How does the Social Security Administration evaluate PTSD under Listing 12.15?

The Social Security Administration categorizes PTSD as a Trauma and Stressor Related Disorder under Listing 12.15. The medical requirements are spelled out in three parts: A, B, and C, and your symptoms must satisfy the requirements of parts A and B or parts A and C. Part A requires medical evidence of exposure to actual or threatened death, serious injury, or violence; involuntary re-experiencing of the event; avoidance of external reminders; disturbance in mood and behavior; and increased arousal and reactivity. Part B requires extreme limitation of one, or marked limitation of two, areas of mental functioning (understand/remember/apply information; interact with others; concentrate/persist/maintain pace; adapt or manage oneself). Part C requires that PTSD is serious and persistent, with a medically documented history for at least 2 years and evidence of ongoing treatment/support that diminishes symptoms and marginal adjustment.

What if you cannot meet the medical listing for PTSD?

If you don’t meet the medical listing, you can still win disability benefits for PTSD through SSA’s medical vocational allowance. This process begins by establishing your Residual Functional Capacity (RFC), or the physical and/or mental level of work you can perform as an impaired person. To qualify, PTSD must be severe enough that you are considered disabled from performing your previous job or any other type of substantially gainful work. SSA looks at the demands of the work you have done in the past 15 years and, if you cannot do it, determines whether there is work available in the national economy that you can do.

What policy restrictions can affect Long Term Disability (LTD) benefits for PTSD?

Common restrictive provisions written into many Long Term Disability policies include coverage restrictions that limit “mental and nervous” conditions (often to 24 months of coverage), an “act of war” exclusion that insurers may try to use to deny PTSD claims, and a Social Security requirement where insurers require you to apply for Social Security Disability benefits because disability payments the insurance company pays may be offset by Social Security Disability payments.

How to Win PTSD Disability Benefits

Q: What are the disabling symptoms of post-traumatic stress disorder (PTSD)?

PTSD symptoms can include flashbacks, dissociation, nightmares, and intense fears. Further common symptoms of PTSD include anxiety and depression, difficulty concentrating, confusion, angry outbursts or an exaggerated startle response, and avoidant behavior.

Lawyer meets with client to explain how to win disability benefits for PTSD.

You can win PTSD disability benefits by proving two things with solid evidence: that you have post-traumatic stress disorder tied to a qualifying traumatic event and that your symptoms keep you from working. You’ll need a clear diagnosis, medical records documenting your stressor and symptoms, and proof of how the condition limits your ability to function day to day. How you present that proof depends on who is deciding your claim. The Social Security Administration, Long Term Disability insurers, and the Department of Veterans Affairs each apply their own standards. All are known to deny PTSD claims when the evidence is not framed the way their examiners expect. Having a Veterans Affairs Disability benefits claims lawyer on your side will help you with this process. An attorney can ensure your claim is supported by strong evidence and handle your case from start to finish. They’ll work tirelessly to get the benefits you’ve already earned.

Understanding PTSD Disability Claims

Post-traumatic stress disorder (PTSD) is a very real mental health disability that is often misunderstood. Living with PTSD becomes more devastating when sufferers find they can no longer do their jobs. Getting needed disability benefits for PTSD can be particularly frustrating. Some people are disabled by PTSD alone, while others with PTSD struggle with additional impairments. Research has linked traumatic stress exposures and post-traumatic stress disorder to such conditions as cardiovascular disease, diabetes, gastrointestinal disease, fibromyalgia, chronic fatigue syndrome, musculoskeletal disorders, eating and sleep disorders. A lawyer can help you seek disability benefits for PTSD if you were wrongly denied by the Social Security Administration (SSA) or by their Long Term Disability insurance carriers such as Unum, Cigna, Prudential, and others. PTSD disability claims are often given a skeptical or unfair review and are denied without proper cause. There are many reasons; perhaps the main reason is that the severity of any mental health condition can be difficult to prove objectively.

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The Many Causes of PTSD

To qualify for disability benefits for PTSD, you should provide sufficient medical documentation of a stressor event. Some cases of PTSD involve experiencing traumatic events such as physical assaults or muggings, terrorist attacks such as 9/11, natural disasters such as tornadoes, civil conflicts, or catastrophic events like car crashes or explosions. Complex cases of PTSD may also involve traumatic and long term physical, psychological, or sexual abuse, such as:

Neglect
Domestic abuse and family violence
Mental abuse
Sexual assault
Human trafficking
Living as a Prisoner of War
Living and fighting in a war zone
Surviving concentration or internment camps

A lawyer can review the medical evidence and treatment records for your mental health condition and help you build a strong claim. They’ll answer any questions you have about Supplemental Security Income, disability ratings, Social Security Disability hearings, and how to win PTSD disability benefits.

