How Decompensation Can Affect Benefits for Mental Health Claimants

decompensation periods for mental health claimants

Mental health issues are the second-most common reason SSD claims get approved today. So, what does the word “decompensation” mean for mental health claimants? And if your claim’s already approved, does decompensation change your ability to collect SSD benefits? If you’re not sure what decompensation means but have anxiety, depression, PTSD, OCD or other mental impairment(s), then keep reading!



Decompensation Is What Happens When Your Medication or Treatment Stops Working

Decompensation is a word you may see in letters from the Social Security Administration (SSA). You may also see or hear that word during your DDS exam. Simply put, decompensation is how the SSA describes your worst days. It happens whenever your medication or standard treatment stops controlling your condition’s symptoms. During these episodes, your overall mental health signs and symptoms usually get worse.

These periods can end quickly or last for a long time. They can happen often, once in a while or even rarely. But the important thing to know is that the SSA expects these decompensation episodes to affect you. And these episodes could impact your eligibility for monthly benefits today or in the future.

Evaluation of Disability for Mental Health Claimants

The evaluation of disability for people who have one or more mental health issues will include:

  • Verifying documents that show you have a doctor-diagnosed impairment
  • Reviewing exactly how much your impairment(s) should limit your ability to work
  • Determining if your inability to work should last for at least 12 months or result in death

If you can’t meet these eligibility requirements, the SSA will likely deny your claim.

Be Willing to Talk About Your Most Challenging Days (“Episodes of Decompensation”) With Your Doctor

Even though you may not want to share these “episodes of decompensation” with your doctor or therapist, you really should. Why? Because tracking your symptoms and treatment results is the best way to get approved for — and keep — your disability benefits.

If your medicine or usual treatment stops working for days or even weeks, you may need to switch things up. That’s because a new treatment or additional meds might work better on your current symptoms. Doctors and therapists know people’s health conditions change over time. What worked 10 years ago or even last month may no longer be an effective treatment for you now.

How the SSA Defines Decompensation Episodes

The SSA calls any times when your condition’s signs or symptoms increase “periods of decompensation.” Because once your symptoms get worse, your ability to function on a daily basis tends to get harder, too. That’s what the SSA means when they talk about decompensation.

These episodes may make the following feel much more difficult than they normally do:

  • Performing activities in your daily life, like showering, brushing your teeth or feeding yourself
  • Maintaining social relationships, like talking to friends or hugging your partner
  • Trouble concentrating, finishing tasks or maintaining the same pace that you usually do

The SSA may look at your medical records for clues that might explain any decompensation episodes after your claim’s approved. (Times when your doctor prescribed a new drug, for example, or when you change therapists.) What else can serve as evidence you’ve suffered a period of decompensation? The items below can serve as evidence showing when you experienced an episode:

  • Documented need for hospitalization from your doctor or therapist
  • Placement in a halfway house or highly structured household setting

Repeated Episodes of Decompensation

When the SSA uses the phrase repeated episodes of decompensation (especially when they last for very long), it usually means:

  • Three episodes within the same year, or
  • One episode lasting for at least two weeks at a time that happens every four months, on average

In most cases, you’ll need a check-up exam with DDS every 3-7 years after your claim’s approved. (These exams are important; DDS uses them to confirm you’re still too disabled to work.) So what if your decompensation episodes are shorter but more frequent (or last longer, but aren’t as frequent)? The SSA may have to evaluate your ongoing eligibility for benefits a little differently. If your episodes seem unusual, the SSA may want you to come in for check-ups more often.

You May Qualify for Legal Assistance

If you’re not sure why your mental illness claim got denied or the SSA stopped your payments, ask a lawyer. Our lawyers are happy to meet with you in person and give confidential answers to all your SSD questions. These consultations are completely free and don’t obligate you to keep that lawyer working on your claim. Last year, about 2 in every 5 applicants got denied automatically for making basic mistakes on their claim forms. A lawyer can help you avoid basic paperwork errors and get you the most SSD benefits you’re owed paid faster. You’ll never pay any legal fees to file or appeal your claim unless a lawyer helps you win benefits. And if you do win, you’ll only pay a small, one-time fee. It’s the law!

Ready to see if you may qualify? Click the button below to start your free benefits evaluation online now!

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