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Mental Disorders
Home Full Impairment Discussion You'll discover as a disability representative that a large number of claimants will allege a mental impairment of varying types as a primary or secondary diagnosis. The claimant will often use terms like nerves, nervousness, depressed, inability to handle stress, etc. as a means of expressing their mental condition. If these types of symptoms are presented to you, investigate the possibility of a restrictive mental impairment. Even if the alleged mental impairment is secondary in nature, if it is significant, it can still be used to lower the claimant’s residual functional capacity. In this segment, we'll explore the many
ways in which a mental impairment can be used to reduce a
claimant's ability to perform work. I'll show you the most
effective ways of evaluating mental cases for the purpose of
lowering a claimant's mental residual functional capacity (MRFC)
to an allowable level. General Evaluation When evaluating a case on a claimant who is suffering from a physical impairment, your goal is to use the available medical evidence to lower the claimant's physical residual functional capacity. In a mental case, your goal is to lower the claimant's mental residual functional capacity (MRFC). If the claimant is under age forty-nine, attempt to lower his MRFC to a level called less than simple unskilled work. The simple unskilled work designation means that the claimant is no longer mentally capable of performing even the simplest types of work available in the national economy. If you can reasonably argue for a MRFC of less than simple unskilled work, the claimant may be awarded disability benefits. No matter what type of mental disorder a claimant is suffering from, it is important that you evaluate the evidence for specific symptoms. Unlike many physical disorders, mental impairments usually do not have definitive diagnostic tests to support their existence. The best way to document a mental disorder is to show by medical history that the claimant has exhibited specific symptoms over a period of time. The claimant's psychological history is of utmost importance because it is the only real proof that an impairment actually exists. If there is a documented mental impairment, determine the disorder's effects on the claimant's ability to perform work. If there are additional symptoms alleged by the claimant, use the medical evidence to support these symptoms. You can then use the additional symptoms as a means of further restricting the claimant's MRFC. Always make the claimant appear as nonfunctional as possible in your argument, and use the medical evidence to support your opinion. The following is a list of the most common mental disorders seen by the Social Security Disability Administration: Organic brain syndrome
Most of the mental impairments you'll encounter as a disability advocate will fall into one of the above diagnostic categories. Given the medical findings in a claimant's case, you must determine how restrictive the claimant's symptoms are in respect to his ability to perform work. This determination is made by scoring the claimant's symptoms as being mild, moderate or marked. Mildly restrictive: Defined as only
slightly reducing the claimant’s ability to perform. Markedly restrictive: Defined as
severely restrictive to the claimant's ability to perform. Mental RFC Assessment Understanding and memorizing for the purpose of creating a mental residual functional capacity is defined as: 1. Remembering locations and work
procedures. If the claimant is only mildly restricted in his ability to understand and remember, this would probably allow him to perform simple unskilled work. If he is moderately limited in his ability to understand and memorize, this may be disabling depending upon his other remaining mental capabilities. If the claimant is markedly limited in his ability to understand and memorize, this finding could result in an allowance determination. Before an allowance determination can be reached, you must still determine the level of the claimant's other remaining mental capabilities in order to get a full picture of the claimant's true MRFC. Sustaining concentration for the purpose of creating a mental residual functional capacity is defined as the claimant's remaining ability to: Carry out short/simple instructions.
If the claimant is only mildly restricted in his ability to perform the above requirements of work, this would probably allow him to perform simple unskilled work. If he is moderately limited in his ability to perform the above requirements of work, this may be disabling depending upon the claimant's other remaining mental capabilities. If the claimant is markedly limited in his ability to perform the above requirements of work, this finding could result in an allowance determination. Before an allowance determination can be reached, you must still determine the level of the claimant's other remaining mental capabilities in order to get a full picture of the claimant's true MRFC.
Normal social interaction for the purpose of creating a mental residual functional capacity is defined as the claimant's remaining ability to: Interact appropriately with the general
public. If the claimant is only mildly restricted in his ability to perform the above social requirements of work, this would probably allow him to perform simple unskilled work. If he is moderately limited in his ability to perform the above social requirements of work, this may be disabling depending upon the claimant's other remaining mental capabilities. If the claimant is markedly limited in his ability to perform the above social requirements of work, this finding could result in an allowance determination. Before an allowance determination can be reached, you must still determine the level of the claimant's other remaining mental capabilities in order to get a full picture of the claimant's true MRFC.
