Qualifying for Disability Based on Mental Impairments

Social Security evaluates mental impairments differently than physical impairments. The purpose of this brief overview is to discuss generally how Social Security evaluates mental impairments and what criteria generally need to be met before a Listing-level impairment is established.

There are nine categories, or Listings, of mental impairments: (12.02) Organic Mental Disorders; (12.03) Schizophrenic, Paranoid and Other Psychotic Disorders; (12.04) Affective Disorders; (12.05) Mental Retardation; (12.06) Anxiety-Related Disorders; (12.07) Somatoform Disorders; (12.08) Personality Disorders; (12.09) Substance Addiction Disorders; (12.10) Autistic Disorder and Other Pervasive Developmental Disorders. Generally, each Listing category contains specific criteria used to determine whether a claimant has a particular mental impairment. A full discussion of each mental impairment and the criteria for each is outside the scope of this overview.

The threshold question is whether the claimant has a medically determinable mental impairment, and whether or not such an impairment is “severe.” The severity of a mental impairment is evaluated not only by the nature of the medical evidence, but also by evaluating the degree of functional limitations caused by the claimant’s mental impairment. The extent of functional impairment ranges from “None,” “Mild,” “Moderate,” “Marked” and “Extreme” and encompasses four different categories of functionality: 1). Activities of daily living; 2). Social functioning; 3). Concentration, persistence or pace; 4). Repeated episodes of decompensation, each of extended duration.

An “extreme” level of impairment in any one level of functioning “represents a degree of limitation incompatible with the ability to do any gainful employment.” 20 C.F.R. Section 404.1520a(c)(4). For a Listing-level impairment to be met, a claimant needs to have a minimum of at least two “Marked” limitations, and in the final area of functioning, Repeated Episodes of Decompensation, a claimant would need to have three episodes of decompensation, each of extended duration. The number of episodes and their duration is required to be three episodes within one year, or an average of once every four months, each lasting for at least two weeks. Decompensation is usually defined as exacerbation of symptoms, loss of adaptive functioning, significant alteration of medication, or documented need for a more structured environment such as a hospital, halfway house, etc. (Section 12.00C.4)

“Marked” degree of limitation means more than “moderate” and less than “extreme.” For example, in the area of social functioning, a “marked” degree of limitation is evident when several activities or functions are impaired, as long as the degree of limitation is such that it interferes seriously with the individual’s ability to function independently, appropriately, effectively, and on a sustained basis. (Section 12.00C)

If a claimant’s drug addiction or alcoholism is a “contributing factor material to the determination of disability,” then that claimant will be found ineligible for disability benefits. The claimant has the burden of showing that drug and alcohol abuse are not contributing factors material to a finding of disability, and that therefore, if he or she stopped using or drugs or alcohol, he or she would still be incapable of working. We had a sad case where an individual continued to drink alcohol following a severe alcoholic seizure, but had documented alcoholic dementia and significant abnormal findings on CT brain scan. Thus, we were able to show that even though the claimant continued to abuse alcohol, the claimant would not be able to engage in any work due to the permanent, physical and mental impairments resulting from the damaging effects of advanced alcoholism, and benefits were awarded.

In order to support a claim for mental disability, a claimant needs to have documented medical evidence of the extent to which the individual can still perform and sustain specific mental activities and mental functions. A qualified treating psychiatrist or PhD psychologist is in the best position to assess and evaluate an individual’s ability to engage in and perform work activities. The opinions of therapists and licensed clinical social workers, are not acceptable “medical evidence” necessary to support a claim. Our law firm has specific Mental Residual Function Capacity evaluation forms that a claimant can submit to a treating psychiatrist or PhD psychologist in order to elicit acceptable medical opinion evidence regarding the individual’s mental aptitudes and abilities needed to engage in different types of work activities and whether or not the individual is unable to meet competitive standards for working at a regular job.

A well-documented history of significant mental impairments, mental health treatment, medications, as well as school records, job history, and most importantly, opinion evidence from the individual’s treating psychiatrist or psychologist, can all assist in supporting a claim for a Listing-level impairment, with the assistance of a qualified Social Security Disability attorney.