How mental disorders are evaluated by the Social Security Administration in Sacramento and California
Mental disorders are a commonly-cited impairment in Sacramento and California Social Security disability cases. And many physical impairment cases include hidden psychological issues. Chronic physical problems take a psychological toll.
A number of these cases are denied and ultimately reach the hearing level.
The Social Security Administration’s rules for assessing whether an applicant for disability benefits qualifies due to a mental disorder are complex. Here is an overview.
Does the claimant have a medically determinable mental impairment: the A criteria
The first step the Social Security Administration takes in evaluating a mental impairment is to determine that the claimant, in fact, has a medically determinable mental impairment. This is done by deciding whether diagnostic criteria in the Listings of Mental Impairments, known as the A criteria, are met. There are nine Listings of Mental Impairments, each with its own separate A criteria:
- 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
The Mental Disorders Listings can be found at http://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm.
Is the impairment severe? The B criteria
If the A criteria are met, the Social Security Administration moves on to the B and, in some cases, the C criteria, which are used to assess the degree of the claimant’s impairment. Under the B criteria, the claimant’s functional limitations are evaluated in four areas:
- Activities of daily living
- Social functioning
- Concentration, persistence, or pace
- Episodes of decompensation (which, according to the Social Security Administration, are “exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning, as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace.”)
The claimant’s functional limitations in each of the first three areas are rated as “none,” “slight,” “moderate,” “marked,” and “extreme.” For the fourth area, the scale is “never,” “one or two,” “three,” and “four or more.”
A rating of “none” or “mild” indicates a degree of limitation that is generally not considered severe by the Social Security Administration, unless the evidence otherwise indicates there is more than a minimal limitation of the claimant’s ability to do basic work activities.
Is the claimant disabled under the B criteria listing?
The claimant (who meets the A criteria) will meet the listing for a mental disorder and be considered disabled if:
- Any one of the B criteria is rated “extreme” (a degree of limitation that is incompatible with the ability to do any gainful activity); or
- Two of the B criteria are rated “marked” and, in the case of episodes of decompensation, three episodes of decompensation have occurred.
A rating of “moderate” indicates a severe impairment, but one that does not meet or equal a listed impairment and therefore requires an RFC assessment. See below.
Establishing that a claimant meets the B criteria
The best sources of information and testimony about the “B criteria” are often the claimant’s family, friends, and neighbors. Sometimes the claimant may be able to provide useful information, but often in mental impairment cases, claimants have insufficient insight into their limitations. The views of the claimant and those who know the claimant well may diverge widely. This problem in itself can turn out to be a major issue in a mental impairment case.
Sometimes denial decisions in mental impairment cases are based on little more than the Social Security Administration’s uncritical acceptance of a claimant’s statements about daily activities, social functioning, and ability to get things done on time. Mental disorders frequently rob claimants of the ability to realistically assess their limitations. In these cases, it is extremely important to have a competent disability attorney who can look beyond what the claimant says about level of functioning.
The C criteria
If the claimant does not meet the B Criteria, the Social Security Administration moves on to evaluate the C criteria when the claimant’s impairment is one of the following:
- An organic mental disorder
- A schizophrenic, paranoid, or other psychotic disorder
- An affective disorder, or
- An anxiety-related disorder
The C criteria for organic disorders, psychotic disorders, and affective disorders are identical. They require a two-year history of a chronic mental impairment with more than minimal limitation in the 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 the individual to decompensate.
- A current history of one or more years’ 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 the area of one’s home.
As a rule, the C criteria must be assessed when a claimant appears to function too well to meet the B criteria.
Establishing that the claimant meets the C criteria
More than the B criteria, deciding whether a claimant’s impairment meets the C criteria may depend on expert opinion, particularly from the claimant’s treating doctors. A single mental status examination may be insufficient. Claimants with long histories of repeated hospitalizations or prolonged outpatient care with supportive therapy and medication often have structured their lives to minimize stress and reduce symptoms. These claimants may be much more impaired for work than their symptoms and signs would indicate.
Claimants who meet the B or C criteria, but not the A criteria
According to the Social Security Administration, the A criteria of the mental disorders Listings “are only examples of common mental disorders that are considered severe enough to prevent an individual from doing any gainful activity. When [a claimant has] 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 a claimant who meets the B or C criteria, but not the A criteria may nonetheless be considered disabled.
Residual functional capacity assessment
If a claimant’s mental disorder causes only moderate functional limitations (i.e., the B or C criteria are not met), the Social Security Administration must do a residual functional capacity assessment to determine if the claimant is disabled. That means the Social Security Administration must determine whether the claimant can do skilled, semiskilled, or unskilled work in spite of impairments, or whether the claimant cannot even do unskilled work. Claimants with a marked impairment in any of the abilities required for unskilled work will be awarded disability benefits even in the absence of any physical impairment.
The Social Security Administration requires a lot of information to make an accurate residual functional capacity assessment. This is another important area in which information from others about how the claimant behaves at home, work, and in social situations can help.
Assistance available for Sacramento mental disorder disability claims
Cases involving mental disorders can be challenging. If you have such a case and are not already represented by a Social Security disability attorney and want our evaluation, give us a brief description of your claim using the form to the right. Or you may e-mail or call our office at:
Smolich & Smolich
Sacramento California Social Security disability attorneys
E-mail us
Phone: 916-443-2988
Fax: 916-443-2675
3200 “J” Street
Sacramento, California 95816
