Law

How does a claimant qualify for PTSD Disability Benefits?

Claimants for PTSD Disability benefits can receive considerable compensation or a medical-vocational allowance if the medical records meet the Social Security listing.

The Social Security Administration (SSA) awards disability benefits to individuals with severe physical health conditions, and also to those who suffer from mental health impairments. Many people suffer from post-traumatic stress disorders (PTSD) that prevent them from performing their day-to-day activities.

Social Security Administration (SSA) is a federal government agency responsible for administering social programs and granting benefits to individuals with disabling impairments such as PTSD. However, the SSA strictly evaluates the evidence of any previous trauma, ongoing symptoms, and severe hindrances before considering a claimant with PTSD eligible for Social Security Disability benefits.

To make the process easier, you can seek help from a disability lawyer.

What is Post-Traumatic Stress Disorder (PTSD)?

Post-Traumatic Stress Disorder is a mental health condition that is triggered by witnessing or experiencing a terrifying incident. Flashbacks, nightmares, severe anxiety, and unavoidable thoughts about the terrifying incident or event are some of the symptoms of PTSD.

Symptoms may start within a month of the event or can even appear years after the event. These symptoms can interfere with a patient’s ability to earn a livelihood.

Patients with PTSD always fear the recurrence of the traumatic event that they have either witnessed or experienced.

Depending on a patient’s history and evaluation of the mental health condition, professional and experienced psychologists or psychiatrists conduct a diagnosis of post-traumatic stress disorder.

Mental health professionals mostly rely on counseling, psychotherapy, antipsychotic medications, and cognitive-behavioral therapy to treat patients with PTSD.

Top ways to receive disability benefits for PTSD

There are two ways to get approved for disability benefits for your PTSD.

The first is to satisfy the requirements of Social Security Administration’s new disability listing for PTSD under Section 12.15 of its impairment listings manual or “Blue Book.”

The second way is to receive a “medical-vocational allowance” by showing that your impairments prevent you from working full-time.

“Third Party Statements” written by friends, family, co-workers, and employers can also be helpful in demonstrating that you are not able to work. Such statements should be based on the third party’s observations of you and their interactions with you, rather than your health issues.

Meeting the SSA’s listing of impairments with PTSD.

The SSA added a disability listing for PTSD in 2017 as Section 12.15 of its impairment listings manual or “Blue Book.” This listing covers trauma- and stressor-related disorders.

To meet the criteria for the listing, you must have medically documented evidence of all the following:

  • An exposure to a death or threatened death, serious injury, or violence,
  • Subsequent involuntary re-experiencing of the traumatic event (intrusive memories, dreams, or flashbacks),
  • Avoidance of external reminders of the event,
  • Disturbance in mood and behavior, and
  • Increase in “arousal and reactivity” (exaggerated startle response, or sleep disturbances).

In addition to proving the above, you must show that you have an extreme limitation in one of the following or a “marked” (severe) limitation in two of the following:

  • Adapting or managing oneself (regulating one’s emotions, adapting to changes, practising personal skills like cooking, cleaning, and wearing appropriate attire)
  • Interacting with others in socially appropriate ways
  • Concentrating on tasks
  • Learning, understanding, and remembering information

If you don’t currently suffer any extreme or severe limitations in the above-stated areas because you are living in a highly-protected environment or supervised situation or you are undergoing intense therapy, you can provide certain information to meet the listing. You must show that:

  • Your PTSD has been serious and persistent over a period of at least two years,
  • You are undergoing medical treatment, or mental health therapy, or living in a highly-structured or protected setting, and
  • Your adaptation is fragile, meaning you have minimal capacity to adapt to changes.

If your condition/impairment does not qualify for full Social Security Disability benefits, there is a chance you may still be awarded a medical vocational allowance.

Qualifying for Social Security Disability with a medical-vocational allowance

Using another criteria, the SSA will give you a rating depending on the type of work it thinks you can do (skilled work, semi-skilled work, or unskilled work). This is called Mental Residual Functional Capacity (Mental RFC).

Your treating doctor will have to complete a functional report that shows that your PTSD has adversely affected your daily life and has made it impossible for you to carry out activities like moving around, shopping, and doing household chores without assistance from someone else.

If the SSA determines that you cannot even perform unskilled work, it will duly grant you benefits under a “medical-vocational allowance.”

Most claimants applying for Social Security Disability benefits for PTSD either qualify under the official listing or a “medical-vocational allowance.” But only a few claimants are successful using the other alternatives.

If your initial application for Social Security Disability benefits for PTSD is rejected by the SSA, you should consult an experienced San Antonio disability attorney who can help you decide your future course of action.

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