The Disabling Symptoms of Post-Traumatic Stress Disorder

PTSD can be acute or chronic, with a broad scope of severity. Once the threat is gone, intense, adverse emotions leave sufferers with a jumble of imagery, sounds, smells, and other vivid memories of the event. PTSD symptoms can include:

Flashbacks: These are reminders of past events that trigger flashbacks, where the person suddenly relives the event as though it is happening again, without control. Triggers can be physical surroundings, smells, sounds, certain people, or other reminders of the painful experience.
Dissociation: This refers to emotional numbness, a sense of being disconnected from yourself and detached from others. The person can lose awareness of what’s going on around them, being taken totally back mentally to the traumatic event.
Nightmares: These are intrusive memories of the event that can be in the form of dreams and night terrors.
Intense fears: These are episodes of intense, debilitating fear memories that may be accompanied by periods of horror and helplessness, also referred to as emotional paralysis.

Further common symptoms of PTSD include:

Anxiety and depression
Difficulty concentrating
Confusion
Angry outbursts, exaggerated startle response
Avoidant behavior

Symptoms normally begin soon after the traumatic event; however, PTSD can also suddenly be triggered years later. Reach out to an attorney to get help documenting your symptoms. Your lawyer will build a strong case on your behalf and work hard to win the disability benefits for PTSD you’re owed.

Winning Social Security Disability Benefits for PTSD

The Social Security Administration (SSA) defines post-traumatic stress disorder as “recurrent and intrusive recollections of a traumatic experience, which are a source of marked distress.” You may qualify for Social Security Disability benefits for PTSD if you satisfy several criteria specified in the SSA’s medical Listing of Impairments. PTSD is categorized as a Trauma and Stressor Related Disorder, under SSA Listing 12.15. The medical requirements are spelled out in three parts: A, B, and C. Your symptoms must satisfy the requirements of parts A and B or parts A and C.

Part A

This part is all about medical evidence and documentation. Part A specifies five characteristics to diagnose a stress- or trauma-related disorder, and all must be present:

Exposure to actual or threatened death, serious injury, or violence
Further involuntary re-experiencing of the traumatic event
Avoidance of external reminders of the event
Disturbance in mood and behavior, and
Increased arousal and reactivity

Part B

This part requires the extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:

Understand, remember, or apply information
Interact with others
Concentrate, persist, or maintain pace
Adapt or manage oneself

Part C

This part of the medical listing for Trauma and Stressor Related Disorders requires that post-traumatic stress disorder is “serious and persistent;” that is, you have a medically documented history of the existence of PTSD for at least 2 years, and there is evidence of both:

Medical treatment, mental health therapy, psychosocial support, or a highly structured setting that is ongoing and that diminishes the symptoms and signs of your mental disorder, and
Marginal adjustment, that is, you have limited potential to adapt to changes in your environment or to demands that are not already part of your daily life.

As you can see, winning Social Security Disability benefits for PTSD can be very technical and medically complicated. An experienced attorney can guide you through this process, whether you are preparing to file your initial claim or appeal a wrongful claim denial.

What if You Cannot Meet the Medical Listing?

If you don’t meet the medical listing, you can still win disability benefits for PTSD. It’s possible that you may qualify for benefits through SSA’s medical vocational allowance. The Medical Vocational Allowance begins by establishing your Residual Functional Capacity (RFC), or the physical and/or mental level of work you can perform as an impaired person. To qualify under these standards, the post-traumatic stress disorder must be severe enough that you are considered disabled from performing your previous job, or any other type of substantially gainful work. SSA will look at the physical and mental demands of the work you have done in the past 15 years. If you can still do this kind of work, SSA will find that you are not disabled. If SSA finds that you cannot do your previous work, the next step is for SSA to determine whether there is work available in the national economy that you can do.

Proving Your Functional Loss to the SSA

These last two steps of the SSA’s evaluation process are where disability benefits for PTSD are often won. While Social Security is interested in your diagnosis of post-traumatic stress or other mental disorder, it is just as interested in determining your degree of functional loss. SSA has specific mental and physical RFC forms that your treating doctor will complete and submit in support of your post-traumatic stress disorder claim. A lawyer works closely with your doctors to get their appropriate and complete documentation. Your attorney will make sure your limitations that result from PTSD are specified distinctly and in the vocabulary of SSA disability.

