PART B CRITERIA WINS MENTAL HEALTH BENEFITS
SSA’S PART B LISTINGS FOR MENTAL HEALTH BENEFITS
Part B of the SSA’s listings is found on every one of the mental health conditions for which SSA pays benefits. The listings for mental disorders are arranged in 11 categories. The first is neurocognitive disorders. Second is schizophrenia and other psychotic disorders under 12.03. Third is depression and bipolar disorders under listing 12.04. Fourth is intellectual disorder under 12.05. Under intellectual disorder the Part B criteria is different than the other listings.
Fifth is anxiety and obsessive-compulsive disorders listing 12.06. Sixth is somatic symptom disorders under listing 12.07. Seventh is borderline personality disorder and impulse-control disorders under listing 12.08. Eight is autism spectrum disorder under listing 12.10. Ninth is neurodevelopmental disorders under listing 12.11. Tenth is eating disorders like anorexia, and they are found under listing 12.13. Finally, PTSD, trauma and stress related disorders are found under listing 12.15.
PART B PROVIDES THE FUNCTIONAL CRITERIA FOR THE SSA
Part B of each listing provides the rules that the SSA uses to look at your mental condition. The SSA looks at your mental health using a rating scale. They do this in order to define how your mental condition limits your ability to function during a normal day and on the job.
The reason they use a rating scale is to compare you with other people who do not have a mental condition. Also, they are looking at how your mental health affects you in a work setting.
The four functional criteria of Part B are:
- 1) understand, remember, or apply information;
- 2) interact with others;
- 3) concentrate, persist, or maintain pace; and
- 4) adapt or manage oneself.
The SSA uses these four areas of mental function to determine if you are able to work. However, they are not looking at how you would do in only one day at work or 8 hours. Instead, they are looking at how you would be able to sustain work over a 40 hour work week. Additionally, they are looking at whether over a longer period of time, like months, your mental health might deteriorate.
To satisfy the Part B criteria, your mental condition must result in “extreme” limitation of one, or “marked” limitation of two, of the four areas of mental functioning.
WHAT ARE THE PART B CRITERIA?
PARAGRAPH B1 – UNDERSTAND, REMEMBER, OR APPLY INFORMATION.
This area of mental functioning refers to the abilities to learn, recall, and use information to perform work activities. Examples include: understanding and learning terms, instructions, procedures; following one or two step oral instructions to carry out a task; describing work activity to someone else; asking and answering questions and providing explanations; recognizing a mistake and correcting it; identifying and solving problems; sequencing multiple steps in activities; and using reason and judgment to make work decisions. These examples show the nature of this area of mental functioning. However, the SSA does not require evidence for all of the examples.
PARAGRAPH B2 – INTERACT WITH OTHERS
This area of mental functioning refers to the ability to relate to and work with supervisors, co-workers, and the public. For instance, if you have mental health issues you may have trouble cooperating with others. Additionally, you may also have problems asking for help when needed or handling conflicts with others.
Other examples of areas at issue are stating your own point of view; initiating or sustaining conversation; understanding and responding to social cue; responding to requests, suggestions, criticism, correction, and challenges; and keeping social interactions free of irritability, sensitivity, argumentativeness, or suspiciousness. These examples show the nature of this area of mental function. Again, the SSA does not require documentation of all of the examples. However, they are looking at your record to see if there are examples of trouble in this area of function. The reason why this area issue important is that almost all jobs require you to deal or interact with other people.
PARAGRAPH B3 – CONCENTRATE, PERSIST OR MAINTAIN PACE
This area of mental functioning refers to the ability to focus attention on work activities and stay on task at a normal rate. Examples include: initiating and performing a task that you understand and know how to do; working at an appropriate and consistent pace; completing tasks in a timely manner; ignoring distractions while working; changing activities or work settings without being disruptive.