Adaptation for the purpose of creating a mental residual functional capacity is defined as the claimant's remaining ability to: Respond appropriately to changes in the
work setting. If the claimant is only mildly restricted in his ability to perform the above adaptive requirements of work, this would probably allow him to perform simple unskilled work. If the claimant is moderately limited in his ability to adapt to a working environment, this may be disabling depending upon the claimant's other remaining mental capabilities. If the claimant is markedly limited in his ability to adapt to a working environment, this finding could result in an allowance determination. Before an allowance determination can be reached, you must still determine the level of the claimant's other remaining mental capabilities in order to get a full picture of the claimant's true MRFC. As you can see, the above mental capabilities are basic to any person's ability to perform and sustain work. No matter what type of mental impairment suffered by the claimant, you should consistently compare the claimant's symptoms with his ability to adjust to the requirements of work.
This disorder is caused by a number of factors, including injury to the brain. When this diagnosis is present, be sure to evaluate the claimant's remaining cognitive skills (math, logic, memory, etc.) level. IQ and memory tests are essential for claimants suffering from organic brain syndrome.
Claimants suffering from Schizophrenia
may have a multitude of symptoms including delusions,
hallucinations, thought disorders, confusion and low stress
tolerance. If a claimant has any of these symptoms which occur
frequently and require hospitalization, the claimant should be
restricted to less than simple unskilled work. Consider a
claimant who has delusions or hallucinations to be psychotic and
totally unable to work. Remember, the impairment must last or
be expected to last for twelve continuous months. Whether
schizophrenia meets the duration requirement will be determined
by the claimant's response to medication and treatment. Depression, Affective Disorders The term affective disorder is sometimes used interchangeably with the term depression, despite the fact that there are several types of affective disorders. In claimants with an affective disorder, look at the length of time the claimant has suffered from the impairment. Depression that is severe will lower a claimant's ability to perform any duties of work that require attention, concentration or emotional stability. Depression often reduces a claimant's level of motivation and interest in the basics of life. Many individuals with an affective disorder will refrain from eating and neglect personal hygiene, which can lead to additional physical impairments. The most common symptom of an affective disorder is withdrawal from family and friends and a constant craving for sleep. Have a family member or friend describe the claimant's symptoms in writing. This can help you to win the case. Third party feedback about a claimant's activities of daily living is very important in all mental cases.
Personality disorders have a vast number of symptoms that can vary from person to person. Usually individuals with this diagnosis manifest inappropriate behavior, combativeness and an inability to get along with others. The most commonly seen social manifestations are the lack of friends and violent behavior.
The substance abuse category of disorders includes both legal and illegal types of drug use. Individuals suffering from this disorder often show profound changes in their personalities. The changes may not be detected until substance abusers loses control of their lives or have some form of noticeable crisis or breakdown. Look for an underlying personality disorder that may have existed prior to substances abuse. Also take note of the claimant's cognitive capabilities, which may be significantly reduced with prolonged use of drugs. It is extremely difficult to win a case for Social Security disability benefits based on addiction alone. If the claimant's primary impairment is alcohol or drug addiction, I would not accept the case for representation.
Any person (adult or child) with an IQ under 75 with either a sporadic or non-existent work history is a good candidate for disability. Look for supportive evidence like a limited work history or work under special circumstances and supervision. Look for a sporadic or non-existent educational history where claimant received less than twelve years of formal training or attended special education classes. In cases where the diagnosis is mental retardation, determine if the claimant needs help with activities that a normal person his age could easily perform. In adults, look for circumstances where the claimant still depends on parents in an age-inappropriate manner. Does the claimant utilize the services of special help programs for daily survival? If so, suspect mental retardation.
The last subject in this segment is concerned with the episodic nature of almost all mental disorders. Most mental impairments come and go and generally improve with treatment. If your claimant is showing this pattern, there is a simple way to approach your argument. If a condition occurs three times a year or more and lasts a few weeks, this claimant will not realistically be capable of work. Keep in mind that competitive work has a sustainability factor that Social Security must consider in making a determination. Your argument should center around the fact that a person suffering episodic relapses of a serious mental impairment will have a very poor chance of both acquiring and keeping competitive work. On this basis, given good supportive evidence of the episodic occurrences, you should have a pretty fair chance of winning the case. There are several other important mental disorders that are not discussed here. For additional information about mental disorders and how they are evaluated by Social Security, see the Social Security Guide chapter 27.
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