Why does Social Security make it so difficult to qualify for SSDI benefits due to PTSD and what do you really need to win?

I have represented hundreds of clients in PTSD cases – some are military veterans who served our country in Iraq, Afghanistan, Bosnia and many other places. Their PTSD often arises from seeing bombs explode nearby, seeing fellow soldiers or civilians killed by roadside bombs, or sometimes just living for months under unrelenting stress, never knowing from one minute to the next whether your life will be at risk.

Other PTSD cases arise from sexual abuse, physical abuse, and emotional abuse from childhood or from a previous relationship or even a toxic work environment.

Still other PTSD cases arise from severe emotional trauma like losing a child or a spouse to violence or an accident.

How could SSA deny any of these cases?

Why PTSD Cases are Difficult for Disability Judges to Evaluate

First, understand that PTSD like any other mental health condition is diagnosed based on what you are reporting to a psychiatrist or therapist. There is no MRI or x-ray that doctors can take to view PTSD. Because PTSD is based on what a patient tells his/her doctor, there is always the possiblity of symptom exaggeration.

Second, your response to a trauma is unique to you, meaning that a Social Security judge has to rely on medical reports and your testimony to decide if your symptoms are consistent with your trauma.  If you had a herniated disc with nerve root impingement on the right, a judge would not question medical evidence that you have pain and weakness radiating into your right leg.  By contrast, two female survivors of childhood sexual trauma might have very different symptoms at age 50 years.  One might be traumatized by men in general, finding herself gravitating from one abusive relationship to another.  A second survivor might have a very different experience with a stable marriage and family but anger control issues and nightmares.  Both are reasonable and understandable reactions to similar traumas.

To put this another way there is no “standard” response to your trauma or anyone elses.  And this makes it difficult for judges to evaluate your case.

In my experience SSA judges expects to see trauma that is personal to you and a trauma that is serious enough to reasonably cause a reaction.  Getting fired from a job or getting into a verbal altercation at the grocery store may be upsetting but it would be difficult to argue that that level of trauma results in PTSD symtoms.  Even the stress from a  toxic work environment is often not sufficient to convince a judge who might ask “why didn’t you just quit and find another job.”

So I think you need to be able to clearly identify the traumtice event or experiences that impacted you and then explain in detail how it changed you.

What it Takes to Win a PTSD Case

Narrative is very important in SSD cases – you need to paint a picture of a hardworking, motivated person who lost the capacity to work due to something real.

Don’t assume that judges will make the connection between childhood sexual abuse or violence in a marriage and PTSD. You need to provide specifics.

By specifics I mean that you need to describe the triggers you experience as well as your reaction. It is not enough to say “I don’t like to be around people,” or “the smell of diesel exhaust” brings back bad memories.

You need to explain that reports of domestic abuse you see on TV will bring back a flood of memories that causes you to relive your trauma all over again. You can’t eat, you have crying spells, you lock the doors and won’t leave the house.

You need to describe what I would call a “visceral reaction” to your triggers.

Similarly if your trauma occurred while in the military you need to describe nightmares, your hair trigger temper, the way you scan rooms when you enter, your feelings of survivors guilt or not fitting in. You need to describe how your trauma has affected relationships with significant others and family. Again, your reaction needs to be coming from the core of your being.

And finally you need a treatment record. You need to show that you have sought treatment with psychiatrists and psychologists. You have tried medications and therapy over and over again all without success. You need to talk about issues you had at work – an angry outburst with a customer or co-worker, difficulty concentrating, confusion at performing tasks.

In short, the judge has to see you as a “damaged person” who, despite your best efforts, no longer has the mental strength to be a reliable employee.  You need to be able to describe your trauma, discuss in detail how that trauma has changed and damaged, you, and document with medical evidence your extensive and good faith (but ultimately unsuccessful) efforts to address your trauma and remain employed.