Bipolar Disorder - Who Gets Disability Payments?
by M.T.J. from MO
(Social Work Student)
This paper was inspired by entries from previous years which look at the issue of whether or not bipolar disorder is a disability.
The consensus seems to be “sometimes”. That is, most people with bipolar disorder can work but some experience bipolar disorder so debilitating that they are effectively disabled.
However, for most of us with bipolar disorder, once we have an accurate diagnosis and an effective treatment plan, usually focused on the right medication and a sensible lifestyle and regular therapy or counseling, we can be successful and productive with work or school.
Although most of us may be able to function in the workplace, there are still many who cannot. One study showed a large percentage of patients presenting for the treatment of bipolar disorder miss some time from work due to psychiatric reasons. Further, there employment problems tended to persist.
Interest in the issue of bipolar disorder as a disability often stems from practical concerns. For the minority who are unable to work because of their bipolar disorder, finding some alternative means of financial support is essential. An obvious solution is social security disability benefits.
This paper addresses what some with bipolar disorder (manic depressive illness) must do in order to receive government disability payments in the US.
There are actually several preconditions and, once these thresholds are the met, the process is a sequential one of five steps:
1. Are you working?
2. Is your condition severe?
3. Is your condition a disabling condition as recognized by the Social Security Administration?
4. Can you do the work you did previously?
5. Can you do any other typed of work?
Dealing with the entire process is beyond the scope of this essay.
My focus will be on the second question, “Is your condition severe?”
This is the important stuff. It is the real guts of any individual case.
We already know that people can have full-blown acute Bipolar Type 1 – certainly a “severe” condition - but who respond well to medication and other treatment and can continue with their work or studies. (This is my situation, at least for now.)
What must your bipolar disorder look like, in the real day to day sense, in order for it to be “severe” enough to meet the requirements needed for social security disability payment?
The answer is that the symptoms of your bipolar disorder must impair you so badly that they cause you functional limitations that are incompatible with the activities required for gainful employment.
Under the Social Security Administration rules, you must have at least TWO of the following:
“1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration.”
To meet the criteria of point one, based on “activities of daily living” you would need to show a marked restriction in performing tasks such as cleaning, shopping, cooking, using public transport like buses and trains, paying your bills, attending to personal grooming and hygiene, using a phone or a phone a phone book, etc.
This is where a lot of applications for disability benefits fail. It is necessary to show more than that you have bipolar disorder. You must show the real world impact of bipolar disorder on your daily life so that the connection between your bipolar disorder and your difficulties in keeping your affairs in order is obvious to others.
To meet the criteria of point two, based on maintaining “social functioning” you would need to show marked difficulties in things like initiating social contact, communicating clearly, participating in group activities, cooperating with others, and responding appropriately to persons in authority.
Again, this can be the downfall of an application. It is not enough that your psychiatrist has a record of a relevant bipolar disorder symptom such as paranoia. You must be able to show a history of how your symptoms have had a practical impact because of an inability to communicate and get along with others. Examples would be getting evicted after fighting with your landlord, or being fired after altercations at your work place.
To meet the criteria of point three, “marked difficulties in maintaining concentration, persistence, or pace”, you need to show problems with things like memory and focus to the point where you are very slow at tasks, make an unacceptable amount of mistakes, and need an unsustainable level of spoon feeding.
According to the Social Security Administration:
“Strengths and weaknesses in areas of concentration can be discussed in terms of frequency of errors, time it takes to complete the task, and extent to which assistance is required to complete the task.”
There is a lot more to be said about the intricacies of being awarded social security disability for bipolar disorder.
However, by now the following should be clear. You will only be granted disability if bipolar disorder is having a severe impact on your day to day functioning.
Proving a claim is not about satisfying a checklist of well known bipolar disorder symptoms. Rather, it is about presenting a highly individualized case that clearly shows the assessors how your internal moods and mental state have external, measurable, observable effects.
You must SHOW THEM the PRACTICAL CONSEQUENCES of bipolar disorder.
Remember, what you are ultimately trying to prove is that your bipolar disorder is so incapacitating in its severity that you cannot do any form of paid work. This is not about your feelings or perceptions. It is about presenting objective EVIDENCE that connects the symptoms in your medical records with your inability to work.
Social Security Administration “Adult Disability Starter Kit” at http://www.ssa.gov/disability/disability_starter_kits_adult_eng.htm
Freeman, Sarah “Social Security Disability & Bipolar Disorder” at http://www.bipolar-lives.com/disability.html
About.com “Bipolar Disorder and Social Security Disability” at http://bipolar.about.com/od/disability/Social_Security_Disability.htm
“Jockey Rides to Victory in Bipolar Disorder Stakes” at http://pn.psychiatryonline.org/content/46/10/16.1.full