Mental Health Problems and Social Security Disability
By Pitt Dickey

The Social Security Administration’s (SSA) Disability system covers persons who suffer not only from physical health problems but also mental health problems. As discussed in prior articles, the SSA uses a system called the “Listings” to evaluate a person’s mental health problems when disability benefits are sought based upon such conditions as depression, schizophrenia and bipolar disorder. This article will take a look at how the SSA determines whether a person’s mental health problems are so serious as to warrant an award of disability payments.

As a an example of how the SSA evaluates disability claims based on depression, I have set out below the actual language of the listing for depression. To put it mildly, the listing for depression is confusing and fairly close to incomprehensible to the average person.

Depression: This condition is characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome. To qualify for disability benefits the claimant must meet two sets of standards as described below:

A. There must be medically documented persistence, either continuous or intermittent of one of the following:

1. Depressive syndrome with at least four of the following symptoms: anhedonia which is the pervasive loss of interest in almost all activities; or, appetite disturbances with change in weight; or sleep disturbance; or psychomotor agitation or retardation; or decreased energy; or feelings of guilt or worthlessness; or difficulty in concentrating or thinking; or thoughts of suicide; or hallucinations, delusions or paranoid thinking; or

2. Manic syndrome with at least three of the following symptoms: hyperactivity; or pressure of speech; or flight of ideas; or inflated self esteem; or decreased need for sleep; or easy distractibility; or involvement in activities that have a high probability of painful consequences which are not recognized; or hallucinations, delusions or paranoid thinking; or

3. Bipolar syndromes with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes; AND

B: Resulting in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marked difficulties in social functioning; or

3. Deficiencies of concentration, persistence or pace resulting in frequent failure to complete tasks in a timely manner; or

4. Repeated episodes of deterioration or decompensation in work or work-like settings that cause the individual to withdraw from that situation or to experience exacerbation of signs and symptoms.

Fortunately the average person doesn’t have to interpret what the listing means. That task falls to the Administrative Law Judge in cases that reach the hearing level. The Judge is aided by his review of the psychiatric and psychological records of the claimant’s treatment by the claimant’s own treating physicians. The SSA will also have the claimant examined by a psychiatrist appointed by the SSA to conduct a psychiatric evaluation of the claimant. The psychiatrist appointed by the SSA does not treat the claimant, but does perform certain standard psychiatric evaluations and then completes a fairly lengthy check list called the Psychiatric Review Technique which tracks the claimant’s symptoms. Frequently the Administrative Law Judge will have a psychiatrist appointed by the SSA to appear at the hearing before the Judge to offer an opinion as to the type of psychiatric problems experienced by the claimant and the effect of these problems on the claimant’s ability to function in a work environment.

The psychiatrist is paid by the SSA but is required to render an independent decision to the Administrative Law Judge. The psychiatrist will not discuss his testimony with the SSA regarding his testimony prior to the actual hearing before the Judge. A claimant has the right to bring in his own psychiatrist or psychologist to testify at his hearing but as a practical matter this happens rarely because the claimant is out of work, funds are tight and he can’t afford to pay a doctor to come testify on his behalf.

Fortunately the U.S. Congress was aware of the financial difficulties faced by claimants during this process and the SSA is required to consider documentary evidence submitted by a claimant’s doctors and does not require live testimony from a doctor. The medical opinion of a mental health professional is not absolutely binding upon the Administrative Law Judge who must make an independent decision but the Judge is required to give substantial weight to the treating doctor’s opinion.

The SSA has other equally detailed listings for such mental health problems as Bipolar Disorder (Manic-Depressive Illness); Anxiety disorders which include generalized persistent anxiety, motor tension, autonomic hyperactivity, apprehensive expectations or vigilance and scanning; persistent irrational fear of a specific object, activity , or situation resulting in a compelling desire to avoid situation; recurrent severe panic attacks occurring on the average of at least once a week, recurrent and intrusive recollections of a traumatic experience (Post Traumatic Stress Disorder), or a complete inability to function independently outside of one’s home.

Of more than passing interest to veterans in our area is the interaction of a VA rating of 100% for Post Traumatic Stress Disorder with regard to a Social Security Disability Insurance Benefits claim. The V.A.’s decision to grant a 100% disability rating for Post Traumatic Stress is not binding upon the Social Security Administration. The SSA must make its own determination as to disability based on SSA guidelines and does not use the same tests as applied by the VA. The SSA will certainly consider the VA’s disability rating in making a decision on the claimant’s SSA disability claim but will not automatically approve a mental health disability claim based solely on the claimant’s VA rating.

A disability claim based upon mental illness is a challenging area of the law. On a number of occasions the claimant is not able to articulate his problems to a judge due to his mental illness unlike a person with a physical ailment who can usually describe “where it hurts” with little difficulty. An attorney’s assistance in assembling a claimant’s medical records and highlighting the claimant’s mental health problems can be of real benefit to a claimant facing the burden of showing disability by mental illness in a Social Security Disability hearing.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over eighteen years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 309 Person Street and can be reached at 484-8195.