Disability Insurance & Bipolar Disorder

Bipolar Affective Disorder is one that affects different individuals indifferent ways.  Many of those diagnosed are able to continue with employment for short or long periods of time after diagnosis.   Many are unable to.  This is where the question of  Social Security Disability Insurance comes in?  Does Bipolar Disorder qualify as a disabling disorder under the SSDI Act?  In short the answer is yes, providing certain criteria are met.

I have divided these pages in two…one for citizens of the United States, the other for citizens of  Canada.  As there are many similarities you may want to take a look at both.

This is an example of the questions we way have found at MHI Ask the Expert:

http://www.neurotimes.com/expert/exp1031599a.html

Q. I am representing a bipolar patient. He is seeking to appeal a Canada Pension Plan ruling (1994) that he cannot receive CPP benefits. This was due to the fact that he was not yet diagnosed as bipolar (diagnosed in 1998), and was not considerered to be disabled in December of 1994. He is middle-aged, suffered from bouts of depression in 1993-1994 and has been on a host of medications since 1986. Given his medical history over the last five years and his age, is it reasonably safe to conclude that he suffered from a disabling condition in December 1994? In other words, does bipolar disorder have a sudden onset in middle age or is it generally gradual (i.e. over a number of years)? 

A. I can't speak to your friend's diagnosis, of course, but perhaps I can try to clarify the issues at stake in his case. First of all, as someone who periodically consults to insurance companies, I can tell you that there is an important distinction between a "disorder" (or disease) and a "disability." I don't know how it works in the Canadian Pension Plan, but in the U.S., a claimant must be able to demonstrate that he or she has been essentially incapacitated in respect to performing usual job functions before the insurer will consider him/her disabled. A diagnosis is not enough. 

There are many individuals with both unipolar and bipolar disorder who are gainfully employed. These are usually the fortunate individuals whose illness has responded to medication, psychotherapy, or both. So to show that your friend was or is "disabled" at any time, it would have to be proved that he could not perform the usual duties of his occupation, not merely that he suffered from a mood disorder. It follows that the critical issue is not when he received his diagnoses, but when, if ever (as per medical or psychiatric records), he was unable to function vocationally. The best route in such cases is to obtain as much psychiatric documentation as possible concerning the individual's functional capacities at the time of the alleged disability. 

Now a few words about bipolar disorder. First, it is unusual for bipolar to have its onset in middle age. In most cases, it appears in late adolescence or early adulthood. However, in some cases an individual shows a "unipolar" pattern of mood disorder for several or even many years before having a manic episode, and thus being diagnosed bipolar. In retrospect, such an individual's depressive bouts were almost certainly the harbingers of a covert bipolar disorder. But again, this is not the same as establishing a disability. You might want to contact Med Help International (www.medhelp.org) and/or the Bazelon Center for Mental Health Law (www.bazelon.org/) for more information and advice on your options. 

Following is a listing of criteria accepted by SSDI as proof of disability.  For full text of this article please visit http://www.cfids-me.org/adl/ssdi.html 

This page offers a wealth of information about  applying for SSDI benefits.

12.04. Affective Disorders: 

Characterized by a disturbance of mood, accompanied by a full or partial manic or depressive
syndrome. Mood refers to a prolonged emotion that colors the whole psychic life; it generally
involves either depression or elation. 

The required level of severity for these disorders is met when the requirements in both A and B are
satisfied. 

A. Medically documented persistence, either continuous or intermittent of one of the following; 

     1. Depressive syndrome characterized by at least four of the following: 

          a. Anhedonia or pervasive loss of interest in almost all activities; or
          b. Appetite disturbance with change in weight; or
          c. Sleep disturbance;. Or
          d. Psychomotor agitation or retardation; or
          e. Decreased energy; or
          f. Feelings of guilt or worthlessness; or
          g. Difficulty concentrating or thinking; or
          h. Thoughts of suicide; or
          i. Hallucinations, delusions or paranoid thinking; or

     2. Manic syndrome characterized by at least three of the following: 

          a. Hyperactivity; or
          b. Pressure of speech; or
          c. Flight of ideas; or
          d. Inflated self-esteem; or
          e. Decreased need for sleep; or
          f. Easy distractibility; or
          g. Involvement in activities that have a high probability of painful
          consequences which are not recognized; or 
          h. Hallucinations, delusions or paranoid thinking;

