Mood Disorders and Social Security Disability

Mood Disorders - Condition and Symptoms

Mood Disorders are one form of mental illness. Mood Disorders can range from mild depression to psychosis. Mood is definite as the way a person experiences internal emotions, and a mood disorder can be thought of as any condition that disturbs one’s emotional life. Mood Disorders are extremely common, and may be caused by a traumatic event, brain chemistry, genetic inheritance, allergens, and any number of other factors.

Mood Disorders can be broadly categorized as being either depression- or anxiety-related.

Depression-related Mood Disorders

Two of the most common depression-related Mood Disorders are depression and bipolar disorder (once known as manic-depression). The definitions of the various types of bipolar disorders almost all include episodes of depression and episodes of mania (extremely disruptive and intense experiences of heightened mood).

Diagnoses of Mood Disorders include Bipolar I Disorder, Bipolar II Disorder, Bipolar Disorder Not Otherwise Specified, Cyclothymic Disorder, Depressive Disorder Not Otherwise Specified, Depression (11 types), Dysthymic Disorder, Major Depressive Disorder, Postpartum Depression, Mood Disorder Due to a General Medical Condition (a direct result of a physiological condition), Mood Disorder Not Otherwise Specified, and Substance-Induced Mood Disorder (the direct physiological result of a substance).

Depression affects people of all ages, both sexes, all races, and in all parts of the world. Symptoms of depression in adults include deep, unshakable sadness and diminished interest in nearly all activities, as well as feelings of despair, hopelessness, and worthlessness, and in extreme cases even thoughts of committing suicide. Depression can dramatically impair a person’s ability to function both in social situations and at work.

Depression can be treated either with psychotherapy, drugs, environmental changes (such as social change, dietary change, and change in one’s level of exercise), or with a combination of the above methods.

Anxiety-related Mood Disorders

Anxiety disorders are the most common form of Mood Disorder in the United States. To be categorized as a “disorder,” a person’s anxiety must interfere directly and significantly with their work, relationships, social life, and/or daily activities. Left untreated, anxiety disorders often progress from relatively mild to severe, leading to panic attacks, phobias, and depression, and it is not uncommon for severe anxiety disorders to interfere with a person’s ability to keep a job. In addition, people with untreated anxiety disorders often resort to alcohol or drug abuse to alleviate symptoms. Unfortunately, this behavior often aggravates the condition.

Anxiety-related Mood Disorders include agoraphobia (fear of public places or situations), panic disorders (panic attacks), obsessive-compulsive disorder or OCD (repetitive or ritualistic behavior that is performed to reduce anxiety), phobias (irrational fears of a thing, such as elevators, or a situation, such as using a public restroom), stress disorders (including post-traumatic stress disorder and acute stress disorder (symptomatic reactions to past events), generalized anxiety disorder (anxiety that is not linked to a specific cause or situation), anxiety disorders occurring as a result of medical conditions or substance abuse, and anxiety disorder not otherwise specified (anxiety not due to any of the causes described above).

Anxiety can be caused by traumatic events in a person’s life and/or by genetic, environmental, and/or social factors. There are many causes of anxiety and a wide range of other conditions that list anxiety as a symptom (such as schizophrenia or major depression), and therefore the diagnosis of an anxiety disorder can be complicated. The physician who is attempting a diagnosis will usually begin by ruling out other causes of anxiety, such as other psychological conditions, medications, physical diseases, temporary life conditions, or simple lifestyle habits (overconsumption of caffeine, for example) that may cause anxiety. When appropriate, the physician may order lab tests for physical causes, such as blood sugar levels and thyroid function. Unfortunately, there are no lab tests or psychiatric tests that pinpoint a diagnosis of anxiety disorder.

Anxiety disorders are treatable, however, with methods including psychotherapy, medication, or a combination of both. Non-standard treatments include meditation, hydrotherapy, tension-relieving physical activities such as some of the marital arts and yoga, homeopathy and traditional Chinese medicine. Regardless of treatment method, recovery depends on the type of anxiety disorder, the severity of symptoms, and the specific causes of anxiety and the degree of control a person has over these causes.

Filing for Social Security Disability with a Mood Disorder Diagnosis

SSA’s definition of disability is “any medically determinable mental or medical impairment that has prevented an individual from performing substantial work for twelve months, that is expected to prevent an individual from working for twelve continuous months, or is expected to end with death.” Social Security Administration (SSA) disability programs are based more upon what you are able to do in spite of your disability, rather than on what you cannot do. Because Mood Disorders have a tendency to wax and wane, allowing you to function well for awhile and then not function at all, it can be very difficult to successfully disability claim SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) benefits on the basis of a Mood Disorder diagnosis.

First there is the problem of documenting Mood Disorders as a condition. Mood Disorders do not lend themselves to objective medical evidence in the way that other physical conditions do. For example, osteoarthritis is listed in the Blue Book and can be seen on x-rays and in blood work. The diagnosis of a Mood Disorder is usually based on behavior and feelings, criteria that are much more subjective and hard to document.

