Post-Traumatic Stress Disorder and qualifying for disability assistance.

Table of Contents:

  Brief Summary
  Functional Challenges
  How do I qualify for disability benefits?
  What if I don’t meet the requirements?
  What if I have Multiple Health Conditions?
  What are the SSA’s Financial Requirements?
  Help for Older Applicants?
  The SSI alternative
  What if I have a long-term disability policy?
  Do I need Representation?
  Conclusion
  Contact a Disability Lawyer

Some of the most common functional challenges include:

•   Inability to concentrate on tasks due to intrusive thoughts or flashbacks
•   Difficulty following instructions or remembering workplace procedures
•   Problems interacting with coworkers or supervisors due to irritability or social withdrawal
•   Unpredictable emotional responses to workplace triggers
•   Excessive absenteeism due to sleep disturbances, medical appointments, or symptom flare-ups

To qualify for disability benefits based on PTSD under Listing 12.15, you must satisfy both the “A” and “B” criteria, or the “A” and “C” criteria:

A. Medical Documentation: You must have medical documentation of all of the following:

1.   Exposure to actual or threatened death, serious injury, or violence
2.   Subsequent involuntary re-experiencing of the traumatic event
3.   Avoidance of external reminders of the traumatic event
4.   Disturbance in mood and behavior
5.   Increases in arousal and reactivity (e.g., exaggerated startle response, sleep disturbance)

AND

B. Extreme limitation of one, or marked limitation of two, of the following areas:

1.   Understanding, remembering, or applying information
2.   Interacting with others
3.   Concentrating, persisting, or maintaining pace
4.   Adapting or managing oneself

OR

C. Your mental disorder must be “serious and persistent” (i.e., you have a medically documented history of the existence of the disorder over a period of at least 2 years) and evidence of both:

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

Your medical records must document the severity and duration of your symptoms. This documentation typically includes:

•   Psychiatric evaluations
•   Therapy notes
•   Hospitalization records
•   Medication history and response
•   Statements from treating mental health professionals

The RFC assessment evaluates what you can still do despite your limitations and considers:

Mental Abilities:

•   How well you can follow instructions
•   Your ability to concentrate on tasks
•   Your capacity to interact appropriately with coworkers and supervisors
•   Your ability to handle workplace stress and changes

Combined with Vocational Factors:

•   Age
•   Education level
•   Work history and transferable skills
•   Other health conditions

When applying with multiple conditions:

•    Ensure all conditions are thoroughly documented in your medical records
•    Make sure the SSA is aware of all your diagnoses
•    Explain how the combination of conditions affects your daily functioning and ability to work
•    Consider how symptoms from different conditions may exacerbate each other

The Social Security Administration has established financial requirements to qualify for disability assistance:

Social Security Disability Insurance (SSDI):

1.    Requires sufficient work credits earned through paying Social Security taxes
2.    Generally, you need 40 credits total, with 20 earned in the last 10 years (younger workers may qualify with fewer credits)
3.    Work credits are based on annual income; in 2025, you earn one credit for each $1,810 in covered earnings, up to four credits per year
4.    There is no income or asset limit for SSDI, but you cannot engage in “substantial gainful activity” (SGA)
5.    In 2025, SGA is defined as earning more than $1,620 per month for non-blind individuals ($2,700 for blind individuals)

For applicants with PTSD who are over 50:

Ages 50-54 (Closely Approaching Advanced Age):

•    The SSA acknowledges it may be difficult to adjust to other work
•    If your PTSD limits you to sedentary work, but you lack transferable skills from previous employment, you may be found disabled
•    Your education level and work history are significantly factored into the decision

Ages 55 and older (Advanced Age):

•   Even greater consideration is given to age as a vocational factor
•   If your PTSD prevents you from performing past relevant work, and you don’t have transferable skills to other jobs within your physical and mental capacities, you’re more likely to be approved
•   The bar for transferability of skills becomes higher; the skills must enable you to adjust to other work with very little additional training

For PTSD sufferers considering SSI:

Qualifying Factors:

•   The medical criteria for disability are identical to SSDI
•   You must have limited income and resources
•   You must be a U.S. citizen or qualified alien
•   The maximum federal benefit in 2025 is $967 per month for individuals and $1,450 for couples (some states provide supplemental payments)

Income Considerations:

•   Not all income counts toward the limit
•   The SSA disregards the first $20 of most income received in a month
•   Additionally, the first $65 of earned income plus half of the remainder is not counted
•   Income from certain sources, such as food stamps or housing assistance, is excluded

Resource Considerations:

•   Countable resources cannot exceed $2,000 for individuals or $3,000 for couples
•   Your home, one vehicle, household goods, and certain burial funds are typically excluded

Key Differences from Social Security:

•   LTD policies typically replace 60-70% of your pre-disability income
•   Many policies have a limited benefit period (often 2, 5, or 10 years) rather than continuing until retirement age
•   The definition of disability is often stricter after the first 24 months, changing from “own occupation” to “any occupation”
•   Most policies require you to apply for SSDI and will offset their payments by the amount you receive from Social Security

PTSD-Specific Considerations:

•   Some policies limit benefits for mental health conditions to 24 months
•   You may need to demonstrate ongoing treatment compliance
•   The insurance company may require periodic independent medical evaluations
•   Documentation of functional limitations is crucial

If you have both LTD coverage and PTSD, you should:

1.   Review your policy carefully for any limitations on mental health claims
2.   Continue all prescribed treatments and therapy
3.   Maintain detailed records of symptoms and how they affect your daily functioning
4.   Consider applying for both LTD and Social Security disability simultaneously
5.   Be aware that approval for one type of benefit doesn’t guarantee approval for the other

Benefits of Attorney Representation:

Experience in PTSD Cases:

•    Attorneys familiar with PTSD claims understand how to translate clinical symptoms into functional limitations that meet SSA criteria
•   They know which medical evidence is most persuasive for PTSD cases
•   They can identify and address potential weaknesses in your claim before the hearing

Hearing Preparation:

•   Your attorney will gather and organize all relevant medical evidence
•   They’ll prepare you for questions the ALJ might ask about your symptoms and limitations
•   They can help obtain supporting statements from treating physicians
•   They’ll develop a theory of your case that aligns with SSA regulations

During the Hearing:

•   Your attorney will present opening and closing statements highlighting how your PTSD meets disability criteria
•   They’ll object to improper questions or procedures
•   They can cross-examine vocational or medical experts effectively
•   They ensure all relevant evidence is properly considered

Statistical Advantage:

•   Represented claimants are statistically more likely to be approved than unrepresented ones
•   The complex nature of PTSD claims makes professional guidance particularly valuable

Financial Considerations:

•   Disability attorneys typically work on contingency, collecting fees only if you win
•   Fees are usually limited to 25% of past-due benefits, up to a maximum of $9,200
•   No upfront costs means legal representation is accessible regardless of financial situation