Mental Disorders are every bit as real as herniated disks, diabetes or hepatitis. If a mental disorder is severe enough, it can prevent a person from being able to work. This column will be an overview of how the Social Security Administration (SSA) evaluates disability claims from people with mental disorders. The SSA requires medical documentation of mental disorders in making its decision. It is not enough for a claimant to come into court and say “I’m depressed and cannot work.” Unfortunately many people suffering from mental disorders do not want to seek mental health counseling for a variety of reasons. This behavior of avoiding psychiatric and psychological care, while common, will prevent the individual from receiving the professional care he needs and can prevent him from receiving SSA disability benefits if he is unable to work due to his mental health problems. Jack wouldn’t be embarrassed to go to a doctor if he had a broken leg. Jack should not be embarrassed to go to a psychiatrist if he has some type of mental illness.
The SSA has divided mental disorders into nine categories: Organic mental disorders; schizophrenic, paranoid and other psychiatric disorders; affective disorders; mental retardation; anxiety related disorders; somatoform disorders; personality disorders; substance addiction disorders; and autistic disorders and other developmental disorders. In general the SSA uses a two pronged approach in evaluating mental disorders. The first step is to review the medical documentation to determine the specific medical diagnosis of the person’s mental disorder. Certain mental disorders are so severe that if the claimant has a particular diagnosis, the SSA will assume that the disorder prevents the individual from working. For other less severe disorders, the SSA takes a second step to determine what functional limitations are imposed on the claimant by his mental disorder.
The evidence considered by the SSA to determine the existence of a mental impairment requires medical evidence of “signs, symptoms and laboratory findings including psychological test findings.” Symptoms are the person’s “own description of your physical or mental condition.” Psychiatric signs are “medically demonstrable phenomena that indicate specific psychological abnormalities such as abnormalities of behavior, mood, thought, memory, orientation, development or perception as described by an appropriate medical source.” The SSA recognizes that symptoms and signs do not have to be continuous at all times to constitute a condition that prevents an individual from working.
The SSA has to determine how severe the person’s functional limitations are as a result of his mental disorder. To evaluate severity, the SSA uses four categories of functional limitation which are: “activities of daily living; social functioning; concentration, persistence, or pace; and episodes of decompensation.” The SSA then evaluates each of the four categories by determining if the limitations are “moderate, marked or extreme.”
Activities of daily living are defined as such things as “cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, caring appropriately for grooming and hygiene.” Social functioning consists of the person’s ability “to interact independently, appropriately and effectively on a sustained basis with other individuals.” Impaired social functioning can be demonstrated to the SSA by “a history of altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships or social isolation.” Concentration, persistence and pace refers to the “ability to sustain focused attention and concentration sufficiently long enough to permit the timely and appropriate completion of tasks commonly found in work settings.” The SSA’s position is that problems in concentration, persistence and pace are particularly well suited to be evaluated by clinical evaluation or psychological testing.
Episodes of decompensation are “exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning shown by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence or pace.” Increases or alteration of medication, or the “need for a more structured psychological support system such as hospitalization, placement in a half way house or a highly structured household” are used by the SSA to determine if an episode of decompensation has occurred. Repeated episodes of decompensation occur if the claimant has three such episodes in a 12 month period and each one lasts at least two weeks. The SSA will also consider shorter periods if they are more frequent in evaluating decompensation.
The SSA will require medical evidence from the claimant’s treating physician to decide if the claimant has a medically determinable mental impairment. The SSA will require the claimant to sign medical releases to allow it to obtain all relevant medical information regarding the claimant’s impairment. The SSA will seek records including “mental status testing examinations, psychological testing, hospitalizations and treatment.” The SSA will also request information from the claimant himself regarding his description of his impairments. The SSA will also seek medical information from other health care providers such as psychiatric nurses or psychiatric social workers.
As a claimant’s mental condition can vary over time, the SSA will seek to obtain long term medical records documenting his mental status. The SSA can require a claimant to undergo a mental status evaluation paid for by the SSA. The SSA will also consider the results of any standardized psychological tests that have been administered to the claimant by a State licensed mental health professional. The SSA will also consider standardized IQ tests and personality measures such as the Minnesota Multiphasic Personality Inventory, or the Rorschach and the Thematic Apperception Test to evaluate some mental disorders. The SSA will also consider neuropsychological assessments which can show if ” certain brain functions have been compromised, particularly in cases involving organic mental disorders.”