Secondly, most people who suffer from Mood Disorders either never get or fail to keep the medical records they need to prove the severity of their condition. Without a history of treatment by a psychologist or psychiatrist, it is hard to prove the consistent nature of a Mood Disorder. Most people have treatment on an irregular basis, when symptoms force them to the doctor’s office, and many try combinations of treatments from a variety of sources, from nutrition to psychoanalysis. Even when you have been seeing your doctor regularly for treatment, it is hard to make the case that your condition meets the SSA’s strict requirements for total disability.

Thirdly, if you do not have adequate medical records to prove the severity of your symptoms, you will probably be seen by an independent medical consultant. These consultants are physicians who will examine you and provide the results to SSA. Although your examination can show that you suffer from a Mood Disorder, there is no way to prove how long you have had the condition. These examinations are no substitute for documented treatment history provided by a qualified physician or psychologist.

Your best chance to receive a favorable outcome for disability benefits is to have received treatment on a regular basis and to have records that document that treatment.

Even though the medical community often considers Mood Disorders to include both anxiety and depression, SSA considers Mood Disorders to be affective disorders, such as depression and bipolar disorder. Depression and bipolar disorders are viewed separately from anxiety-related disorders, and SSA has differing criteria for an approval of benefits for these two sub-categories of mental illness.

Therefore, in addition to the difficulty of documenting your condition, you will also have to decide whether to file for disability benefits under Affective Disorders (for Mood Disorders such as depression and bipolar disorder) or under Anxiety-Related Disorders (Mood Disorders that are anxiety-based).

Applying for Benefits Under Affective Disorders (for Depression and Bipolar Disorder)

To qualify for either Social Security Disability or Supplemental Security Income benefits on the basis of an affective disorder, your medical records must satisfy at least one of the following two sets of criteria.

The first set of criteria:

  1. Your depression must result in marked restrictions or difficulty in at least two of the following areas:
    1. daily activities
    2. social functioning
    3. your ability to maintain concentration, persistence, or pace
    4. repeated occurrences in decompensation episodes (meaning a deterioration of you condition), with each episode having extended duration
  2. Your depression must also result in at least four of the following, either occasionally or consistently:
    1. anhedonia (a condition in which you are unable to experience pleasure) or a pervasive loss of interest in nearly all activities
    2. significant changes in eating habits and weight
    3. sleep disturbances
    4. agitation or retardation of psychomotor function
    5. decreased energy levels
    6. feelings of guilt or worthlessness
    7. suicidal thoughts
    8. difficulty thinking or concentrating
    9. hallucinatory episodes, delusions, or paranoid thinking

If you are unable to meet the first set of criteria, you may qualify for benefits by meeting each of the elements of a second set of criteria:

  1. You must have a medically documented history of depression, lasting at least two years.
  2. Your medical records must show that your depression has limited your ability to work. There may be some improvement in your ability to work being the result of treatment in the form of counseling or prescribed medicine.
  3. Your records must show you are subject to repeated episodes decompensation (meaning a worsening symptoms of your symptoms), each episode being of an extended duration

    OR evidence that the aftereffects of a disease causes worsening of your symptoms with even a minimal increase in mental demands or changes to the environment

    OR evidence that you are unable to live at least one year outside a ”highly supported living arrangement” together with evidence that this arrangement needs to be continued.

It is possible to be awarded either complete disability benefits or to be awarded a medical vocational allowance if you meet the tests discussed above. Most people receive Social Security Disability benefits under this heading in the form of a medical vocational allowance.

Applying for Benefits Under Anxiety-Related Disorders

If you apply for disability benefits under Anxiety-Related Disorders, you must meet the conditions of Paragraphs A and B below OR the conditions of Paragraphs A and C below.

  1. You must have medical documentation of one of the following:
    1. Constant generalized anxiety, with three of the following four symptoms: motor tension, vigilance and scanning, autonomic hyperactivity, or apprehensive expectation.
    2. Constant irrational fear of a situation, object, or activity that results in a significant desire to avoid the situation, object, or activity.
    3. Recurring severe panic attacks that are characterized by sudden unpredictable episodes of intense fear, apprehension, terror, and a sense of impending doom that happen at least once a week.
    4. Recurrent compulsions or obsessions that cause marked distress.
    5. Recurring intrusive remembrances of a traumatic experience that causes marked distress.
  2. The condition under Paragraph A above must result in at least two of the following OR Paragraph C below:
    1. Marked problems maintaining concentration.
    2. Marked difficulties with persistence, or pace.
    3. Repeated periods of decompensation, each of extended duration.
    4. Marked difficulties maintaining social functioning; or restriction of routine activities of daily life.
  3. The conditions described in Paragraph A must result in your total inability to function independently outside your home.

It is possible to be awarded either complete disability benefits or to be awarded a medical vocational allowance if you meet the tests discussed above.

Your Mood Disorder Disability Case

If you are disabled because of a Mood Disorder that interferes with your day to day activities prevents you from working, you may well be entitled to Social Security Disability (SSDI) benefits. Although total disability based on a Mood Disorder can be difficult to prove compared to other disabling conditions, working closely with medical professionals and a qualified Social Security Disability attorney or advocate to collect and present the appropriate documentation to support your disability claim can help to ensure that your Mood Disorder disability case will have the best possible chance of success.

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