PTSD and Social Security Eligibility

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.

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.

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.

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.

Have You Been Denied The Benefits of PTSD and Social Security? 

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 lawyer 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.