SSI Application Process
Also known as SSI/SSDI, disability is money the government grants you because you've tried your hardest and it's simply not possible for you to maintain employment because of your body or mind. SSI is the disability you get if you've never been able to work. If you've paid taxes within the last 5 years, you'll get SSDI, which is a higher dollar amount based on how much you paid into the pot. SSDI is an all-or-nothing deal, so if you can work 20 hours a week, the evaluator will encourage you to move somewhere where that's enough to live on. LMFTs are not allowed to provide support documentation for the state disability process, so this article focuses on the federal process.
When To Apply
I strongly recommend that people apply for permanent disability as soon as possible, even if they don't think they want it, even if they plan to work, even if they don't think they qualify. SSI/SSDI approval usually takes 3-5 years, including 3 rejections and a court appearance. If a person files for disability today, and the government approves it in four years, they will receive backpayment for those four years the government kept the person waiting. I've had clients receive tens of thousands of dollars in backpayment at the conclusion of a case, so it's best to start early. There are disability lawyers who will work for a (usually quite large) percentage of this backpayment. If a person doesn't qualify for representation through Bay Area Legal Aid, BALA usually can refer them to someone who works this way through their helpline: 800-551-5554.
An SSI/SSDI application is going to include 100% of an applicant's medical and psychotherapy records for the "period of disability," even ones that are not explicitly related to the challenges they're experiencing. Getting approved for SSI/SSDI is not about symptom acuity, but about functional impairment. All the government cares about is "Can this person work?" If the answer is yes, they deny. If the answer is no, they approve. What Social Security is looking for is for a set of medical and mental health records that tell a clear story of a person with challenges, that person seeking help, and that help being insufficient to manage their symptoms in order for them to return to work. For an applicant with panic attacks, a strong SSI case could include records that document them going to meditation classes, seeing a psychiatrist for medication support quarterly, and learning a variety of relaxation skills in weekly therapy, but still having debilitating panic attacks three times a week.
Rejection Is Normal
The first rejection is basically guaranteed. During the appeals process, the applicant will continue to assemble documents that tell the story of their challenges through medical records. At various points during the rejection and reapplication process, the government will make specific treatment recommendations: go to psychiatry, connect to primary care, stop drinking. Ideally, the applicant tries whatever the government says and then resubmits the application. What the government is looking for is evidence that the applicant has done everything in their power to become well enough to work but it hasn't been enough. The government will send the applicant to their own doctors as well for assessment, too. Their goal is to end up with a cohesive narrative about a person, their symptoms, and their (in)ability to work.
Because SSI is based on a person's inability to work, the applicant usually doesn't work during the application process. This means that identifying alternate resources (General Assistance, family or friends, food banks, etc.) is essential to that person surviving. The process can feel unnecessarily arduous or arbitrary so getting the applicant support in building patience is a must.
At some stage in the process, the person will be given what's called a function report, wherein the applicant and a third party both explain the impact of the applicant's disability on their day-to-day functioning. Applicants are often hesitant to "overstate" their symptoms on the function report, and will end up inadvertently presenting what their life is like when their symptoms are not acute. The function report should represent why the person isn't able to work, so I encourage people to think about what a "bad day" (but not the "worst day") looks like, and complete it with that in mind. When completing a third party function report for a client, I try to keep the same thing in mind.
Another pitfall I've run across has to do with substance use. Social Security will not approve SSI for someone they believe has a substance use disorder. If the applicant has PTSD and uses alcohol to manage the anxiety associated with the trauma, Social Security will reject the application stating that the cause of the PTSD symptoms is the alcohol use, regardless of whether the person or their care team perceive that to be true. So, if the person has any substance use history in their records anywhere, it would be a good idea for them to seek treatment so that can become part of the narrative in their records as well.
Responsiveness during the application process is key for applicants. They'll receive mail letting them know about medical evaluations, appeals that need to be submitted in a certain number of days, function reports, etc. If they don't respond, they may need to begin the SSI/SSDI process over again.
Connecting With Me
My name is MacKenzie Stuart and I'm a licensed marriage and family therapist (LMFT) who specializes in suicidality and chronic depression. I launched an SSI advocacy program during my years working in community mental health. I might be a good psychotherapist for you or your loved one. Feel free to explore my availability for new clients and reach out to me directly.
© 2016, MacKenzie Stuart, LMFT