OR A. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic
picture of both manic and depressive syndromes (and currently characterized by either or both
syndromes); AND B. Resulting in at least two of the following: 

     1. Marked restriction in activities of daily living; or
     2. Marked difficulties in maintaining social functioning; or
     3. Deficiencies of concentration, persistence or pace resulting in frequent failure to
     complete tasks in a timely manner (in work settings or elsewhere); or 
     4. Repeated episodes of deterioration or decompensation in work or work-like settings
     which cause the individual to withdraw from that situation or to experience exacerbation
     of signs and symptoms (which may include deterioration of adaptive behaviors). 
 

Bipolar World thanks NAMI and Brian at http://www.schizophrenia.com/ami for the following document:

Social Security and Bipolar Disorder
 

Below is Section (ß) 7.37, under Listing 12.04, Bipolar Disorder, of the Federal Code of
Regulations (20 CFR). Section 7.37 contains the medical basis for determination of Disability by The
Social Security Administration (SSA) for Bipolar Disorder.

Further information regarding Bipolar Disorder and disability guidelines (or guidelines for other
potentially disabling chronic illnesses and disabilities) can be obtained by consulting The Code of
Federal Regulations; 20 CFR; accessible through most major Research Libraries as well as a number
of other sources. 

The value of this material lies in assisting physicians in addressing specifics of their patients' condition
when addressing correspondence to the Social Security Administration on the patient's behalf when
the patient is applying for disability benefits.

It cannot be emphasized enough that when the diagnosis and prognosis is being submitted to SSA (or
any government or health organization) the physician, caseworker, or individual, should be as specific
and as brutally honest as possible. Ie: Avoid "general" statements such as "100% disabled," "unable
to work," etc.... as they are effectively meaningless. "Specificity," particularly on SSA's terms, is the
surest route to approval.

Anyone familiar with serious chronic illnesses and the various issues surrounding them, no matter the
particular illness (the various mental illnesses, cancer, seizure disorders such as epilepsy, multiple
sclerosis, parkinson's, .....), will become aware that "common sense" and "the obvious" are generally
the last things one chooses to rely upon when dealing with case workers, social workers, lawyers,
government employees, advocates, therapists, and medical personel. We seem to live in an
increasingly strange time when "reality" has been drastically re-defined in an essentially meaningless
manner, while "opinion" assumes characteristics and attributes it never before held. 

Regardless of the severity of the illness or the situation, expect disability applications to SSA to be
turned down on the first pass. Most commonly it is the second, or third pass (re-consideration
stages) when approval is finally obtained; Usually, as a result of a public hearing and a Judge's
overturning of the SSA decision. Obviously essential for those so disabled that they are unable to
work is the support of family and/or friends. Persistence and perseverance are key in this process. 

Keep in mind, that once approval of disability is made, the baseline date for disbursements is that
when it was first applied for and back payments from that date will be included in the first
disbursement.

Apply as soon as possible and be sure to submit appeals within days of any rejections in spite of the
longer time periods provided. The longer the delay in appealing, the longer the delay in receiving final
approval. While it's probably not as necessary in the first application (provided as suggested above,
all information possible has been provided to SSA, and a forthright, with specificity, address of the
disability made to them), it is highly suggested that expert assistance be obtained throughout an
appeal process. Whether that assistance is from an attorney or a legal aid or disabilities organization,
is up to the individual. Legal fees may be leveled, however, there is a maximum of 25% of net first
disbursement imposed by SSA. Consider that this is often provides very small to no incentive to
practicing attorney's. It's not uncommon for an attorney to arrive at court 10 - 15 minutes ahead of
time and have that be the first attempt to familiarize him/herself with the brief. 

Do look into State general assistance programs. Food stamp eligibility will often provide the quickest
relief, even if generally in small amounts. General financial assistance may take longer (days, weeks,
months depending upon the state) for approval but usually provides more meaningful financial
assistance. This will be re-imbursed by the individual upon first disbursement of disability benefits
when they are approved, hence the reference to "net" disbursement above. So, given ultimate
approval of disability, the latter is no free gift but effectively a no-interest loan until first disbursement..

