How Hard is it to Get Disability for PTSD?

PTSD and Social Security Eligibility

Doug Mann

Last updated on August 8th, 2023

Post-traumatic stress disorder (PTSD) is a serious condition that can impact every area of your life, including the ability to earn a living. But, as a psychological condition (termed “mental disorder” by the Social Security Administration), PTSD is assessed differently than a disability like a spinal injury or a terminal illness.

That means an applicant seeking Social Security disability (SSDI) benefits for post-traumatic stress disorder or another mental health issue may face more significant hurdles. If your initial SSDI claim for PTSD has been denied, it is generally in your best interest to consult an experienced Ohio SSDI appeals attorney as soon as possible to find out how hard it is to get disability for PTSD.

What is Post-Traumatic Stress Disorder?

PTSD is a mental health condition triggered by a traumatic event, which can present with a wide range of symptoms. Some common symptoms include:

• Flashbacks
• Insomnia
• Nightmares
• Recurrent intrusive memories of the traumatic event
• Severe anxiety and/or emotional response to “triggers” that bring back the traumatic event
• A sense of hopelessness
• Emotional outbursts, especially anger
• Memory problems
• A sense of detachment
• Difficulty maintaining relationships
• Difficulty concentrating
• Hyper-vigilance
• Being easily startled or frightened
• Self-destructive behavior

The symptoms of post-traumatic stress disorder can be short-term, especially with treatment. Or, they can persist for years or for the rest of your life. The unpredictability of the duration of PTSD and the possibility of intermittent symptoms can further complicate a PTSD-related Social Security disability claim.

PTSD is much more common than most people realize. According to SSA, 7-8% of the U.S. population will suffer post-traumatic stress disorder at some point in their lives. Women are more than twice as likely as men to be impacted by PTSD. Even teens and children are affected: about 5% of adolescents have or have at some point in their lives met the criteria for PTSD. As with adults, girls are at significantly greater risk than boys.

Get a Free Consultation

If you’ve faced an injustice with your disability benefits, reach out for legal guidance without delay!

contact us or call us: 1.937.222.2222

Common types of PTSD

PTSD can manifest in diverse ways. Although PTSD symptoms can overlap, they often cluster into types that emphasize certain features. Here are the common types of PTSD and how they affect individuals:

Uncomplicated PTSD

Uncomplicated PTSD refers to cases where symptoms are primarily linked to a single traumatic event rather than multiple incidents. Symptoms can include:

• Re-experiencing the traumatic incident through flashbacks or nightmares.
• Avoidance of reminders of the trauma.
• Negative changes in mood related to the event.
• Heightened reactions, like being easily startled.

Complex PTSD

Complex PTSD results from exposure to prolonged or repeated traumatic events, such as ongoing abuse, war, or captivity. In addition to standard PTSD symptoms, individuals might experience difficulties with emotional regulation, a persistent sense of threat, feelings of guilt or shame, and difficulties in relationships with others. Complex PTSD can also involve distorted perceptions of the perpetrator, such as attributing total power to the perpetrator or preoccupation with revenge.

Comorbid PTSD

This occurs when individuals suffer from PTSD alongside other mental health disorders such as anxiety. The overlapping symptoms and the interaction between conditions can complicate diagnosis and treatment. For example, substance use may be a coping mechanism for PTSD symptoms, further entangling the conditions.

Dissociative PTSD

This subtype is characterized by symptoms of dissociation—a sense of detachment from oneself or reality, as a primary response to the trauma. Individuals might experience depersonalization or derealization. Dissociative symptoms usually come as a coping mechanism to help individuals distance themselves mentally from the trauma.

Acute Stress Disorder

Acute Stress Disorder (ASD) refers to a psychological condition triggered by experiencing a traumatic event. This condition is characterized by severe stress responses that begin shortly after the trauma. If symptoms persist beyond this period, the diagnosis may transition to PTSD.

Can PTSD Be Treated?

Yes, post-traumatic stress disorder can be treated with both medication and therapy. However, it’s important to be aware that medication simply suppresses the symptoms of PTSD. Therapy is typically required for actual recovery.

Does PTSD qualify for disability?

Post-Traumatic Stress Disorder (PTSD) can qualify as a disability under certain circumstances. In the United States, the Social Security Administration (SSA) considers PTSD within its criteria for disability benefits under the category of mental disorders. To qualify, an individual must demonstrate that their PTSD matches what’s listed in the Blue Book for trauma disorders or according to Medical-Vocational Allowance.

Disability by Meeting the PTSD Listing

The Blue Book is a guide that lists various physical and mental health conditions that are severe enough to prevent one from engaging in substantial gainful activity. This essentially means the person can’t work enough to support themselves due to their condition.

For PTSD, the relevant section in the Blue Book covers trauma- and stressor-related disorders. To meet the listing for PTSD, you must provide comprehensive medical documentation proving you have been diagnosed with PTSD by a qualified professional.

Basically, the key aspects required to meet the PTSD listing include:

• Medical documentation. Proof of exposure to actual or threatened death, serious injury, or violence
• Symptom severity. The presence of specific symptoms from categories such as intrusive thoughts (like flashbacks or nightmares) and marked changes in arousal and reactivity (e.g., being easily startled or having angry outbursts).
• Functional limitations. The symptoms cause impairment in important areas of functioning. This might involve difficulties concentrating, interacting with others, or managing daily tasks.
• Duration. The disturbance must last for at least 12 months, indicating it is not a transient response to stress.

Two key terms used in this evaluation are “marked limitation” and “extreme limitation.” A “marked limitation” refers to a significant restriction in the ability to perform daily activities. This doesn’t mean a complete inability but indicates that the individual’s functioning in certain areas is seriously limited.

