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Post-Traumatic Stress Disorder (PTSD) is a mental illness associated with anxiety and panic resulting from extreme mental trauma, such as seeing the possibility of death or bodily harm. There are many symptoms of a PTSD disability, including hypervigilance, difficulty concentrating, feeling guilty, disinterest in regular activities, flashbacks, etc. These symptoms can last a lifetime or be intermittent. As a result, they can be disabling since they can seriously hinder daily activities.
There is no short answer to this question. It all depends on the severity of symptoms, effectiveness of treatment options, the strength of medical evidence, age, educational level, and job experiences. PTSD disability claims often face a challenge because the cause of the symptoms often cannot be determined medically, which means there is no objective test that can confirm the severity of the disorder.
Social Security has difficulty assessing the severity of alleged conditions in this situation. A PTSD disability claim typically depends on your credibility and the quality of your treatment. Your claim is more likely to be approved if your medical professional has specialized training and has convincing medical treatment records. In addition to psychiatric treatment and medication, one can also employ hospitalization and other forms of treatment. People living with PTSD disability have a harder time adhering to treatment regimens, making appointments, etc., making their claims less credible since compelling medical evidence is more difficult to obtain.
Social Security uses a five-step sequential evaluation process if you have a disability and wish to receive benefits under SSDI and SSI. An adjudicator, or decision-maker, oversees each step of the disability claim process. An Examiner from the Disability Determination Service (DDS) consults with a DDS Physician for the initial application and redetermination phases. The Administrative Law Judge makes the decision during the Hearing stage, often accompanied by a Medical Expert (ME). The adjudicator evaluates the case at each phase based on the following criteria.
Step 1: Non-Medical Criteria
Social Security prohibits you from working more than what they call Substantial Gainful Activity (SGA). You cannot earn more than $1,090 in gross (pre-tax) income every month. For a claim to advance to the second step, a complete medical review must also satisfy the SGA rule. You cannot move forward with your claim if you do not meet the non-medical eligibility requirements, regardless of how severe and debilitating your PTSD disability might be (even if you have extensive medical evidence). It is possible to appeal a technical denial, but generally, the appeal will not be successful if the facts are accurate.
Step 2: Severe Impairment
In Step 2, you will be asked whether your symptoms are severe. All the medical evidence will be gathered to determine whether you have severe impairments. Whether an attorney represents you or not, they should play a key role in this procedure. Also, the adjudicator may ask you to take an Activities of Daily Living and Vocational Questionnaire, which provide you with a chance to present your views on how your symptoms have impacted your ability to function normally. A physician contracted by DDS to conduct medical evaluations on their behalf may also be scheduled for a Consultative Examination (CE).
The adjudicator reviews all available evidence and determines whether your symptoms are severe based on the evidence gathered. It must be difficult to perform basic work-like activities for symptoms to be considered severe. Physical limitations can include problems walking, standing, lifting, pushing, carrying things, etc. In addition to the inability to speak, hear, see, concentrate, follow basic instructions, cooperate with coworkers, etc., severity may also include the inability to communicate. If your symptoms are severe, you will proceed to Step 3. Otherwise, your claim will be denied at Step 2, and you can appeal.
Step 3: Medical Listings
Social Security breaks down the human body and mind into fourteen different impairment categories, called the Listing of Impairments. If you have chronic pain, you need to confirm that it meets or equals a listed impairment. Listing 12.06 Anxiety-Related Disorders evaluates claims related to bipolar disorder. To qualify for disability, the individual must have anxiety either as the predominant disturbance or encountered when attempting to control symptoms of an obsessive-compulsive disorder or resist obsessions and compulsions.
When both A and B are met, or when both A and C are met, the required level of severity for these disorders is met:
A. One or more of the following medically documented findings:
- Three out of four of the following symptoms or signs accompany generalized persistent anxiety:
- Motor tension; or
- Autonomic hyperactivity; or
- Apprehensive expectation; or
- Vigilance and scanning;
- Having an irrational fear of something specific that leads to an intense desire to avoid seeing or dealing with the feared object, activity, situation; or
- At least once a week, they suffer from severe panic attacks that manifest as sudden and unpredictable apprehensions, terror, feelings of impending doom, and a sense of impending doom or terror; or
- A pattern of obsessions or compulsions that are causing marked distress; or
- A traumatic experience is recalled repetitively to the point that it causes marked distress, and
B. Having at least two of the following:
- A marked restriction to day-to-day activities; or
- Difficulties have marked the maintenance of social functioning; or
- A tendency to lose focus, be inconsistent, have trouble keeping pace; or
- The occurrence of repeated episodes of decompensation lasting longer each time,
C. Leaving one completely incapable of independent living outside of their home.
Once the adjudicator has reviewed your medical records and found that you meet the medical listing at Step 3, you will be determined to be disabled and eligible for disability benefits. If your medical condition does not qualify you for a medical listing, your claim will proceed to Step 4.