Also, Keep in mind, that once approved, the first SSDI payment will not be disbursed until 6 months
following approval (effectively 5 months). Medicare eligibility is 2 years following approval. If an
individual qualifies for SSI, then payment should begin immediately (although, generally the amount is
minimal for those who qualify for both SSDI and SSI). If the individual qualifies for SSI, then they
will probably also qualify for Medicaid, also available immediately [Note Medicaid is administered by
the respective states and qualifications, guidelines, etc.. vary state to state. In many cases and
situations Medicaid is available in spite of SSI qualifications.] 

Further exacerbating the situation is the increasingly heavy load being placed upon all government
services, Social Security especially, as a result of the wide scale closing of public psychiatric facilities
with little to no thought given to their replacement. Hundreds of thousands of Americans with these
illnesses are homeless and abandoned. The problem has literally overwhelmed the nation. Without
support of family and friends, particularly throughout the long arduous process of seeking disability
benefits, many would never survive.

Look into any and all possible entitlements. It may be a long process and any and all possible safety
nets that can be established to avoid calamity and to relieve pressure on family, friends, and self
should be investigated and, if possible, put in place. Always keep in mind that there is NO final or
absolute safety net. Hence the many homeless in shelters and living on the streets. 

Lastly, be aware that this was written in November 1994. The Social Security Administration is
currently attempting an attempt at "re-engineering" the process and a great deal, process wise, that
has held prior to this date may change. Regardless of change it is suggested that the basic common,
sense suggestions listed here be followed. 

***********************************************************
20 CFR, Listing 12.04, Section 7.37:

Listing 12.04 Determination of Disability

ß 7.37 Bipolar Disorder (Manic Depressive Illness) 

[See D. Morton Medical Proof of Social Security Disability (1983), ß 2.13

Listing 12.04. Affective Disorders: Characterized by a disturbance of mood,
accompanied by a full or partial manic or depressive syndrome. Mood refers to a prolonged emotion
that colors the whole psychic life; it generally involves either depression or elation.

The required level of severity for these disorders is met when the requirements in both A and B are
satisfied.

A. Medically documented persistence, either continuous or intermittent, of one of the following:

1. Depressive syndrome characterized by at least four of the following:

a. Anhedonia or pervasive loss of interest in almost all activities, or
b. Appetite disturbance with change in weight; or
c. Sleep disturbance; or
d. Psychomotor agitation or retardation; or
e. Decreased energy; or
f. Feelings of guilt or worthlessness; or
g. Difficulty concentrating or thinking; or
h. Thoughts of suicide; or
i. Hallucinations, delusions or paranoid thinking;
OR

2. Manic syndrome characterized by at least three of the following:

a. Hyperactivity; or
b. Pressure of speech; or
c. Flight of ideas; or
d. Inflated self-esteem; or
e. Decreased need for sleep; or
f. Easy Distractibility; or
g. Involvement in activities that have a high probability of painful
consequences which are not recognized; or
h. Hallucinations, delusions, or paranoid thinking;

OR

3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of
both manic and depressive syndromes (and currently characterized by either or both syndromes);

AND

B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in
a timely manner (in work settings or elsewhere); or
4. Repeated episodes of deterioration or decompensation in work or work-like settings which cause
the individual to withdraw from that situation or to experience exacerbation of signs and symptoms
(which may include deterioration of adaptive behaviors). 

NAMI/ NYC (formerly AMI/FAMI) does not endorse any medicines or treatments. This
info is a public service as part of our efforts to educate and help others affected by these
disorders. Do not rely on it. Consult your doctor before making any decisions. NAMI/NYC
is a non-profit dedicated to improving the lives of people with neurobiolgical disorders ("NBD",
formerly known as 'mental' illness) through education, advocacy, support, and research. If this has
been useful to you, PLEASE JOIN US. Send a deductable contribution of $30 (or more) to
NAMI/NYC, 432 Park Avenue South, New York, NY 10016 to get on our mailing list or call
(212) 684-3AMI. To join chapter outside NYS: 1 800 950 NAMI. This was downloaded from
http://www.schizophrenia.com/ami 

             Families Helping Families is what NAMI/NYC is all about. 
                       Thank you for helping us help others.
 

To learn more about SSDI and whether or not you qualify talk to your doctor.
 
 

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