On the other hand, “extreme limitation” is the most severe level of functional limitation recognized by the SSA. It indicates a very significant restriction in the ability to independently initiate, sustain, or complete activities related to daily living, work, and social interaction.

The documentation should provide details on how the PTSD symptoms meet the Blue Book section 12.00 criteria.

Disability for PTSD by a Medical-Vocational Allowance

If your PTSD does not precisely meet the Blue Book listing but still significantly impairs your ability to work, you may be evaluated under a medical-vocational allowance. This takes into account your age, education, work history, and how PTSD affects your capacity to perform work you were once able to do or adjust to other types of work.

Each case is reviewed individually, and the decision to grant disability benefits for PTSD will depend on the specific details and documentation of the case. It’s advised to consult with a Social Security disability lawyer for guidance through the process.

How hard is it to get disability benefits for PTSD?

Getting disability benefits for PTSD can be manageable with the right preparation and documentation. Since PTSD is a condition that Social Security claims examiners and judges often see, they are familiar with its symptoms. This familiarity can make it less likely for your symptoms to be misunderstood.

Here is what we recommend you to do:

• Gather all medical records – Collect all the medical records related to your PTSD. This includes records from any hospital stays and notes from therapy sessions. Although Social Security will ask for records from the last year, providing information from several years back is even better.
• Get support from your doctor – Ask your mental health provider to fill out a form known as an RFC form that talks about how your PTSD affects your work abilities. Since Social Security values doctors’ opinions highly, this can really help your case. The form explains that you have limitations because of your PTSD.
• Collect statements from others – Statements from people you know, like friends, family, or coworkers, can also support your claim. These should talk about how they’ve seen your PTSD affect your daily life and work, not just your medical condition.

Having everything well-prepared and clearly showing how PTSD affects your ability to work can greatly improve your chances of approval. To make the process simple, consider working with an Ohio SSDI appeals attorney for professional guidance.

How Does the Social Security Administration Evaluate PTSD Claims?

The Social Security Administration classifies PTSD as “trauma- and stressor-related disorders.” To be approved for SSDI benefits under this category, the applicant must provide medical documentation of all of the following (described as “paragraph A requirements”):

• Exposure to actual or threatened death, serious injury, or violence;
• Subsequent involuntary re-experiencing of the traumatic event (for example, intrusive memories, dreams, or flashbacks);
• Avoidance of external reminders of the event;
• Disturbance in mood and behavior; and
• Increases in arousal and reactivity (for example, exaggerated startle response, sleep disturbance)

The applicant must also fulfill the requirements of either paragraph B or paragraph C:

Paragraph B

Requires documentation of extreme limitation of one or marked limitation of two of the following areas of mental functioning:

• The ability to understand, remember, or apply information
• The ability to interact with others
• The ability to concentrate, persist, or maintain pace
• The ability to adapt or manage oneself

Paragraph C

Requires that the mental disorder is “serious and persistent”. SSA defines serious and persistent in this context as ongoing for at least two years, and also requires evidence of:

• Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder, and
• Marginal adjustment (minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life)

Gathering adequate medical documentation to prevail in a PTSD and social security claim can be difficult, for a number of reasons. Depending on the symptoms and types of impairment the applicant is suffering, it may be difficult to keep up with doctor appointments and treatment regimens. Often, someone suffering from serious PTSD will require assistance to fulfill those requirements.

In some cases, existing medical records are insufficient, and additional evaluation is required, particularly if the applicant was diagnosed by and received medication from their medical doctor, but has not been evaluated or treated by a psychiatrist.

Mental disorder cases generally can be more difficult simply because there are fewer objective measures available. Assessment of the degree to which certain functions are impaired depends largely on self-reporting, opinions of medical providers, and questionnaires completed by people in the applicant’s day-to-day life.

Other Criteria for SSDI

The Social Security Blue Book sets forth the specific criteria an applicant suffering from PTSD must fulfill to medically qualify for SSDI benefits. But, it’s important to keep in mind that there are technical requirements as well. First, the applicant must have sufficient work credits–and sufficient recent work credits–to qualify for benefits. This calculation will depend on the applicant’s age at the time they became disabled.

The applicant must also either be unemployed due to the disability or have earnings so low that they do not meet SSA’s definition of “substantial gainful activity” (SGA). That limit is updated regularly. In 2022, the SGA limit is $1,350/month. The limit is higher if the applicant is blind. However, that doesn’t mean that a person who is receiving SSDI benefits can continue to earn up to $1,350/month without impacting their benefits.

If you are applying for SSDI and have earnings from work, be sure to talk to your attorney about trial work periods and what level of earnings will put you on a path toward ineligibility.

When to apply for PTSD benefits?

You need to have a formal diagnosis of PTSD from a qualified healthcare professional before applying for benefits. This diagnosis will confirm that you have PTSD and also provide a foundation for your claim. Although starting the application process can be easy, getting the support of a Social Security lawyer can help manage your application for PTSD benefits and secure your financial future.

Have You Been Denied The Benefits? Contact a Disability Attorney Right Away

If you’ve been denied Social Security disability benefits, it’s important to understand that most initial applications are denied. That’s true for SSDI applications generally, and claims relating to mental disorders can be even more complicated. That initial denial doesn’t necessarily mean you’re not eligible for benefits, and it doesn’t necessarily mean you won’t get them.

An experienced Social Security disability attorney like the ones at Dyer, Garofalo, Mann & Schultz can help you assemble the type of evidence the Social Security Administration is looking for when you attend a hearing with an administrative law judge or file an appeal in federal court. We’ll put our experience to work building the strongest possible case on your behalf in all related to PTSD and social security benefits.

To learn more, call 937-222-2222 or fill out the contact form on this page.