Step 4: Past Work
Step 4 involves determining whether you can perform the same work you have previously performed. A person's Residual Functional Capacity (RFC) helps the adjudicator determine this. After taking into account your medical symptoms, your RFC determines how much your body and mind can do. The adjudicator will consider all symptoms and impairments, including physical and mental impairments. In addition to estimating how capable you are at standing, sitting, walking, lifting, carrying, pushing, pulling, reaching, handling, crouching, remembering, understanding, etc., the adjudicator will rate your ability to handle different tasks.
Among the many limitations in your RFC, you may find that you cannot stand and walk for longer than 4 hours throughout an 8-hour workday and cannot sit for more than 2 hours. You are also unable to lift or carry more than 10 pounds, climb ropes or ladders, maintain concentration, persistence, pace, etc.
Once the adjudicator develops your RFC, they will list your Past Relevant Work (PRW), meaning any job you were employed at in the 15 years immediately preceding the Alleged Onset Date (AOD) of your disability. If you have worked full-time for at least a few months at a job you held within 15 years of your AOD, you can consider that job as Past Relevant Work.
As soon as the adjudicator has completed your list of Past Relevant Work, they must classify it. We will be able to separate your past work based on both your exertional level and your skill level. An example would be a nurse working at a medium exertional level and the position being considered skilled. A security guard working at a light exertional level is considered semi-skilled. When all of your PRW has been classified, an adjudicator will need to determine whether you have the functional ability to perform any of your past work.
The claim would advance to Step 5 if, for instance, the security guard’s impairments prevented them from standing and walking as required for jobs at the Light exertional level. They would not be able to perform security guard duties due to the restrictions found in the RFC. The adjudicator will find you Not Disabled if you can still perform the functions required in your past employment. Upon denial, you can appeal.
Step 5: Other Work
In Step 5, you should determine whether you can perform any other work, regardless of whether you have done it before. Additionally, the adjudicator considers your age, education, work experience, and Residual Functional Capacity (RFC) developed in Step 4.
Your level of education is classified by Social Security as follows:
- Illiterate (or incapable of communicating in English)
- Marginal (generally not higher than 6th grade)
- Limited (usually 7th through 11th grades)
- A high school education (and above)
As your education level affects the level of skills you possess for different jobs, it is important to consider it. A marginal education, for example, would limit you to unskilled jobs, while a high school education would allow you to perform both semi-skilled jobs and skilled jobs.
Work experience is the next factor considered by the adjudicator. Your past work experience can be viewed as a source of skills and abilities. You have now reached Step 5 because the adjudicator at Step 4 determined that you cannot perform your past work. If your skills and abilities from your previous work can be transferred to another job, the adjudicator will review them. In the case of a nurse who previously carried out her job at the Medium exertional level and is unable to perform her previous work, she might have acquired skills that could be transferred to the medical assistant position, which she could perform at the light exertional level.
Finally, the adjudicator will take age into account. The following are the age categories assigned by Social Security:
- Younger (ages 18-49)
- Closely approaching advanced age (ages 50-54)
- Advanced age (ages 55-59)
- Closely approaching retirement age (ages 60+)
Younger individuals are responsible for proving that they cannot perform any type of work, while in the more advanced age categories, the responsibility decreases. As a result, Social Security calls these guidelines the Medical-Vocational Guidelines or the "Grid Rules," since the key factors are arranged in a grid, with the final column deciding whether someone is disabled or not. A person who is older, less educated, and has fewer transferrable skills acquired in the past is more likely to find themselves disabled.
You will be found not disabled and denied if the adjudicator determines that you can perform some other type of work given your age, education, and previous work experience. If you are denied, you may appeal the decision. On the other hand, if the adjudicator finds you cannot perform any other type of work, you will be found disabled and approved for benefits at Step 5.
Applying for Social Security benefits can be an overwhelming process. If you seek SSDI benefits, check out our article on who’s eligible for social security disability benefits. To learn more, visit DisabilityHelp.org today!