How Do You Win a Disability Case for Mental Illness?

Winning a disability case for mental illness can be difficult because you do not have the same type of medical evidence available you might for a physical ailment.

There are no X-rays, scans, or laboratory tests to confirm most mental health concerns. Instead, you must rely on notes from your doctor, the outcome of treatments, and other evidence.

Mental health conditions present many challenges for people living with them, and they are often disabling. Mental illness manifests in many ways, and people may struggle to receive a diagnosis. These difficulties can make it hard to earn Social Security disability benefits for a mental illness, but a Pittsburgh Social Security Disability lawyer can help navigate this complex process.

The Process for Evaluating Disability Benefits for Mental Illness

When applying for Social Security Disability (SSD) benefits for mental illness, the five-step sequential evaluation process is the framework used by the Social Security Administration (SSA) to determine eligibility. Understanding this process can help to build a strong case, particularly when dealing with the unique challenges of mental health claims. 

A Pittsburgh mental illness lawyer can guide you through all of these steps and work to win a disability case for mental illness.

Step 1: Determining Substantial Gainful Activity (SGA)

The SSA starts by assessing whether you are working and earning above the SGA limit. In 2025, this limit is $1,620 per month for most individuals. Many individuals with mental illness may still attempt to work despite significant impairments. 

However, difficulty maintaining consistent employment or earning below the SGA threshold can support your claim. A lawyer can help demonstrate that sporadic or part-time work does not equate to the ability to engage in substantial gainful activity. They can also identify gaps in documentation and guide you in gathering the necessary records.

Step 2: Severe Impairment Evaluation

Next, the SSA examines whether your mental illness is considered a severe impairment—one that significantly limits your ability to perform basic work activities, such as concentrating, interacting with others, or managing stress.

Conditions often result in unpredictable symptoms that impact work performance. A lawyer can gather detailed medical records, treatment notes, and statements from mental health professionals to show the severity of your impairment. A lawyer works closely with your mental health providers to create a compelling narrative about the severity of your condition and its impact on your ability to work.

Step 3: Meeting or Equaling a Blue Book Listing

If your condition matches or equals one of the SSA’s BlueBook listings, you may automatically qualify for SSD benefits for mental illness. Section 12.00 of the Blue Book includes specific criteria for mental disorders. 

A lawyer can identify the correct listing for your condition, ensure all necessary evidence is provided, and argue equivalence if your condition does not exactly meet the Blue Book criteria.

Step 4: Residual Functional Capacity (RFC) and Past Work Analysis

If your condition does not meet or equal a Blue Book listing, the SSA evaluates your residual functional capacity (RFC) to determine whether you can still perform past work. RFC considers your ability to perform physical and mental tasks, such as concentrating, understanding instructions, or interacting with coworkers.

Mental illnesses often lead to limitations in focus, decision-making, or handling stress. A lawyer can work with your doctors to document how these issues prevent you from performing past work. For example, if you previously worked in a high-stress environment and now experience debilitating anxiety, this evidence can be crucial.

Step 5: Adjusting to Other Work

At the final step, the SSA considers whether you can adjust to other jobs, given your age, education, work history, and RFC. This step often involves vocational experts who assess whether suitable work exists in the economy.

Symptoms like difficulty interacting with others, maintaining a routine, or adapting to new tasks can make transitioning to other jobs impossible. A lawyer can argue that your limitations preclude all forms of work.

Winning a disability case for mental illness requires navigating a complex process while providing clear evidence of how your condition affects your ability to work. This evaluation process is the backbone of every claim, and understanding it is key to success. 

However, the process can be daunting without professional support. A disability lawyer helps you at every step, from preparing your application to filing your appeals and representing you at your hearing.

Proving You Qualify for Mental Illness Disability Benefits

In the Blue Book, each section includes the evidence necessary to qualify based on that diagnosis. Some evidence that could strengthen your case includes:

• Detailed treatment records from psychiatrists, therapists, or psychologists.
• Hospitalization records or emergency intervention documentation.
• Statements from healthcare providers explaining how your condition limits your ability to work.
• Medication history

Your application information and medical records will need to prove you meet the criteria to get benefits based on the impairment listing.

