Post-Traumatic Stress Disorder and qualifying for disability assistance.

Can I get disability benefits if I am suffering from PTSD?

Author Attorney Greg Reed:

Post Traumatic Stress Disorder, or PTSD, is a disorder that develops when a person experiences a frightening, shocking or dangerous event. PTSD was first observed during the Civil War and was officially recognized by the American Psychiatric Association in 1980. Approximately seven million people in the U.S. suffer from PTSD, and according to the National Center for PTSD, 10% of women and 5% of men in the U.S. will develop PTSD at some point in their lives.

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The Social Security Administration added a new impairment listing in 2017 under which a person with PTSD may qualify for Social Security Benefits.

People often associate PTSD with a military experience such as war, but anyone can suffer from PTSD.

It can be triggered by a serious accident, violent assault, a natural disaster, or even the loss of a loved one. It is normal for a person to be frightened during and after a traumatic event as the event triggers a “fight-or-flight” reaction to protect the person and defend against danger. Most people recover over time, but individuals afflicted with PTSD continue to experience a feeling of danger long after the event has passed.

When a person experiences a stressful or traumatic, it affects the autonomic nervous system, endocrine system and immune system.

Large amounts of inflammatory hormones pour into the body. For a person with PTSD, these hormones are released even with the memory of the traumatic event, causing emotional stress overload. People with PTSD may relive the event through flashbacks or nightmares; they may feel sad, fearful or angry. Some may feel detached from others and avoid situations that remind them of the event. Others may have negative reactions to loud noises or a sudden, accidental touch.

PTSD usually begins within three months of an event, but sometimes symptoms do not surface until years later.

The severity and duration of illness varies. PTSD may be confused with acute stress disorder because they share similar symptoms. Acute stress disorder occurs immediately after the trauma and symptoms usually resolve within a month. Some people with PTSD recover in six months, but in other cases the illness may continue for years.

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from PTSD. If you have been denied disability don’t give up!

The symptoms of PTSD are divided into four groups:

  Reliving (or re-experience).

The individual relives the event through flashbacks, nightmares and hallucinations. Events or location remind them of the traumatic event; for example, an anniversary date. A person’s own thoughts or feelings can also trigger symptoms.

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  Avoidance.

The person avoids situations, places and people who remind them of the event. This can cause a person to change their daily routine and lead to isolation from family, friends and colleagues. The person may also lose interest in activities they once enjoyed.

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  Increased arousal.

Excessive emotions or difficulty feeling or expressing affection and relating to others. The person may experience anger, irritability or have trouble sleeping. They may be easily startled or behave in a destructive way. Physical symptoms include rapid breathing, muscle tension, nausea and diarrhea.

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  Cognitive and mood.

The person may have ongoing and distorted beliefs concerning the event, themselves and others. These feelings include blame, guilt, estrangement and shame. They may also have trouble remembering key details of the event.

To be diagnosed with PTSD a person must have:

•    One re-experiencing symptom, such as flashbacks or nightmares
•   One avoidance symptom
•   Two arousal symptoms
•   Two cognitive and mood symptoms

Children can also experience PTSD, but will present different symptoms:

•    Be unable to speak or forget how to talk
•   Act out the event during play
•   Bedwetting
•   Cling to a parent or adult

The symptoms of PTSD last more than one month and may continue for years, interfering with a person’s daily life and possibly result in depression, substance abuse, and memory problems.

Treatment for PTSD includes medication, psychotherapy or both. Medications such as Paxil, Zoloft and Elavil can control feelings of anxiety while other medications may be prescribed for nightmares. Over the years, tranquilizers have been found unhelpful and carry the risk of dependence and addiction. Psychotherapy can help a person develop skills to manage their symptoms and cope in daily life. Psychotherapy also educates the person and their family about PTTSD and helps the person work through any fears associated with the event. Seeking the support of friends and family and finding a support group after the event can reduce the effects of PTSD.

