Episodes of Decompensation

The term “episodes of decompensation” is a crucial concept to understand if you’re applying for Social Security Disability (SSD) and/or Supplemental Security Income (SSI) benefits based on a diagnosed mental illness.

Decompensation is a clinical term used to describe a mentally ill individual’s state of mental health when he or she was previously managing the illness well but suffered a downturn at a certain stage. That stage is considered a decompensation or decline in overall condition.

Episodes are periods of decline that occur. Each period during which a patient’s mental health declines, even if for a very limited time, is considered an episode.

Episodes may occur frequently and last for a short duration or may happen less often and last for a longer period of time. Regardless of how common or uncommon they may be, and no matter how long they may last, episodes of decompensation must be clearly detailed in your medical records if you’re pursuing SSD benefits based on a psychiatric condition or mental illness.

Episodes of decompensation are a crucial component of meeting eligibility requirements for SSD benefits for those disabled by a mental illness, and like all other medical documentation, the SSA defines what documentation is acceptable for meeting the burden of proof in a claim. With episodes of decompensation, the SSA requires documentation showing:

  • The applicant’s symptoms worsened for a period of time.
  • The claimant was unable to adapt or appropriately respond to stress and/or normal changes.
  • The applicant was severely limited during the episode and was therefore unable to perform normal activities of daily living like completing tasks, concentrating, remaining social or communicative, etc.

In other words, the documentation that is contained within your mental health records and your SSD application must show that during episodes of decompensation your symptoms got worse and you were unable to function because of them.

In addition to proving the existence of episodes and documenting what affect they have on your ability to maintain employment, you must also attribute episodes to specific causes. Your application must contain explanations for what triggers episodes and your medical records must communicate the reason for the episode, as well as the length and duration of each episode.

There are multiple causes of episodes of decompensation with mental illnesses. The specific cause doesn’t typically affect eligibility for SSD other than that it must be defined and clearly documented in order to prove episodes occurred at all. Potential causes can include:

  • Treatments that become ineffective over time,
  • Situation-based stressors,
  • Increases in patient-specific drivers that fuel condition decline,

There are a number of conditions that require the clear documentation of episodes of decompensation. These include, but are not limited to: Anxiety, Autism, Bipolar Disorder, Depression, Mental Retardation, and Schizophrenia.

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