You can get mental illness disability without meeting the qualifications under an impairment listing as well. You will, however, need to show that your condition prevents you from working and earning a living. A residual functional capacity assessment can prove this for you. This assessment considers:

• Your training, education, experience, and age
• Your ability to work any job you might qualify for
• How long you can work
• How often you can work or your ability to maintain a consistent work schedule.
• Your ability to handle workplace stress and interact with others

If you cannot work your previous job or any other job often enough to earn at least the current substantial gainful activity (SGA) limit, and you meet all other qualifications, you are more likely to be approved for Social Security Disability (SSD).

A Lawyer Can Help Seek Approval for the Disability Benefits You Deserve

As SSD lawyers, we know how vital disability benefits can be to you and your family. We understand how hard it can be when you cannot work because of a mental illness and how difficult it is to make ends meet when your health does not allow you to work. SSD benefits were historically designed to help you in this instance.

Our team can review your application, help you submit your information, and even file an appeal on your behalf if they denied your initial application.

We can work to secure you the most out of Social Security Disability benefits based on your qualifications but only if you call us for a free review of your disability case for mental illness.

Call us as soon as possible if you get a denial letter; we can represent you during your hearing and present a strong case to the Administrative Law Judge. In many cases, we can get our clients approved for disability during this process.

Winning a Disability Case for Mental Illness Could Mean Making an Appeal

If your initial application for mental illness disability benefits is denied, you are not alone. The SSA denies a significant percentage of first-time applications. However, many claimants succeed during the appeals process by providing additional evidence and addressing issues in their original application and with the support of a disability attorney at your hearing.

Our team is well-versed in the appeal process, and we’re ready to guide you today.

Key Deadlines in the Appeals Process

The SSA strictly enforces deadlines for each stage of the appeals process. Missing these deadlines can result in losing your right to appeal. When appealing your mental illness application, here are some time-sensitive deadlines to keep in mind:

• Request for Reconsideration: Must be filed within 60 days from the date on your denial letter.
• Hearing with an Administrative Law Judge (ALJ): If reconsideration is denied, you must request a hearing within 60 days of the reconsideration denial.
• Appeals Council Review: If the ALJ decision is unfavorable, you have 60 days to request a review by the Appeals Council.
• Federal Court Review: If the Appeals Council denies your case or upholds the ALJ’s decision, you have 60 days to file a lawsuit in federal court.

Reconsideration

The first stage of the appeals process is called reconsideration. When your initial mental illness disability claim is denied, we must act quickly to begin this step. The SSA will conduct a complete review of your application by someone at the SSA who was not involved in the original decision.

At this stage, the SSA will re-evaluate your medical evidence, work history, and other documentation. You also have the opportunity to submit new evidence to strengthen your case. For example, you might include:

• Updated medical records showing your diagnosis and ongoing treatment.
• Notes from your psychiatrist, psychologist, or therapist detailing how your mental illness affects your ability to work.
• And new medications or hospitalizations.

Our lawyers will carefully read the SSA’s explanation of why your claim was denied so we can identify gaps or weaknesses in your initial application. We will work with you and your care team to provide updated or missing documentation, such as progress notes, test results, or additional statements from healthcare providers. 

We can also review any other reason your claim may have been denied. 

Hearing with an Administrative Law Judge

If your claim is denied at the reconsideration level, the next step is to request a hearing before an Administrative Law Judge (ALJ). The ALJ hearing is often the most crucial stage in the appeals process, as it provides a chance to present your case in person.

The ALJ will conduct a thorough review of your case, including your medical records, work history, and any new evidence you submit. You and your representative (if you have one) will have the opportunity to explain how your mental illness prevents you from working. The judge may also hear testimony from:

• You: Be prepared to answer questions about your daily life, work history, symptoms, and treatment.
• Medical Experts: The SSA may call a medical expert to testify about the severity of your condition.

