Evaluation of mental disorders in Florida Social Security disability cases

Many visitors and callers to our Miami disability law firm cite mental conditions as the reason for their disability. Others who mention only physical impairments also have hidden psychological issues because chronic physical problems take a toll on mental health.

Here is an overview of the complex rules the Social Security Administration uses to determine whether an applicant with a mental disorder is entitled to disability benefits.

The Listings for mental disorders

Social Security Administration regulations, known as the Mental Disorders Listings, recognize nine different categories of mental impairments:

  1. Organic mental disorders.
  2. Schizophrenic, paranoid and other psychotic disorders.
  3. Affective disorders.
  4. Mental retardation.
  5. Anxiety-related disorders.
  6. Somatoform disorders.
  7. Personality disorders.
  8. Substance addiction disorders.
  9. Autistic disorder and other pervasive developmental disorders.

The listing for each disorder contains diagnostic criteria and severity criteria that describe a degree of impairment that would prevent a person from performing substantial work and thus make him or her disabled.

The Mental Disorders Listings can be found at http://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm.

Do you have a “medically determinable mental impairment?”

The assessment of whether you have a medically determinable mental impairment is the first step in the disability analysis.

Each of listings has its own separate diagnostic standards, called the “A criteria.” A claimant who meets the A criteria for any of these impairments has a medically determinable mental impairment. For example, the criteria for depression (an affective disorder) require that you have at least four of the following:

  1. Anhedonia or pervasive loss of interest in almost all activities; or
  2. Appetite disturbance with change in weight; or
  3. Sleep disturbance; or
  4. Psychomotor agitation or retardation; or
  5. Decreased energy; or
  6. Feelings of guilt or worthlessness; or
  7. Difficulty concentrating or thinking; or
  8. Thoughts of suicide; or
  9. Hallucinations, delusions, or paranoid thinking;

If you meet the A criteria for any mental disorder, the Social Security Administration next considers the severity of your condition.

Is your medically determinable mental impairment severe?

Severity is assessed under the B criteria of the Mental Listings. Under the B criteria, the limitations caused by your mental impairment are evaluated in four areas: (1) activities of daily living; (2) social functioning; (3) concentration, persistence, or pace; (4) episodes of decompensation.

The Social Security Administration rates your functional limitations in each of the first three areas as (from most to least limited) “extreme,” “marked,” “moderate,” “slight” or “none.” The ratings for the fourth area are “four or more,” “three,” “one or two” or “never.”

As a general rule, if the Social Security Administration rates the degree of your limitation in the first three functional areas as “none” or “mild” and “none” in the fourth area, it will generally conclude that your impairment is not severe and you will not be disabled.

Are you disabled by your mental impairment under the B criteria?

If you have a medically determinable mental impairment (you meet the A criteria) that is severe, you will meet the listing for a mental disorder and be considered disabled if:

  • You have been rated “extreme” for any one of the first three B criteria; or
  • You have been rated “marked” for any two of the first three B criteria; or
  • You have experienced three episodes of decompensation.

If you have received a rating of “moderate” you have a severe impairment, but one that does not meet or equal a listed impairment and therefore requires an RFC assessment. See below.

Are you disabled by your mental impairment under the C criteria?

In addition to the A and B criteria, the listings for the following mental impairments also have C criteria:
Organic mental disorders,
Schizophrenic, paranoid, or other psychotic disorders,
Affective disorders, and
Anxiety-related disorders.

If you do not meet the B criteria, you may still be disabled under the C criteria. As a rule, the Social Security Administration will assess the C criteria when you function too well to meet the B criteria.

The C criteria for organic, psychotic, and affective disorders are the same. They all require that you have a two-year history of a chronic mental impairment with more than minimal limitation in your ability to do basic work activities. In addition, the criteria require at least one of the following:

  • Repeated episodes of decompensation, each of extended duration.
  • A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause you to decompensate.
  • A current history of one or more years of inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.

The single C criterion for anxiety-related disorders is an anxiety disorder resulting in complete inability to function independently outside of your home.

How to establish that you are disabled under the B or C criteria

Often your family, friends, and neighbors are the best sources of information and testimony about the B criteria. You may also be able to provide useful information, but sometimes, your mental disorder will make that difficult. Mental disorders frequently rob people of the ability to realistically assess their limitations.

Deciding whether your impairment meets the C criteria may depend on expert opinion, particularly from your treating doctors. After repeated hospitalizations or long-term outpatient care, therapy and medication, you may have organized your life to minimize stress and reduce your symptoms. If this is the case, you may be much more impaired for work than your symptoms and behavior would indicate.

What if you meet the B or C criteria, but not the A criteria for your mental impairment?

According to Social Security Administration regulations, the A criteria are only examples of common mental disorders that are considered severe enough to prevent an individual from doing any gainful activity.

“ When you have a medically determinable severe mental impairment that does not satisfy the diagnostic description or the requirements of the paragraph A criteria of the relevant listing, the assessment of the paragraph B and C criteria is critical to a determination of equivalence.”

This means that if you meets the B or C criteria, but not the A criteria for any mental disorder, you may nonetheless be considered disabled.

What if you do not meet the B or C criteria?

If you have no more than moderate limitations in your ability to function (that is, you do not meet the B or C criteria), you may still qualify for benefits. But the Social Security Administration must do a residual functional capacity assessment to determine if you are disabled. The Social Security Administration will determine whether you can do skilled, semiskilled, or unskilled work in spite of your impairments, or whether you cannot do even unskilled work. If you have a marked impairment in any of the abilities required for unskilled work, you will be awarded disability benefits, even if you do not have any physical impairments.

An accurate assessment of your ability to do skilled, semiskilled, or unskilled work requires a lot of information. Here is another area in which information about your behavior from your family, friends, neighbors, doctors, and other people who know you can help. An experienced disability attorney can determine what information is needed from you, your doctors, and others to present the strongest case possible for you.

Assistance available from Miami disability lawyers

Cases involving mental disorders can be challenging. If you have such a case and are not already represented by a Social Security disability lawyer and want our evaluation, give us a brief description of your claim using the form to the right. Or you may contact us.

E-mail us.