Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that can significantly impact an individual’s ability to focus, organize tasks, and control impulses. This disorder typically starts during childhood and can remain until adulthood. For many people with ADHD, these challenges can extend beyond their personal lives and affect their ability to maintain gainful employment. In such cases, social security disability benefits might be a lifeline, providing financial support to those who are unable to work due to their medical condition. The important question is whether ADHD qualifies for Social Security Disability Benefits. When determining eligibility, medical record review for attorneys becomes a very important consideration.
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Does the SSA Consider ADHD As a Disability?
When evaluating a disability claim related to ADHD, the SSA’s (Social Security Administration)’s focus is usually on the symptoms the patient experiences and how such symptoms impact his/her ability to engage in physical and mental activities. Typical symptoms among children include hyperactivity, inattention and impulsive behavior. When it comes to adults, symptoms such as anger control issues, chronic boredom, mood swings and disorganized lifestyle also appear. Medical record review is of course an important requirement because it helps establish the disability.
To qualify for disability, an individual must meet certain criteria:
- Severity of Impairment: The ADHD symptoms must be severe enough to interfere significantly with the individual’s ability to perform basic work tasks.
- Duration of Impairment: The symptoms must have persisted for at least 12 months or are expected to last for at least 12 months.
- Inability to Perform Substantial Gainful Activity: The individual must not be able to engage in substantial gainful activity (SGA), which refers to work that generates a certain level of income as defined by the SSA.
Medical Records Review: A Crucial Requirement
When determining eligibility for Social Security Disability Benefits, a comprehensive review of medical records is a crucial step. Medical records provide evidence of the severity and duration of the impairment. Disability attorneys utilize professional medical review solutions to have a clear understanding of the plaintiff’s medical condition and present a valid disability claim to the SSA.
For individuals with ADHD, the required records might include:
- Psychological Assessments: These assessments can provide insights into the individual’s cognitive functioning, attention, and impulse control. The results can support the claim of impairment.
- Treatment History: Documentation of hospitalization, medication prescriptions, therapy sessions, and other treatment modalities can demonstrate the efforts made to manage the condition.
- Work History: Records of past employment and job performance can showcase the challenges the individual faced due to his/her ADHD symptoms.
- Statements from Healthcare Providers: Expert opinions from medical professionals who have treated the individual can carry significant weight in establishing the severity and impact of ADHD.
- Documentation of aspects such as impulsive or hyperactive behavior
Medical record review for attorneys focuses on aspects such as whether the plaintiff’s records show consistent treatment history and psychological assessments, supporting his or her claim for SSDI benefits due to their inability to maintain substantial gainful activity.
Doctors and Healthcare Professionals Specialized in Treating ADHD
The SSA would require medical records and evaluations from ADHD specialists including the following professionals.
- Psychiatrists who prescribe medications and provide therapy.
- Psychologists who provide mental health therapies such as psychotherapy, talk therapy and so on.
- Speech – language pathologists who specialize in speech and language development.
- Social workers, counselors and therapists who are not doctors but are trained professionals who provide suitable therapy.
Evaluation by the SSA – Important Steps
- Whether the claimant can work gainfully: If the claimant is engaged in Substantial Gainful Activity (SGA), he/she will not be considered disabled. For 2023, the monthly SGA amount for statutorily blind individuals is $2460. For non-blind individuals, this amount is $1470. SGA for the blind doesn’t apply to SSI (Supplemental Security Income) benefits whereas SGA for the non-blind disabled applies to both social security disability (SSDI) and SSI benefits. If the claimant earns more than that amount, he or she may not receive disability benefits (apart from exemptions such as a trial work period).
- Whether the claimant’s ADHD can be considered severe: This means that the claimant’s medical condition must significantly limit his or her ability to do even basic work activities such as standing, sitting, walking, carrying, lifting, understanding, remembering, making work-related decisions, and dealing with changes in a routine work setting among other things. To be eligible for the benefits, the claimant must have a medically determinable physical or mental disability or a combination of impairments that is severe and has lasted/expected to last one year or end in death.
- Whether the claimant’s ADHD matches an SSA listing: The SSA maintains a listing of disabilities that are considered so severe that the claimant will be found disabled if his/her medically determinable physical or mental disability matches them. There are separate listings for adults and children.
- Whether the claimant can perform any of the work he or she has done in the last fifteen years: If the claimant doesn’t have an impairment that meets or equals one of the SSA’s disability listings, the SSA next determines what the claimant is capable of doing despite his or her disability – his or her Residual Functional Capacity (RFC). RFC is a function-by-function evaluation of the claimant’s maximum ability to do sustained physical and mental activities related to work, on a regular and continuing basis. If the SSA finds that the claimant’s medical condition prevents him/her from performing full-time jobs they have done in the past fifteen years, they go to step 5.
- Whether the claimant can perform other types of work: If the SSA determines that the claimant cannot perform his/her past relevant work, they will check whether the claimant can do other work. For this, the claimant’s age, medical condition, education, previous work experience, and any skills he/she has that can be used to do other types of work are evaluated. If the claimant cannot do other types of work, the SSA will find him or her disabled.
The Social Security Administration is strict in reviewing ADHD-based disability claims. The application process is more challenging for adults applying for disability because the evaluation will depend a great deal on how severely this condition affects their ability to earn an income. Medical evidence is therefore most crucial in ADHD disability determination. Accurate and relevant medical records and opinions of treating physicians are strong types of evidence. ADHD can qualify for SSDI benefits if the condition’s severity and impact on work meet the criteria set by the SSA. Medical record review is essential to extract the required medical evidence that can substantiate the claim. Given the importance of medical records, which can be voluminous, attorneys handling such cases will find medical record retrieval services very useful.
Benefit from dedicated medical record retrieval and medical record review services from MOS.
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