A disability attorney can help you organize your case, identify gaps in evidence, and prepare you for the hearing. Here are some of our firm’s tips for this stage:

1. Be Honest and Specific: When answering questions, explain your limitations clearly and provide real-life examples of how your mental illness affects your ability to work or function.
2. Maintain Consistent Medical Treatment: Recent treatment notes, hospital records, and statements from your healthcare providers are needed to support your claim.

The ALJ hearing is an important step in fighting for your claim for benefits. It is your best opportunity to present your case directly to the decision-maker.

Appeals Council Review

If the ALJ denies your claim, you can request a review by the Appeals Council. The Appeals Council does not hold hearings but will review your case to determine if the ALJ made any errors or if new evidence warrants reconsideration.

The Appeals Council examines the ALJ’s decision for any procedural or legal errors. It may:

• Approve your claim outright.
• Send your case back to the ALJ for further review.
• Deny your request, upholding the ALJ’s decision.

Our team can work with you to identify specific mistakes or inconsistencies in the ALJ’s decision. Our Pittsburgh Social Security Disability appeals lawyers can also submit additional medical records or evidence that supports your claim, as needed. We work to create a clear argument that explains why the ALJ’s decision was incorrect and how your condition qualifies you for benefits.

Federal Court Review

If the Appeals Council denies your claim or upholds the ALJ’s decision, the final stage of the appeals process is filing a lawsuit in federal court. This is a more formal legal process, and a disability attorney can provide valuable representation.

At this stage, a federal judge will review your case to determine if the SSA made any errors in handling your claim. The judge does not decide whether you are disabled; instead, the judge evaluates whether the SSA followed the correct procedures and considered all evidence.

While the appeals process can be lengthy and complex, many applicants succeed at the ALJ hearing. Each step provides an opportunity to present new evidence, correct mistakes, and make a stronger case for your eligibility. If you’re unsure about navigating the appeals process, our team is here to support you. 

Getting Disability for Mental Illness Based on an Impairment Listing

In the same way that the Social Security Administration publishes a list of impairment listings and criteria to qualify for physical ailments, the Blue Book contains a section for mental health disorders. 

If your mental illness prevents you from earning the substantial gainful activity (SGA) limit on a monthly basis, and you meet the criteria under the applicable section, you can get approved for benefits.

Section 12.00 — Mental Disorders is the section of the Blue Book you will need to look at to determine the evidence you need to prove your case. As of 2024, the Blue Book covers 11 different types of mental health disorders. This includes:

Section 12.02 — Neurocognitive Disorders

This category includes disorders that significantly affect cognitive function, such as memory, attention, and problem-solving abilities. Examples include:

• Alzheimer’s disease or other dementias.
• Traumatic brain injury (TBI) resulting in cognitive impairment.
• Huntington’s disease.
• Cognitive decline associated with Parkinson’s disease or multiple sclerosis.

To qualify, claimants must demonstrate significant cognitive impairment that impacts their ability to work or manage daily tasks.

Section 12.03 — Schizophrenia Spectrum and Other Psychotic Disorders

Disorders in this category are characterized by psychotic symptoms like hallucinations, delusions, or disorganized thinking. Examples include:

• Schizophrenia.
• Schizoaffective disorder.
• Brief psychotic disorder.
• Delusional disorder.

These conditions often require evidence of ongoing symptoms, impaired functioning, and the inability to maintain gainful employment despite treatment.

Section 12.04 — Depressive, Bipolar, and Related Disorders

This section focuses on mood disorders that cause significant emotional and behavioral disturbances. Examples include:

• Major depressive disorder (MDD), characterized by persistent sadness, loss of interest, or suicidal thoughts.
• Bipolar disorder, including both manic and depressive episodes.
• Persistent depressive disorder (dysthymia).

To qualify, claimants must show how symptoms such as fatigue, poor concentration, or mood instability prevent consistent work activity.

Section 12.05 — Intellectual Disorder

Intellectual disabilities involve significant limitations in intellectual functioning and adaptive behaviors. Examples include:

• Cognitive impairments caused by genetic conditions like Down syndrome.
• Developmental delays affecting functioning into adulthood.

Generally, claimants must demonstrate low IQ scores (typically 70 or below) and significant difficulties in areas like communication, social interaction, or daily living.

