What Do I Do if My Disability Claim Is Denied for PTSD?

Posttraumatic stress disorder (PTSD) is a serious, debilitating psychological disorder suffered by a large percentage of combat veterans, as well as many other Americans regardless of military service. According to the U.S. Department of Veterans Affairs (VA), around 7-8 percent of the U.S. population will have PTSD at some point in their lives. Severe PTSD can render a person unable to work, providing a reasonable basis for a Social Security Disability Insurance (SSDI) or VA disability claim. Unfortunately, despite the prevalence of PTSD and the scientific backing for the disorder’s debilitating nature, many people suffering from PTSD are denied disability coverage. Below, our California social security disability insurance lawyers discuss disability coverage for PTSD and how to respond to a disability denial for PTSD-related claims.

Social Security Disability Covers PTSD

Social Security disability benefits are available to individuals who suffer from PTSD. There are two main avenues for PTSD-related disability coverage: satisfying the SSA’s trauma listing, and obtaining a “medical-vocational allowance.”

To obtain disability via the trauma listing, an applicant must obtain an official medical diagnosis of PTSD, including medical documentation of five specific factors: exposure to actual or threatened death, injury, or violence; later re-experience of the traumatic event; avoidance of reminders of the event; disturbance in mood and behaviors; and increases in mental reactivity. The underlying cause could be any kind of traumatic event, such as war, a fire, a serious car accident, criminal violence, or any other incident that exposed the applicant to the threat of serious injury or death. The applicant must also suffer a requisite level of functional limitation.

Applicants who do not satisfy all of the listing requirements for PTSD may still get a medical-vocational allowance if their PTSD-like symptoms prevent them from working.

Reasons PTSD Claims Are Denied

PTSD claims for SSDI benefits are denied for a number of reasons. Understanding the reason for the denial is critical to overturning the decision. Some of the more common reasons for denial include the following:

• SSA error. Sometimes, a denial is simply made in error. The Social Security Administration (SSA) may not fully explain its reasoning, or its reasoning may not make sense (particularly if the denial was erroneous). You and your attorney can contact the SSA to track down the proper reason for the denial and find out if they simply made a clerical error.
• Lack of sufficient supporting evidence. Obtaining disability benefits requires providing sufficient documentary evidence to support the claim. The SSA may deny a claim if they do not see sufficient supporting evidence, including medical records, statements from employers, statements from treating physicians, and other relevant evidence. As explained above, there are very specific requirements for obtaining benefits based on PTSD and the Social Security trauma listings; the applicant must provide sufficient, specific medical evidence to prove each element.
• Failure to follow treatment. The SSA will deny benefits to an applicant who refuses to follow their doctor’s recommended treatments, including psychological counseling and medication.

Appealing a Social Security Disability Denial

Applicants denied SSDI benefits have the right to request an appeal. Applicants must submit a written appeal request within 60 days of receiving the notice of denial. There are typically four levels of appeal:

• Reconsideration by the SSA
• Hearing by an administrative law judge
• Review by the SSA’s Appeals Council
• Additional review by a federal court

With the help of your Social Security benefits denial attorney, you can continue to pursue your claim through all levels of appeal until you obtain a satisfactory result. A Social Security disability lawyer can review your case and help you understand why your claims were denied and whether you have reasonable grounds to challenge the decision.

Get Help Today Pursuing a California Disability Claim

For help obtaining disability benefits in southern California or statewide, call the professional and effective Social Security Disability (SSD/SSI) attorneys Drake & Drake at 818-624-4695.