The Social Security Administration added a new impairment listing in 2017 under which a person with PTSD may qualify for Social Security Benefits.

12.15 Trauma– and stressor-related disorders (see 12.00B11), satisfied by A and B, or A and C:

  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 (for example, intrusive memories, dreams, or flashbacks);
3.   Avoidance of external reminders of the event;
4.   Disturbance in mood and behavior; and
5.   Increases in arousal and reactivity (for example, exaggerated startle response, sleep disturbance).

AND

  Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):

1.    Understand, remember, or apply information (see 12.00E1).
2.   Interact with others (see 12.00E2).
3.   Concentrate, persist, or maintain pace (see 12.00E3).
4.   Adapt or manage oneself (see 12.00E4).

OR

   Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:

1.   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 (see 12.00G2b); and
2.   Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life (see 12.00G2c).

To qualify for Social Security Disability Income, a person with PTSD must satisfy the requirements of the above listing.

Social Security will request your medical treatment records (inpatient and outpatient, counseling and therapy) for the previous year, but it’s best to provide all records from the past several years. It is very important to include your doctor’s opinion regarding your mental state.

You should also ask your doctor to complete a Residual Functioning Capacity Form or letter detailing your:

•    Ability to sustain a routine without supervision
•   Ability to understand, remember, and carry out instructions
•   Ability to maintain concentration
•   Absences from work due to your condition (more than 2 days per month)
•   Ability to make simple work-related decisions
•   Timeliness at work and avoiding unscheduled breaks

Third-party statements from family, friends and former employers and co-workers are helpful and should focus on your interactions with others – not medical issues.

Although most cases of PTSD are not severe enough to qualify under the Social Security listing, a mental consultant for Social Security may determine that an applicant’s symptoms are severe enough to prevent them from working and may award a medical-vocational allowance.

Trouble concentrating, poor memory, and sleep disturbances all interfere with a person’s work performance. If other mental disorders are present, an applicant has a better chance of receiving benefits, especially if the applicant is 55 or older, has little education, and no past history of skilled employment.

Case Study:

Multiple physicians, including treating physicians, Aetna’s own reviewing physicians, and independent physicians working for the Social Security Administration, had stated that one of our Austin clients was disabled.

He suffered from anxiety and depression, as well as certain features of agoraphobia. He had been suffering from mental health issues with PTSD since childhood. Aetna’s own psychologist concluded that our client was functionally impaired since his last day of work, and continued to be functionally impaired. The Social Security Administration determined he qualified for disability benefits. Aetna, however denied his claim. We filed suit and were able to settle his claim.

If you have PTSD and it has prevented you from working, you may be eligible for Social Security Disability benefits. Because it is so difficult to qualify with this condition, it’s best to have a qualified disability attorney by your side.

In order to qualify for Social Security Disability, you will need to satisfy a few specific requirements in two categories as determined by the Social Security Administration.

The first category is the Work Requirements which has two tests.

1.   The Duration of Work test.   Whether you have worked long enough to be covered under SSDI.
2.   The Current Work Test.   Whether you worked recently enough for the work to actually count toward coverage.

The second category is the Medical Eligibility Requirement.

1.   Are you working?   Your disability must be “total”.
2.   Is your medical condition severe?    Your disability must be “severe” enough to interfere with your ability to perform basic work-related activities, such as walking, sitting, and remembering.
3.   Is your medical condition on the List of Impairments?   The SSA has a “List of Impairments” that automatically qualify as “severe” disabilities. If your disease is not listed this does not mean you cannot get disability, it means you must prove you cannot maintain employment due to your limitations.
4.   Can you do the work you did before?   SSDI rules look at whether your medical condition prevents you from doing the work you did prior to developing the condition.
5.   Can you do any other type of work?   If you cannot do your prior work, an evaluation is made as to whether you can perform any other kind of work.

More details can be found on our Qualifying for Disability page.