A Summary of How Social Security Evaluates Mental Impairments

Although people are much more open then they used to be about mental illness, it is still an uncomfortable subject for many. Nonetheless, statistics show that in any given time, one in four Americans have a diagnosable mental disorder. Many people suffer from disabling mental illnesses which prevent them from working on a regular basis. This article gives a brief overview of how Social Security evaluates disability claims involving mental disorders.

Like many other medical conditions, there are impairment listings for mental disorders. The listings are best considered a catalogue of disabling conditions. The impairment listings cover many different kinds of medical problems, divided up into several chapters.  There is a chapter for orthopedic disorders, neurological problems, and cardicac issues. The mental impairments appear in chapter twelve.

The first issue in a mental impairment claim is whether not there is a severe, medically determinable impairment. In other words, is there a diagnosis?  This is often referred to as the "A" criteria.  In our experience, this is often not an issue.

When deciding whether or not there is a medically determinable impairment, the Social Security Administration must decide what kind of diagnosis the medical evidence shows. The listings include several groups of conditions, or diagnoses, ranging from organic mental disorders to affective disorders (depression), and anxiety related disorders.  These are groups of diagnoses.  For example, a Claimant with PTSD has an anxiety disorder, just like another Claimant who has been diagnosed with Generalized Anxiety Disorder.

Once the decision maker finds that the claimant meets the "A" criteria, the next step in the evaluation is to determine the severity of the condition. The decision maker is attempting to determine how much the mental impairment interferes with certain areas of function. This is referred to as the "B" criteria.

In evaluating this part of the claim, the Social Security Administration decision maker is assessing how much the mental impairment interferes with activities of daily living, social functioning, and the ability to maintain appropriate concentration, persistence or pace.  The concentration, persistence and pace element is looking at how much the mental impairment would interfere with a person's ability to focus at work, even on simple, unskilled tasks.

The decision maker will also look to see whether or not there has been a number of "decompensations."  A decompensation is where the person's mental symptoms increase significantly, and they are not able to function at a basic level.  This is comparable to someone having to go to the hospital for mental health issues. 

For activities of daily living, social functioning, and the ability to concentrate, or work at inacceptable pace, the choices for the decision maker rates the severity of the interference from none at all, to mild, moderate, marked, and severe.  There is also a choice of "no evidence."

Generally, if a person is markedly impaired in two areas of function, or has suffered enough decompensations over the required period of time, and has sufficient limitations in one of the other areas of function, then they "meet a listing," and are found disabled.

There is in "C" criteria that serves as an alternative to the "B" criteria. This criteria is limited to organic mental disorders, schizophrenic disorders, and affective disorders. A claimant will meet this criteria if there is a medically documented history of one of these disorders lasting at least two years, and that has caused more than a minimal limitation in the ability to do basic work activity. There must also be evidence of symptoms or signs attenuated by medication or psychosocial support, and one of the following:

1.  Repeated episodes of decompensation;

2.  A very high susceptibility to decompensation with added stress, or

3.  A history of one or more years of an inability to function outside a highly supportive living arrangement with evidence of a continued need for such an arrangement.

Even if a person does not meet an impairment listing, he or she may still be disabled if her residual mental functional capacity prevents her from working in a competitive work environment on a sustained basis. To determine mental residual functional capacity, the evaluator will look at various work related skills including the ability to follow instructions, interact with the public or coworkers, show up to work on time, and concentrate as required.

Mental impairment claims bring special challenges. We have extensive experience handling these kinds of cases, and if you have a question, call us at 503-325-8600. We are approachable, empathetic, and can answer your questions.