Other examples include working close to or with others without interrupting or distracting them. Also, they will look at whether you can keep up with a normal routine at work and whether you have regular attendance. Other examples include working a full day without needing more than then the given number or length of rest periods during the day. These examples illustrate the nature of this area of mental functioning. The SSA does not require documentation of all of the examples. But, the examples illustrate the evidence the SSA is looking for in your records.
PARAGRAPH B4 – ADAPT OR MANAGE ONESELF
This area of mental functioning refers to your ability to regulate your emotions, control behavior, and maintain normal behavior in a work setting. For instance, if you have mental health issues in this are you may have problems responding to demands and adapting to changes. Additionally, you might have trouble managing your psychologically based symptoms.
Other examples include, distinguishing between acceptable and unacceptable work performance; setting realistic goals; making plans for yourself independently of others; maintaining personal hygiene and attire appropriate to a work setting; and being aware of normal hazards and taking appropriate precautions. These examples illustrate the nature of this area of mental functioning. The SSA does not require evidence of all of the examples. If you have evidence from a boss at an old job that shows you cannot manage yourself in a work setting, then you should submit it to the SSA.
HOW DOES SSA USE THE PART B CRITERIA TO EVALUATE YOUR MENTAL DISORDER?
The SSA uses the Part B criteria along with a rating scale to rate the degree of your mental condition. They consider only the limitations that result from your mental disorders. They will determine whether you are able to use each of the Part B areas of mental functioning in a work setting. For example, the SSA will consider the kind, degree, and difficulty you would have at work. They will also consider whether you could function without extra help, structure, or supervision. Finally, they will consider whether you require special conditions with regard to activities or getting along with other people.
THE FIVE POINT RATING SCALE
The SSA evaluates the effects of your mental disorder on each of the four areas of mental functioning based on a five-point rating scale. The scale consists of these ratings: none, mild, moderate, marked, and extreme. To satisfy the Part B rules, your mental condition must result in an extreme limitation of one, or a marked limitation in two of the Part B areas of mental functioning. Under these listings, the five rating points are defined as follows:
- No limitation (or none). You are able to function in this area independently, appropriately, effectively, and on a sustained basis.
- Mild limitation. Your function in this area independently, appropriately, effectively, and on a sustained basis is slightly limited.
- Moderate limitation. Your function in this area independently, appropriately, effectively, and on a sustained basis is fair.
- Marked limitation. Your function in this area independently, appropriately, effectively, and on a sustained basis is seriously limited.
- Extreme limitation. You are not able to function in this area independently, appropriately, effectively, and on a sustained basis.
MARKED LIMITATIONS AND HOW THE SSA APPLIES THEM TO THE PART B DEFINITIONS
The SSA has specific instructions for how to apply the definition under Part B and this includes paragraphs B2, B3 and B4. Under each of those paragraphs, the SSA states that in order to a work task, for example, you must be able to understand, remember, and apply information required by the task. So, if you cannot do one part of the task, such as remember, then you cannot perform the work task.
SSA states, for instance, under paragraphs B1, B3, and B4, the greatest degree of limitation of any part of the area of mental functioning directs the rating of limitation of that whole area of mental functioning. For example, to do a work task, you must be able to understand and remember and apply information required by the task.
Similarly, you must be able to concentrate and persist and maintain pace in order to complete the task, and adapt and manage yourself at work. Limitation in any one of these parts (understand or remember or apply; concentrate or persist or maintain pace; adapt or manage oneself) may prevent you from completing work tasks.
THE SSA WILL NOT ADD RATINGS FROM ONE PART B FUNCTION TO ANOTHER
Also, the SSA does not add ratings of parts of function together. For example, the SSA:
- Will document the rating of limitation of the whole area of mental functioning, not each individual part. They will not add ratings of the parts together. For example, with respect to paragraph B3, if you have marked limitation in maintaining pace, and mild or moderate limitations in concentrating and persisting, the SSA will find that you have marked limitation in the whole mental area of paragraph B3 .
- Marked limitation in more than one part of the same paragraph B area of mental functioning does not satisfy the requirement to have marked limitation in two paragraph B areas of mental functioning.
HOW DOES THE SSA EVALUATE EXACERBATION OR REMISSION IN MENTAL HEALTH SYMPTOMS?
When the SSA looks at the effects of your mental condition, they will consider how often you have exacerbations and remissions. They will also consider how long they last and what causes your mental condition to get worse or improve. Likewise, they will look at any other information.
The SSA will assess any limitation of the affected paragraph B areas of mental functioning using the rating scale for the paragraph B criteria. They will also consider whether you can use the area of mental functioning on a regular and continuing basis. For example, this means can you work or perform the task for 8 hours a day, 5 days a week. The SSA will not find that you are able to work just because you have a period of improvement, or that you are disabled simply because for a period of time your mental illness was worse.
ACTIVITIES OF DAILY LIVING FORM
One of the forms Social Security will have you complete is a form that has questions about your “activities of daily living,” or ADL form. The form, called the Function Report, asks you to describe the ways that your mental condition limits your daily life. The form asks about a number of activities. For instance, the form asks if you spend time with others and do work around your house. It also asks how you get around outside the home, use money, and how you shop.
If your mental illness causes you to have trouble following instructions, trouble getting along with coworkers or supervisors, or trouble handling stress, then you should describe those problems in your ADL form. You can learn more about other forms that SSA needs by going to our client application and appeal forms page.
Social Security is required to look at all of your relevant medical records for at least twelve months before the date of your application for benefits. When you complete your application forms, you should list all of your treatment providers. For example, list your doctors, counselors, clinics, and include any hospital visits.
Social Security will ask you to sign its Authorization to Disclose Information so that they can get your records from your doctors and all of your mental health providers. While Social Security has an obligation to help you get all of your medical records, submitting 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 to the SSA and expect to get it back. You won’t. Always keep the original or your copy of your records for your future use.
PSYCHIATRIC OR NEUROLOGICAL TESTING
Your medical records should contain the results of any psychiatric, neurological, or psychological tests that you have had. In order to win benefits, you must prove most mental health conditions with objective testing. Where objective testing is possible, Social Security will be looking carefully at those results. For example, if you are applying for disability for intellectual disorder, then you will need to show the results of IQ testing.
CONSULTATIVE EXAM TO DOCUMENT PART B LIMITS
DDS will look at the information you write about your mental illness. They will also look at your medical records in order to decide whether more information could be useful in whether or not they should grant your claim. In some cases, DDS will order a consultative exam. You need to go to the exam and explain your mental health conditions to the doctor. The SSA will pay for your visit to the doctor they hire to do the exam. Find our more information about consultative examinations here.
STRUCTURED WORK SETTING FOR THOSE WITH MENTAL ILLNESS
Your mental condition may also require you to have support or a person to watch over you all the time in order to work. The more support you need from others or the more structured the setting you need in order to function at work, the more limited the SSA will find you to be. If you need a structured work setting with constant supervision, then the SSA will find you cannot work at a normal job in the our economy.
HOW MUCH MONEY IS THE SSD OR SSI PAYMENT FOR MENTAL DISABILITY?
Disability with a mental health condition pays each person a different amount. The reason for that is that no one earns the same amount of money during their working years. Since SSD payments are based on your personal earnings record, you are unique. Therefore, your monthly payment is also a unique amount. The monthly benefit amount for mental health conditions also varies depending on if you receive SSI or SSDI benefits, or both.
The average SSI payment for adults in 2021 is $586 per month. Whereas, the average SSDI payment for adults in 2021 is $1,277. If you have a mental health condition, then how much monthly money SSA pays in SSI benefits can also depend on your income and current assets
If you win SSI benefits for a mental illness, the amount you could receive depends on what state you live in. It will also depend on how much monthly income you have.
That is because SSI benefits is a needs based program and it is only intended for individual with very limited income and resources, as well as a severe mental health condition.
If you are filing for SSDI benefits because you have a mental health condition, then you’ll need to be able to show that you are no longer able to work full time.
You also need to have worked a specific amount of time and have earned enough work credits to qualify. Because SSDI benefits are for workers who at one time could work full time, but now can not anymore because of a medical condition, such as a mental illness. Usually, SSDI monthly payments from the SSA are larger than SSI monthly payments.
WE WORK ON CONTINGENCY FEE IN YOUR MENTAL HEALTH CASE
If you have a mental health case, you should hire an attorney to help you win your benefits. Why? Because you need to provide for your family. A lawyer can help you win your SSD benefits using the Part B rules. You are three times more likely to win your benefits if you hire an attorney. In order to hire Cannon Disability, all you need to do is contact us. We offer a free discussion about your case over the phone. Furthermore, it doesn’t cost you any upfront money to hire us. Why?
Because you only pay us an attorney fee if we win your case. This is a contingency fee. It means if we win your SSD case, you pay the attorney fee out of your back benefits. If you do not win, there is no attorney fee to pay.
Additionally, the attorney fee has a cap or a limit. The SSA sets the limit of the attorney fee at 25% of the back benefit or the maximum attorney fee cap. Whatever is less.
If there are costs in your case, then you pay those. But usually those costs are less than $100. Once we win your case, the attorney fee comes from your back benefit. In order to hire most lawyers you have to pay upfront. We don’t work like that. You don’t have a job. So, the only way for you to pay us is for us to win your case. That is our goal. Call and see what we can do for you.
HIRE CANNON DISABILITY FOR OUR YEARS OF EXPERIENCE
In the past 30 years, we have won millions of dollars in ongoing and past due due benefits for our clients. If you want to win benefits for you mental condition, then you need to hire an attorney with the experience to win your case. Also, you need a lawyer to prove to the SSA that you deserve SSD benefits under their rules. Contact us today and we will help you using the Part B criteria.
If you want to learn more about Cannon Disability then read our About Us page. For instance, Andria Summers is an amazing advocate. She can help you with your Medicare plan. She has also won thousands of SSD cases. Dianna Cannon has been helping clients win benefits for thirty years. Brett Bunkall also has years of legal experience helping people obtain their SSI and SSD benefits. We are experts. You can trust us to help you win SSD benefits for mental illness.
In the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. Also, we help our clients chose the best Medicare benefits for their situation. Our lawyers and staff can help you apply for benefits using the SSA’s website.
Likewise, if you need an appeal, we can help you do that too. The SSA also has many forms you will need to fill out. But, don’t worry. If you have questions about these forms, then we will answer them. You can learn more about SSA’s appeal forms here. Call us for free today.
HIRE THE BEST ATTORNEY TO HELP YOU WIN BENEFITS WITH PART B
A lot is riding on winning SSDI benefits. Your future financial needs, as well as that of your family, are at stake. Because it is so important, you need to hire the best attorney to help you in your case.
How will you know who the best SSD and SSI attorney? It is simple. Look for two things.
First, find an attorney who has the legal experience to help you win benefits. Legal experience is important. The attorneys at Cannon Disability have over 30 years of legal experience. We have won over 20,000 SSD and SSI cases in the last 30 years. Therefore, we have the legal experience you need to win your case. We also understand the Part A, Part B, and the Part C rules of the mental health listings. We know how to obtain the evidence to prove you meet the Part B listing for your mental condition.
Second, find an attorney you like. Make sure the attorney and the law firm staff treats you with kindness and respect. When you apply for disability benefits, it may take up to two years to receive benefits.Because of the length of time that it takes to win benefits, you will develop a relationship with your attorney and their office.
Pick an attorney that you can get along with. You will be happier with the whole process. Contact Cannon Disability Law and see if we are a good fit for you. Let us help you with win your mental health case using the Part B Criteria. Contact us now.