Mental Health Evidence for a Social Security Disability Claim: What SSA Looks At

How Social Security defines disability

The Social Security Administration (SSA) says plainly that its definition of disability is different from the one used in other programs, and that it is strict. It pays only for total disability, not for partial or short-term disability.

In general terms, SSA looks at whether a medical condition keeps you from doing substantial work, whether you can do the work you did before or adjust to other work, and whether the condition has lasted or is expected to last at least one year. A state agency called Disability Determination Services (DDS) makes the decision about your medical condition.

This article is general information taken from SSA's own pages. It is not legal advice, and it cannot tell you how a claim will turn out.

The two questions the evidence has to answer

SSA describes medical evidence as the cornerstone of a disability determination. Its guidance separates two questions.

The first is whether an impairment exists. For a mental disorder, SSA says it needs objective medical evidence from an acceptable medical source to establish that you have one.

The second is how severe it is. Once an impairment is established, SSA considers all the evidence, from medical and nonmedical sources, to assess how far it affects your ability to function in a work setting. For mental disorders it looks at four areas of mental functioning:

• Understanding, remembering or applying information
• Interacting with others
• Concentrating, persisting or maintaining pace
• Adapting or managing oneself

Who counts as an acceptable medical source

"Acceptable medical source" is SSA's own term, defined in its rules. For mental health conditions, the sources on SSA's list that matter most are licensed physicians (medical or osteopathic doctors) and licensed or certified psychologists at the independent practice level. For claims filed on or after March 27, 2017, the list also includes licensed advanced practice registered nurses and licensed physician assistants, for impairments within their licensed scope of practice.

That list is narrower than the group of people whose records SSA will read. In its mental disorders rules, SSA says it considers all relevant medical evidence from your physician, psychologist and other medical sources, and it names licensed clinical social workers and clinical mental health counselors among those other sources.

Put simply, records from a therapist are evidence SSA considers, while the evidence that establishes the disorder needs to come from a source on the acceptable list. If you are unsure whether your records include that, ask SSA or your representative.

What mental health evidence can include

SSA lists the kinds of information that evidence from medical sources may contain. Among them:

• Your reported symptoms and your medical, psychiatric and psychological history
• The results of mental status examinations, structured clinical interviews, rating scales or other clinical findings
• Psychological testing
• Your diagnosis
• The therapy you receive, including its type, frequency and duration, and the medications you take, with any side effects that limit functioning
• Observations of how you function during examinations or therapy
• How long your symptoms are expected to last and how they affect your functioning

Why records over time matter

SSA uses the term longitudinal evidence for records that cover a period of time. It says this kind of evidence helps it learn how you function over time and evaluate variations in your level of functioning. When your providers have records about you over months or perhaps years, SSA will request them.

This matters because mental health symptoms often change from week to week. SSA recognizes that in one-time or unfamiliar situations a person may appear more limited, or less limited, than they are on a daily basis. A single appointment shows one day.

SSA also acknowledges that some people, for example those who have been homeless for a long time, cannot easily provide medical records over time. In that case it may turn to family members, former employers, case managers or others who know the person's history. Where there is no longitudinal evidence, SSA says it will use current objective medical evidence and everything else in the record, and that current evidence alone may not be enough to show that a disorder meets one of its listings. It then continues with the rest of its process.

Consultative examinations that SSA arranges

You are responsible for providing medical evidence, and SSA, with your permission, helps gather it from the sources who have evaluated, examined or treated you. If that evidence is not adequate to make a decision, the agency may go back to your provider for more information or arrange a consultative examination.

SSA pays the fee for a consultative examination. It says your own medical source is generally the preferred source to perform it, but it may use an independent source in several situations, for example when your source prefers not to do the examination or is not qualified under its rules, or when there are conflicts in the file that your own source cannot resolve.

The report from a consultative examination describes findings and your ability to do basic work-related activities. SSA's guidelines say it should not include an opinion on whether you are disabled under the law. That decision stays with the agency.

Where a private evaluation fits, and how we can help

A private evaluation is one piece of evidence among many. It does not replace treatment records, it does not decide a claim, and no one can promise how SSA will weigh it. Before you pay for one anywhere, ask SSA or your representative what your claim needs and who must sign it.

Locascio Wellness offers a disability evaluation that describes how a mental health condition affects daily life and work. Our evaluations are carried out under clinical supervision, and reports are co-signed by a supervising licensed psychologist. We do not claim that our reports meet SSA's requirements, and the report describes what was found, whether or not it supports a claim.

Evaluations are carried out by secure video for people physically located in Pennsylvania, West Virginia or Arizona. They are private-pay, with a sliding scale available: see what evaluations cost. The first step is the short evaluation request form or a free 15-minute consultation, which you can schedule on our booking page.

Therapy is a separate service, and it is there for your wellbeing, not for a claim. Applying for benefits while living with a mental health condition is hard work, and you deserve support while you do it. Our depression therapy page is one place to start.

If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page lists more options.