Mental Illness As Basis For Disability: No Objective Evidence, No Problem

Mental illness can be as devastating as any physical impairment. Depression and bipolar disorder form the basis of SSA disability determinations every day. The key to any social security disability case is proving disability – the inability to work. That proof can be challenging in cases of mental illness.

In a low back injury, we can use the results of magnetic resonance imaging (MRI) scan to show the extent of the injury. The scan may show a herniated disc with compromise of the nerve root. The claimant, absent fraud, cannot fabricate the results of the MRI scan. The scan is objective evidence of the medical impairment. It is important to note that although the scan demonstrates a severe medical impairment, it does not say anything about the claimant’s disability. The claimant’s doctor might, however, indicate that the claimant should not lift more than 10 pounds. With those particular scan results, the SSA is likely to find that restriction to be supported by objective medical evidence.

It sure would be nice if we could show evidence of depression in an MRI. Unfortunately, in mental illness cases we must rely on the opinions of doctors as to the existence and severity of a mental illness. These opinions, though, are not based on the results of objective tests – like an MRI – but rather the doctor’s observations of the claimant and what the claimant has said to the doctor. What the claimant says to the doctor is subjective. The problem in mental illness cases is that there is no objective proof of mental illnesses such as depression or bipolar disorder. As it turns out, however, the fact that there is no objective evidence of mental illness can actually make it easier to prove disability.

The key to mental illness cases is the support of the doctor. The treating physician’s opinion – according to Federal law controlling in Maryland – is entitled to “great weight.” Moreover, the treating physician’s opinion can only be disregarded if there is persuasive contradictory evidence. So let’s assume the treating physician provides an opinion that the claimant has bipolar disorder. The treating doctor further indicates that the condition is so severe that the claimant would not be able to hold down a job due to frequent absences. Thus, according to the treating physician the claimant is disabled.

The SSA can only disregard that opinion if there is persuasive contradictory evidence. What might that evidence be? There is no MRI, x-ray, or blood test that counters the physician’s opinion. Remember, there is no objective evidence in mental illness cases. SSA might send the claimant to a doctor for a second opinion – the SSA calls it a “consultative examination.” Theoretically, that examining doctor might indicate that the condition is not as severe. But how can a doctor that only sees the claimant once, who has no history with the claimant, understand the claimant’s mental condition better than the treating physician? The answer: they can’t – the consultative examination is not persuasive contradictory evidence.

The lack of objective medical evidence should not be seen as a barrier to pursing social security disability benefits for mental illness. In fact, with the support of the treating physician, these claims for disability are frequently granted.

By David Galinis