You will discover as a disability representative that a large number of claimants will allege a mental impairment of one degree or another.  The claimant will often use terms like nerves, nervousness, depressed, inability to handle stress, etc., as a means of expressing the mental condition.  If these types of impairments are documented and are approached correctly, they can actually help you win cases. 

     In this chapter we will attempt to show you the most effective ways of evaluating mental cases for the purpose of lowering a claimant's mental RFC to an allowable level.

General Evaluation

    When evaluating a case where the claimant is suffering from a physical impairment, your goal is to use the available medical evidence to lower his physical RFC.  In a mental case, the goal is to lower the claimant's mental RFC to a category level called less than simple unskilled work.   This means that the claimant no longer has the mental capacity to perform even the simplest types of work available in the national economy.  If you can prove this RFC via a reasonable argument, the claimant will be awarded benefits.

     No matter what the mental diagnosis, mental impairments in general will have much the same effect on all claimants suffering from the same type mental disorder.  With this in mind, it is important that you evaluate the evidence for the specific symptoms of a given individual, using the diagnosis as proof of the existence of the impairment.

     Mental impairments, unlike other disorders, do not have lab tests to support their existence.  The best way to document and argue a mental case is to show by medically documented history that the claimant has suffered from the disorder for a period of time.  The claimant's psychological history is of the utmost importance because it is the only real proof that an impairment actually exists.

     If there is a diagnosable mental impairment, extract from the evidence the disorder's effects on the claimant's mental state.  Add in the symptoms alleged by the claimant and use the medical findings to support or enhance those alleged restrictions.

    Always make the claimant look as nonfunctional as possible in your arguments and use the medical evidence to support your opinions.  Its that simple!     

    The following is a list of the most common mental conditions seen by the Social Security Disability Administration.  Following this list, we will discuss the restrictive factors which should be noted, regardless of the mental disorder suffered by the claimant.

Organic brain syndrome
Schizophrenia
Psychosis
Affective disorders
Personality disorders
Substance addiction
Somatoform disorders
Mental retardation

    All of mental impairments you will encounter will fall into one of the above categories.   We will discuss each one separately later.   Below is a list of restrictive factors which you should attempt to identify and prove via the medical evidence.

    Always ask yourself these questions when evaluating the medical evidence.  Given the medical findings in this claimant's case, is he/she restricted in any of the factors below?  If the answer is yes to any of the factors below, then try to determine if the limitation is moderate or marked.

    Do the claimant's symptoms moderately or markedly reduce his ability to function under any of the factors listed on the following page?   Moderate is defined as occurring some of the time.  Markedly is defined as most of the time.   These two terms are a loose way of describing how often symptoms are evident in a particular mental disorder.

    Does the claimant have the ability to work in spite of the restrictions you have identified?    If the answer is yes, look for more restrictions!

Mental RFC Capacity Assessment

 Understanding / Memory

1.  Remembering locations and work procedures.
2.  Understanding and remember very short/simple instructions.
3.  Understanding and remember detailed instructions.

 
Sustain concentration

4.   The ability to carry out short/simple instructions.
5.   The ability to carry out detailed instructions.
6.   The ability to maintain attention/concentration.
7.   The ability to perform within a schedule, maintain regular attendance, and be punctual.
8.   Sustain an ordinary routine without special supervision.
9.   The ability to work with others.
10. The ability to make simple work-related decisions.
11. The ability to complete a normal work week without   interruptions from the mental disorder.  The claimant must also be able to reach and maintain a competitive work pace.

Social interaction

12.  The ability to interact appropriately with the general public.
13.  The ability to ask simple questions or request assistance when appropriate.
14.  The ability to accept instructions and respond appropriately to criticism from the supervisor.
15.  The ability to get along with co-workers without distracting them from their work duties.
16.  The ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness.

Adaptation

17.  The ability to respond appropriately to changes in the work setting. 18.  The ability to recognize hazards and take appropriate action or precautions.
19.  The ability to use public transportation.
20.  The ability to set realistic goals and plan events independently of others.

    As you can see, the above questions are basic to any person's ability to work.  No matter what the mental impairment, you should always be sure to compare your claimant's symptoms and abilities to the list above.  Some of the questions above will have a greater effect on the claimant's ability to work than others.

Example

    Your client has been diagnosed as having depression, sometimes referred to as an affective disorder.  Due to the symptoms of the claimant's disorder, he is moderately restricted, in your opinion, on numbers 2,4,6,8, and 12 above.  Go back and look at these numbers.  Common sense would dictate that a person with such restrictions would be totally incapable of performing work, and this is what you would argue.

    The medical evidence must directly or indirectly support your argument.  The strongest arguments are supported by historical evidence; in other words, if the claimant has had documented mental problems for at least a year or more.

    Direct support of your argument comes when a doctor makes comments which spell out one or more of the claimant's alleged restrictions.