Section 12.06 — Anxiety and Obsessive-Compulsive Disorders

This category includes disorders where anxiety, fear, or obsessive behaviors dominate daily life. Examples include:

• Generalized anxiety disorder (GAD), characterized by excessive worry.
• Panic disorder, with recurrent panic attacks.
• Obsessive-compulsive disorder (OCD), involving intrusive thoughts and repetitive behaviors.
• Phobias that severely restrict daily functioning.

Claimants must show symptoms that interfere significantly with work, relationships, or other important activities.

Section 12.07 — Somatic Symptom and Related Disorders

Disorders in this section involve physical symptoms that cannot be fully explained by medical conditions but cause significant distress or impairment. Examples include:

• Somatic symptom disorder, where individuals experience chronic physical complaints.
• Illness anxiety disorder (formerly hypochondriasis), characterized by excessive worry about having a serious illness.
• Conversion disorder, involving neurological symptoms (e.g., paralysis or seizures) without a medical explanation.

Applicants need evidence of how these symptoms limit their ability to function or maintain employment.

Section 12.08 — Personality and Impulse-Control Disorders

This section addresses chronic patterns of behavior and emotion that deviate from societal norms and impair functioning. Examples include:

• Borderline personality disorder (BPD), with intense emotional instability and fear of abandonment.
• Antisocial personality disorder, characterized by disregard for social rules and others’ rights.
• Intermittent explosive disorder, marked by recurrent, aggressive outbursts.

Qualifying requires evidence that these traits severely limit interpersonal relationships and the ability to work.

Section 12.10 — Autism Spectrum Disorder

This category covers neurodevelopmental disorders characterized by difficulties with communication, social interactions, and repetitive behaviors. Examples include:

• Autism spectrum disorder (ASD), including cases formerly categorized as Asperger’s syndrome or pervasive developmental disorder.

Applicants need to show that their symptoms significantly impair daily functioning, such as the inability to adapt to workplace environments or maintain relationships.

Section 12.11 — Neurodevelopmental Disorders

This section includes developmental disorders that typically present in childhood and persist into adulthood. Examples include:

• Attention-deficit/hyperactivity disorder (ADHD), characterized by inattention, impulsivity, and hyperactivity.
• Learning disabilities, such as dyslexia or dyscalculia, that impede work performance.

Claimants must demonstrate how these disorders create substantial barriers to employment or daily life.

Section 12.13 — Eating Disorders

Eating disorders involve disturbances in eating behavior that severely impact health and functioning. Examples include:

• Anorexia nervosa, characterized by extreme food restriction and weight loss.
• Bulimia nervosa, involving binge eating followed by purging.
• Binge eating disorder, marked by recurrent episodes of overeating.

Applicants must show evidence of medical complications or psychological impairments that limit their ability to work.

Section 12.15 — Trauma- and Stressor-Related Disorders

This category focuses on conditions resulting from exposure to trauma or severe stress. Examples include:

• Post-traumatic stress disorder (PTSD), with symptoms like flashbacks, hypervigilance, or avoidance.
• Acute stress disorder, which can evolve into PTSD if untreated.
• Adjustment disorders, involving emotional or behavioral responses to life stressors.

Qualifying claims often require detailed medical records, therapy notes, and evidence of how the trauma impacts daily functioning and work.

Each category requires substantial medical evidence, including detailed records from qualified healthcare providers, consistent treatment history, and documentation of how symptoms interfere with work and daily activities. 

The SSA evaluates not only the diagnosis but also the severity and functional impact of the disorder on the individual’s ability to perform substantial gainful activity. Meeting the criteria for one of these categories, combined with documentation proving your inability to work, can help secure SSD benefits for mental illness.

Talk to a Pittsburgh Social Security Lawyer About Your Disability Case

If you need help filing for SSD or SSI in Pittsburgh, or if they denied your initial claim, the team from Berger and Green is standing by to take your call. We know what it takes to win a disability case for mental illness and can help you build a strong case and represent you during the process.

Call our team today for a free review of your Pittsburgh disability case.