Mental Retardation, Autism and Social Security Disability Claims
By Pitt Dickey

Mentally retarded persons may qualify for disability payments from the Social Security Administration. This column will exam how the Social Security Administration evaluates Disability Claims for people who suffer from mental retardation and autism. The Social Security Administration (SSA) has a set of criteria that it uses called Listings to determine whether a person is eligible for monthly disability insurance payments.

To see how the SSA reviews claims that involve persons who suffer from mental retardation it is useful to take a look at how the SSA defines mental retardation and autism.

The SSA defines mental retardation as a "significantly subaverage general intellectual functioning with deficits in adaptive behavior initially manifested before age 22." The SSA defines autism as a "pervasive developmental disorder characterized by social and significant communication deficits originating prior to age 22." The National Mental Health Association describes autism as a mental, emotional or behavioral disorder that appears in early childhood and can last for a lifetime.

The standard test that the SSA uses to establish mental retardation is the Wechsler Adult Intelligence Scale (WAIS). The results of the WAIS must be administered and interpreted by a psychologist or psychiatrist who is qualified by training and experience to administer the test. The SSA can also use other standard IQ tests but the SSA requires that the results be translated into the percentile of the population. For example, a person who has a 70 IQ on the WAIS test according the to SSA falls in the lowest 2% of the population. A claimant who was tested on some other standard IQ test would have to fall into the 2% percentile to meet the same level as the 70 IQ on the WAIS test. The professional administering the IQ test must also submit a report to the SSA evaluating whether the IQ results obtained were considered valid and consistent with the person's developmental history and level of functional restrictions.

The WAIS IQ test returns results in three areas: verbal, performance and full-scale IQ. The SSA uses the lowest of these measurements in determining if the claimant meets the listing for disability benefits payable under the criteria for mental retardation.

If a claimant is not capable of taking a standardized IQ test due to severe retardation, the SSA will accept medical reports specifically describing the level of the person's intellectual, social and physical functioning.
 
A person meets the SSA guidelines for eligibility to receive disability benefits by meeting one of the following four standards:

A. The person's mental capacity is shown by dependence on other people for personal needs such as toileting, eating, dressing, or bathing. In addition the person must be unable to follow directions to the extent that he cannot take a standardized test for measuring intellectual functioning.

OR

B. The person has a valid verbal, performance or full scale IQ of 59 or less.

OR

C. The person has a valid verbal, performance, or full scale IQ of 60 through 70, and a physical or other mental impairment imposing additional and significant work-related limitation of function.

OR

D. The person has a valid verbal, performance or full scale IQ of 60 through 70, or in the case of autism, gross deficits of social and communicative skills, with either of these conditions resulting in at least two of the following:

1. Marked restrictions of daily living. These include such activities as cleaning, shopping, taking public transportation, caring for personal hygiene, and using telephones or directories; Or,
2. