THE PART C CRITERIA WINS MENTAL HEALTH BENEFITS

UNDERSTAND PART C OF THE MENTAL HEALTH LISTING

If you are filing an application for SSDI and SSI benefits because a mental disorder keeps you from working, then you should understand SSA’s Part C criteria. The SSA evaluates mental disorders under the Listing of Impairments. Each mental disorder in the listing contains symptoms and those appear under the Part A criteria.

The second part of the mental health listing is the Part B criteria. Part B defines the severity of your mental symptoms. There is another article that discusses the Part B criteria for mental health disorders.

The Part C criteria, however, offers another way to meet a mental health listing. Part C is about “marginal adjustment.” Understanding the Part C rules can be critical in winning your SSDI and SSI claim. This post will explain the Part C criteria and how it applies to mental disorders. It will also discuss what evidence you need to prove you meet the Part C rules.

WHAT IS PART C UNDER SSA’S MENTAL DISORDER CATEGORY?

The SSA uses the Part C criteria to assess whether a person with a mental disorder can cope with changes at work or the demands of daily life. The term “marginal adjustment” refers to your ability to adjust to new or difficult mental demands. If the SSA finds that you cannot handle changes due to your mental symptoms, then you may meet the Part C criteria.

Part C rules apply in situations where a person with a mental illness achieves only marginal adjustment in their life. Even with ongoing treatment and support, for example, a person might continue to experience mental challenges. The Part C criteria requires medical records from the past two years that show mental conditions remain severe despite treatment.

The SSA acknowledges that while mental symptoms may be helped by treatment or support, the person could still experience extreme episodes of deterioration. For example, mental symptoms can get worse under stress, leading to a loss of function. However, some mental conditions do not include the Part C criteria at all. This is primarily because those mental conditions are covered by the Part A and B functional criteria.

MENTAL DISORDERS THAT INCLUDE THE PART C CRITERIA

Only some of the mental health conditions in SSA’s listing include the Part C criteria. The specific mental disorders that include Part C are 12.02, 12.03, 12.04, 12.06, and 12.15:

• Neurocognitive disorders: Cognitive decline from a prior level of function in memory, executive function, and language and speech. For example, dementia or a neurological disease, like Huntington disease would use Part C criteria.
• Schizophrenia and Other Psychotic Disorders: Sudden changes in environment or routine can trigger episodes or worsen symptoms.
• Bipolar Disorder: Stress and life changes can cause mood swings, making it difficult to function.
• Major Depressive Disorder: Even minor stressors can cause symptoms to get worse.
• Generalized Anxiety Disorder: Fear, dread and other symptoms that are out of proportion to the situation.
• Post Traumatic Stress Disorder (PTSD): Adjusting to new situations can cause anxiety and emotional problems.

The SSA recognizes several mental health conditions. Each condition has specific rules under Part A and Part B of SSA’s Listing of Impairments. However, some people with mental illness may not fully meet the SSA listing. This is where Part C can help.

Under Part C, you don’t need to meet every single requirement for a listing. Instead, you must show that changes in your life—whether it’s going to school, changing jobs, or handling daily tasks—make your symptoms worse. In short, if you can prove that stress, changes, or mental demands make it impossible for you to function, then you might qualify for benefits under Part C.

HOW TO PROVE YOUR MENTAL CONDITION MEETS THE PART C CRITERIA

Meeting Part C criteria can be challenging because it requires solid medical evidence. Here is what you need to do to strengthen your case:

1. Medical Records: Make sure your medical records clearly document how your condition gets worse under stress or change.
2. Treating Statement from your Doctor: A statement from your treating doctor that explains how changes in your routine impact your ability to function.
3. Consistency: Ensure that your medical records, testimony, and statements from family or friends are consistent with each other and show the problems you face when trying to adapt to new situations.

Social Security will look at all of your medical records from the date that you claim your disability began. They will ask you to sign a Release of Information form which gives them permission to review your medical records. Therefore, when you complete your application form, you need to list all of your treatment sources. For example, you should list the names of doctors and counselors.

If you have been in the hospital for mental illness, then list your hospital stays. Finally, make sure you include the phone numbers, correct addresses, and the time frame when you saw your treating sources. Without the correct information, the SSA won’t be able to collect your records.  Learn about filing for mental health benefits in Nevada.

FILL OUT THE FUNCTION REPORT USING THE PART C CRITERIA

One of the forms Social Security will have you complete is a form about your “activities of daily living.” The form is the Function Report. It asks you to describe how  your mental condition limits your daily life. The form asks about a number of activities. For instance, it asks if you spend time with others, like going to family parties or going out to dinner. It asks if you do chores around your house, like laundry, cooking, or dishes. It also asks what you do outside the home. For example, it asks if you are able to use money, go shopping, or drive a car.

If your mental illness causes you trouble with your daily activities, then say so on the form. Also, if you have trouble getting along with other workers or your boss, then you should describe those problems in your ADL form. You should not fill out the form as though it is the past.

Instead, fill it out as you feel now. For example, some people will write that they play basketball, go to church, play golf, hike, and jog. Those are the things you used to do, not the things you can do now. The form is about now, not your interests in the past. Learn about other forms that SSA needs under client application and appeal forms.

YOUR MEDICAL RECORDS NEED TO SHOW YOU MEET A LISTING

Social Security will ask you to sign an Authorization to Disclose Information. They do this so they have your permission to review your mental health records. While the SSA should help you get your medical records, sending them yourself will help you avoid delays in your case. Only submit a copy of your records to the SSA. Never submit your only copy of your records and expect to get it back. You won’t. Always keep the original or a copy of your records for future use.

Even if the SSA collects your records, it is still your burden to prove you deserve benefits. Therefore, it is up to you to make sure the SSA has all of your records. When you have an attorney, they have access to your SSA file. Your attorney can make sure the judge reads all of your records. Learn about the importance of medical records in your benefit case.

HOW TO OBTAIN FREE AND LOW COST MENTAL HEALTH SERVICES

In addition to filing SSA’s forms, you will need to obtain your progress notes. Progress notes are the notes that your doctor or counselor writes when you visit them. This is the medical evidence the SSA reviews to see if you they can pay you benefits. They will read through the progress notes and the medical opinion of your doctor to see if you meet a mental health listing.

In order to meet the Part C criteria, your medical records need to contain evidence that you are getting mental health therapy. It should also show that are getting psychological support or that you are living in a mental health facility.

If you do not have a doctor or counselor, then call the resources that accept your health insurance. If you do not have mental health insurance, we have a list of free and low cost health resources. You can start with our list and if these doctors can’t help you, then ask them who can. If you live in Nevada, then review Nevada’s Free and Low Cost Mental Health Providers.  If you live in Utah, then review Utah’s Free and Low Cost Mental Health Providers. In addition to ongoing treatment, if you need access to mental services, then these lists will help you too. Also, learn information about a payee to help you manage your benefits.

Learn about free or low cost mental health services in Colorado. Likewise, you can learn about free mental health resources in Idaho.

WHAT ARE THE PART C CRITERIA?

The Part C criteria are an alternative to the Part B criteria. Therefore, if you do not meet the Part B criteria, then it is still possible to meet a mental health listing using the Part C criteria.

The SSA uses the Part C criteria to evaluate mental disorders that are “serious and persistent.” The SSA believes your mental disorder is serious and persistent when you have a medical history of a mental disorder for a period of at least 2 years. Next, they require that your mental disorders meets the C1 and C2 criteria.

THE C1 CRITERIA

• The C1 criteria are satisfied when the evidence shows you rely upon medical treatment, mental health therapy, or a highly structured setting, to diminish the symptoms and signs of your mental disorder. The SSA believes you receive ongoing medical treatment when the evidence establishes that you obtain consistent medical treatment of the type required for your medical condition.
• They will consider periods of lack of treatment and lack of compliance with treatment that may result from your mental disorder. If the evidence indicates that lack of treatment or lack of compliance is a feature of your mental disorder, and it has made your symptoms and signs worse, then they will not use it as evidence to support a finding that you are not getting ongoing medical treatment.

THE C2 CRITERIA 

• The C2 criteria are satisfied when the evidence shows that, despite your symptoms and signs, you have achieved only marginal adjustment. “Marginal adjustment” means that your adaptation to the requirements of daily life is fragile. For example, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life.
• The SSA will believe you have only marginal adjustment when the evidence shows that changes or increased demands have led to a decline in your ability to  function. For example, you have become unable to function outside of your home or similar setting, without substantial supports. When this occurs you may require a significant change in medication or other treatment. Similarly, because of the nature of your mental disorder, evidence may document mental episodes that require you to be in the hospital. Or, they require you to be absent from work, making it difficult for you to sustain work over time.

If you’re struggling with a mental disorder and filing for Social Security benefits, then understanding the SSA’s Part C criteria is key to your claim. Showing that you cannot adjust to changes in life due to your mental health may be what helps win your SSD benefits.

REACH OUT TO US FOR HELP WITH YOUR MENTAL HEALTH CLAIM

If you need help in finding free medical care to prove the Part C criteria, then use our list of free and low cost medical resources. Take the first step, by calling us. This is the first thing you need to do to begin your journey to winning benefits. Don’t be worried to reach out to our legal team. It won’t cost you anything.

Our legal team wants to help you. We offer a free review and discussion of your case. What that means is that you can call us and explain your situation. At that point, we will look at the merits of your case for free. Then, we let you know if you have a chance to win SSI benefits. We do not charge you for our review of your case. In fact, there is no attorney fee for you to pay until we win your benefits for you.

Make sure to apply for SSDI and SSI benefits as soon as you know you are not going to be able to work. SSI benefits only pay out from the date of your application.  However, if you get SSI benefits, then you will also get Medicaid benefits. Additionally, SSDI benefits do not pay if meet SSA’s rules after your date last insured. Learn about the date last insured.

With SSDI benefits, you can receive past due benefits one year prior to the date of your application. The opposite is true with SSI benefits. SSI benefits begin the day you apply. They do not go back in time prior to your application date. Therefore, if you do not apply quickly, then you are losing benefits. Learn about past due SSD benefits.

IS IT WORTH THE ATTORNEY FEE TO HIRE AN SSD LAWYER?

It isn’t easy to get Social Security benefits.  The application process can be frustrating for most people. But, having an attorney during the five step SSA review process can relieve stress. In our experience, when you have a law firm handling your SSD case, the SSA follows their own procedures.

Additionally, when you have an attorney with legal experience, they will have access to Social Security’s decisions throughout the process. They can also submit medical evidence that may be missing from your case. Hiring an attorney also helps your entire family get benefits. Learn about how your children can qualify for SSDI benefits based on your earnings record.

There is evidence that hiring an expert SSD attorney triples your chances of winning SSD benefits. It is also smart to hire an attorney to represent you at your hearing. After all, you are the star witness at your hearing. If you hire an attorney with experience, then they can prepare you to testify. Find out how to prepare for your hearing.

HIRE US TO PROVE YOU MEET THE PART C CRITERIA

The SSA benefit process can be long and complex. Hire Cannon Disability Law to give you legal advice and walk you through the application process. In the past 30 years, we have won millions of dollars in ongoing and past due SSD benefits for our clients.

If you need SSD benefits, then hire an attorney with the legal experience to win. If you don’t win, then you don’t pay an attorney fee. For help, contact us.

If you want to learn more about our lawyers and staff, then read About Us. For example, you can learn about Andria Summers. She has spent 23 years working at our law firm. She can help you with your Medicare advantage plan.

Additionally, Dianna Cannon has been helping clients win SSDI benefits for over thirty years. Ms. Cannon has years of Federal Court experience. She has also taught law school and written a book on SSDI benefits. Brett Bunkall also has years of legal experience helping people win their SSI and SSDI benefits. We are Social Security law experts. Together, we have won over 20,000 disability cases.

You can trust us to help you win benefits. It is important to hire the right attorney to help you prove the Part C criteria in your mental health case. Call now. We will do everything we can to make the process of winning SSD benefits as easy as possible for you.