A Mental Health Practitioner's Guide to Evaluation of Mental Impairments for Social Security Disability Applicants

Social Security reviews mental impairments claims under special rules that focus on whether there is a mental impairment in the first, place, and if so, how much that mental impairment interferes with a person’s ability to function in the work place.

 Often times, whether there is mental impairment is not disputed. However, it is good practice to identify the particular DSM-4, or DSM-5 diagnoses, and although the current DSM does not include the Global Assessment of Function (GAF) scale, some assessment of diagnostic severity, symptom severity, or disability, which is covered in Section III of DSM-5.

The second question, which is usually in dispute, is how much the mental impairment affects the person’s ability to function in a competitive work environment. In other words, Social Security is looking at how the impairment affects a person’s ability to work on a sustained basis. First, Social Security looks at broad areas of function, and determines how much the mental impairment interferes with the applicant’s function in those areas.  Activities of Daily Living, Social Function, and Concentration, Persistence and Pace are the three broad areas of function assessed. If an individual is markedly impaired in two of these areas, then that person meets the criteria for being disabled.

The fourth item on this list involves Decompensation.  The claimant experiences decompensation if there are exacerbations or temporary increases in symptoms with a loss of adaptive functioning. These exacerbations must result in difficulties in performing activities of daily living, maintenance of social relationships, or the ability to concentrate, or work at inacceptable pace. In order for a claimant to meet this criteria, the claimant would have to experience to episodes of decompensation lasting at least two weeks within the last 12 months. There may be shorter durations of decompensation that occur more frequently, and if so, the number and duration of these episodes should be dcoumented.

If an individual does not meet the criteria after review of these four spheres of function, the Social Security Administration will determine the individual’s mental residual functional capacity. This inquiry examines more specific tasks that involve work activity on a day-to-day basis.   This involves assessing the claimant’s ability to carry out tasks associated with different kinds of work, beginning with unskilled work, then moving on to semi-skilled and skilled work activity.  Social Security is also interested in how a claimant gets along with the general public, co-workers, and supervisors, and if accomodations must be made in this area.

Part of assessing the claimant’s residual capacity function involves a determination of how often the claimant’s mental impairment would cause absenteeism from work, or the amount of time in a work day that the claimant would be “off task.”  An individual that would miss two or more days a month of unskilled work is likely not to be able to engage in any kind of competitive work.

Another important question in many cases is whether alcohol or substance abuse are materially contributing to a claimant’s  ability to perform work activity on a regular basis. Past effects from drug or alcohol abuse, like liver cirrhosis or some other physical manifestation of drug or alcohol abuse are not considered as a contributing factor. Active dependence however, is.

The contribution from the drug or alcohol dependence must be “material.” In order to determine whether the drug or alcohol dependency is material, Social Security first determines whether or not the individual meets the definition of a “disability.” If Social Security decides that the person does meet this definition, it then determines whether not the person would still be considered disabled despite any drug or alcohol dependence. To do this, Social Security looks at the person’s functional ability in absence of any affects from drug or alcohol abuse. If the individual, and absence of any effects from drug or alcohol abuse, is still not able to work on a sustained basis due to their mental impairment, then the individual is disabled under the statute.

In assessing functional impairment, reference to medical and clinical findings, like mental status exam findings, or other testing to support the assessment, is crucial.

Another common issue is the assessment of the onset date. This is the date that the claimant is alleging the onset of their disability.  Often times, the alleged onset date is determined during the application process, and is a function of when the claimant last worked or was insured for disability benefits, and is not necessarily tied to any manifestation of symptoms.

Some mental health opt not to provide an opinion of an onset date prior to their first encounter with the patient, and others are willing to base their opinion upon patient history or prior mental health treatment records.

If you have a patient or client in the midst of a disability claim, we can help.  We have over twenty years of experience helping clients struggling with mental illness on their Social Security Disability claims. Call us at 503-325-8600.