a look at:
The Library section below entitled Applying for Disability Benefits When You Have: This section spells out how the Social Security Administration evaluates particular physical and mental impairments and provides medical opinion forms. There are articles about Anxiety disorders, Depression/bipolar disorder, and Schizophrenia, in addition to articles about other common impairments.
Frequently Asked Questions about Social Security disability benefits. This article is a good introduction to Social Security disability benefits if you are new to the topic.
The video “Are you likely to qualify” for an introduction to the Social Security Administration’s disability determination process.
Experienced New Jersey Social Security lawyer available to assist with your mental disorder disability claims
Cases involving mental disorders can be challenging. I am experienced in helping Social Security disability claimants in New Jersey through this process. I also received my undergraduate degree in psychology, and I was a volunteer counselor and facilitator for a number of years, working with individuals with addiction and mental health disorders. As a result of this experience, I am sensitive to disability claimants dealing with mental illness.
If you have a mental impairment case, or a physical impairment case, and are not already represented by a New Jersey Social Security lawyer and want my evaluation, give me a brief description of your claim using the form to the left. Or you may e-mail or call me at: