Yes. Post-traumatic stress disorder is a recognized disabling condition under the Social Security Administration’s rules, and it can qualify you for Social Security Disability Insurance or Supplemental Security Income if the condition is severe enough to prevent you from working. But qualifying is not automatic. The SSA evaluates PTSD under specific medical criteria, and meeting those criteria requires detailed clinical documentation from a treating mental health professional.
How the SSA evaluates PTSD
The SSA evaluates PTSD under Listing 12.15 of its Blue Book — the official list of impairments that qualify for disability benefits. To meet Listing 12.15, you must have medical documentation of exposure to actual or threatened death, serious injury, or violence, followed by involuntary re-experiencing of the traumatic event, avoidance of external reminders, disturbance in mood and behavior, and increases in arousal and reactivity.
In addition to these clinical criteria, you must demonstrate that the PTSD results in either an extreme limitation in one area of mental functioning or a marked limitation in two areas. The four areas the SSA evaluates are: understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; and adapting or managing oneself.
Alternatively, if you do not meet the functional limitation criteria, you may qualify if your PTSD is “serious and persistent” — meaning you have a medically documented history of the condition for at least two years, with evidence of ongoing treatment that diminishes the symptoms, and marginal adjustment (minimal capacity to adapt to changes in your environment or to demands not already part of your daily life).
The medical evidence required
The SSA will not take your word for it. The claim must be supported by clinical records from a psychiatrist or psychologist documenting the diagnosis, the specific symptoms, the frequency and severity of episodes, the treatment history, and the functional limitations the condition produces. Standardized assessment tools like the PCL-5 and CAPS-5 provide objective measurements that the SSA can evaluate.
The treating mental health professional’s opinion about your functional limitations is the most important evidence in the claim. A detailed letter from the treating psychiatrist explaining how the PTSD prevents you from maintaining employment — inability to concentrate, inability to interact with coworkers or supervisors, inability to maintain a regular schedule due to sleep disruption and hyperarousal — is what connects the diagnosis to the disability.
PTSD from a workplace injury or accident
If your PTSD was caused by a workplace injury or a motor vehicle accident, you may have multiple claims running simultaneously: a personal injury or workers’ compensation claim for the event that caused the PTSD, and an SSDI claim for the disability it produced. These claims are independent but interact with each other. Workers’ compensation benefits are subject to the 80% offset against SSDI. A personal injury settlement does not directly affect SSDI eligibility, but income from investments of the settlement proceeds could affect Supplemental Security Income.
The timeline and appeals process
SSDI applications take three to six months for an initial decision. If denied, reconsideration takes another three to six months. If denied again, a hearing before an ALJ can take 12 to 18 months to schedule depending on the backlog. The entire process from initial application to ALJ hearing can take two years or more. Back benefits are paid from the date of disability (with a five-month waiting period), so the longer the process takes, the larger the back benefit award if you are ultimately approved.
How Schwartzapfel Holbrook coordinates PTSD claims
At Schwartzapfel Holbrook, we handle the personal injury and workers’ compensation claims that arise from the event that caused the PTSD. When the PTSD is severe enough to prevent our client from working, we coordinate with SSDI counsel to ensure the medical evidence supports both the injury claim and the disability claim, and we structure any settlement to minimize the offset between workers’ compensation and SSDI benefits.
Schwartzapfel Holbrook / Fighting For You