    Indirect support comes from your ability to interpret and translate the claimant's symptoms into mental limitations.  This is not difficult to do if you use the common sense approach.  If the claimant has symptoms which are noted in evidence, use the symptoms to support your limitations.  Example, claimant states that he can't concentrate because of his condition.  A psychological test done on this claimant shows that he has difficulty with attention and concentration.  The result is a very strong argument supported by the evidence indicating that the claimant cannot concentrate.  Therefore, this claimant could not do any type of skilled or semiskilled work, because these types of work require some level of concentration.

    The most important mental restrictions listed above are numbers 1,2,4,6,10,11,14,15,16, and 18.   Always try to reduce the claimant's RFC by indicating numbers 3 and 5 as being moderately limited.

    Moderate restrictions of numbers three and five would reduce the claimant's mental RFC to no more than simple unskilled work.   If any other restrictions are added to restrictions three and five, this would indicate a less than simple unskilled work RFC, which is a medical vocational allowance.  

    A marked restriction in numbers two and four would eliminate the claimant's ability to perform even simple unskilled work, mandating a medical vocational allowance for less than simple unskilled work also.  The more mental restrictions you can identify, the better your chance of winning the case.

Organic brain syndrome

    This disorder is caused by a number of factors, including injury to the brain.  Always be sure to evaluate the cognitive skills (math, logic, memory, etc.) in a person with this disorder.  An IQ and memory test are essential in order to evaluate the claimant's true remaining functional level.

Schizophrenia

    Claimants suffering from this disorder may have a multitude of symptoms including delusions, hallucinations, thought disorders, confusion and low stress tolerance.  If the claimant has any of these symptoms which occur two or more times a year and require hospitalization, the claimant should be restricted to less than simple unskilled work.  Consider a claimant having frank delusions or hallucinations as being psychotic and totally unable to work.  Remember, the impairment must be expected to last or has lasted for twelve continuous months.

Affective Disorders

    This term includes most disorders which are associated with depression.  Again, look at the length of time the claimant has suffered from the impairment.  Depression which is severe will lower a claimant's ability to perform any duties which require attention, concentration, or emotional involvement.  Depressed individuals lose their drive for life.  They don't want to eat, play, work, or interact with others.  The most common symptom is withdrawal from family and friends, and a constant need to sleep.

    Have a family member or close friend of the claimant's describe the claimant's symptoms in writing, and send the information to SSA to be incorporated into the case.  Third party feedback about the claimant's symptoms is very important in all mental cases.

Personality disorders  

    This disorder also has a vast number of symptoms that can vary from person to person.  Usually individuals with this disorder manifest inappropriate behavior, combativeness and an inability to get along with others.  The most commonly seen social manifestations are the lack of friends, and violence.

Substance abuse

   This category of disorders include 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 the claimant loses control of their lives or has some form of noticeably strange outburst of  behavior.  Look for an underlying personality disorder which may have been induced by the use of drugs.  Also take note of the claimant's cognitive abilities which may be significantly reduced with prolonged use of many types of drugs.

Somatoform disorder

    People suffering from this disorder usually complain of multiple medical problems which may or may not be present.  You will recognize one of these individuals by the sheer number of their complaints, which are usually physical in nature.  If a claimant believes he is ill, acts the part and constantly seeks medical help, the person is ill and should be restricted even if there is no real physical proof of a disorder.  In these cases the underlying problem is mental, not physical.   Only restrict a claimant in this situation if the diagnosis of a somatoform disorder or hypochondria has been made.

Mental Retardation

    Any person with an IQ under 75 with either a sporatic or no work history is a good candidate for disability.  Look for such supportive evidence as a poor work history or work under special supervision.  Look for an educational history where claimant received less than a twelfth grade education or attended special education classes.   

    Does the claimant need help with activities which a normal person of his age could easily do?   Does claimant attend special programs for the retarded?   Does an adult claimant still depend on parents in an age-inappropriate manner?    Does the claimant utilize the services of special help programs for daily survival?

    Always ask yourself if the claimant is capable of performing competitive work.  If you feel he is not, argue those points which gave you that opinion.  The best arguments you can put forth in any disability case are those which make good common sense.

Activities of daily living (ADLs)

  ADLs are special forms sent to a claimant and possibly a third party.  These forms ask for a description of a claimant's average day's activities.   The form will ask the person to describe the targeted claimant's daily activities in detail, to include his ability to function in both private and public settings.  If the claimant appears to have normal activities and relationships, this information will be used by SSA to deny the case.  Always attempt to make the claimant appear as restricted as possible on these types of questionnaires.

Episodic Mental Disorders

    The last subject in this chapter 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 is episodically occurring three times a year or more and lasting one from two weeks too one month per episode, this claimant will not realistically be capable of work.  Remember, work capability has a competitive factor which must be taken into consideration by the ALJ.

   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.