Winning Long Term Disability Benefits for PTSD from the Insurance Company

Convincing the insurance company that PTSD is a disability can be an uphill battle, but it is necessary for winning PTSD disability benefits. What does it take to show an insurance carrier that you are unable to work because of your disorder and its complications? Your first action is to read the policy and understand any limitations and exclusions. Here are a few common restrictive provisions written into most Long Term Disability (LTD) policies:

Coverage restrictions: Insurers often take a hard line and limit coverage of “mental and nervous” conditions. In this case, you may be limited to 24 months of coverage. If you are awarded Short Term Disability benefits, just as the 24 months of benefits expire, the insurer will say you don’t qualify for LTD, and disability payments will end.
Act of war exclusion: LTD policies often have an “act of war” exclusion upon which insurers may try to base denials of disability benefits for PTSD.
Social security requirement: Most insurers will require that you also apply for Social Security Disability benefits. The reason is that any disability payments the insurance company pays you will be offset by the amount of your Social Security Disability payments.

One of the most important elements of a successful LTD insurance claim is having the support of your doctors. We work in close collaboration with physicians and mental health professionals so that your claim satisfies an insurer’s threshold of evidence required to prove you are disabled due to PTSD. A lawyer can meet with you to discuss your Long Term Disability claim and how they may be able to help. Whether your coverage is under a group disability or an individual disability policy, an attorney can help you file an initial application for disability benefits for PTSD and manage your case from start to finish, or handle all phases of your disability appeal.

Disability Compensation for Veterans with PTSD

The VA will acknowledge PTSD is a service-related disability provided you can verify that your PTSD symptoms are directly linked to your military service. The VA considers the following scenarios to be traumatic events, or “stressors,” in a veteran’s claim for disability benefits based on PTSD:

You sustained serious injury, personal or sexual trauma, or sexual violation, or
You were threatened with injury, sexual assault, or death

The VA reports that PTSD is the leading mental health issue suffered by troops returning home from combat. As stated by the VA’s National Center for PTSD, many veterans of recent combat operations experience PTSD, including:

11 to 20 out of every 100 veterans (11 to 20%) who participated in Operations Iraqi Freedom (OIF) or Enduring Freedom (OEF)
12 out of every 100 Gulf War Veterans (12% ) who participated in the Gulf War (Operation Desert Storm)
30 out of every 100 Vietnam veterans (30%) who participated in the Vietnam War had PTSD in their lifetime.

PTSD can also relate to a traumatic sexual event. A distressing number of veterans have suffered sexual assault, abuse, and harassment while serving in the armed forces, referred to as military sexual trauma (MST). If you or a loved one is suffering from PTSD after service, a lawyer can help you win PTSD disability benefits.

Criteria For Winning PTSD Disability Benefits

To win the disability benefits for PTSD that you need to support yourself, meeting certain criteria is a must. Eligibility for disability benefits for PTSD from the VA is based on the following:

You have symptoms related to a traumatic event or stressor, or your experience with the stressor is related to the PTSD symptoms
The stressor happened during your military service
You can’t function as well as you once could as a result of your symptoms
You’ve been diagnosed with PTSD

Many veterans seek our help when they disagree with the PTSD ratings the VA has assigned. The VA is known to often rate at a percentage that does not consider the veteran’s actual disabilities and extent of impairment. To this end, we have prepared informative articles to help you understand your PTSD rating and what you can do to increase your PTSD rating. Remember, if you are a veteran diagnosed with PTSD, you may qualify for VA compensation, Social Security Disability Insurance (SSDI) benefits, or both.

Learn More About How To Win Disability Benefits for PTSD

If you are a veteran of any branch of the U.S. Military and need help obtaining disability benefits for PTSD, contact Marc Whitehead & Associates for a free consultation. We will help you verify the stressor, establish a nexus, and communicate the extent of your disability to the VA, making certain your case is properly developed and presented. We’ll do everything we can to optimize your chances of getting maximum disability benefits for PTSD. We are familiar with the complex array of symptoms associated with PTSD, both psychological and physical. We know the medical and vocational evidence the Social Security, insurance, and VA examiners are looking for, and how to present all evidence most effectively. Schedule a free consultation with us today to learn more about how to win disability benefits for PTSD and get the help you deserve from an experienced attorney.

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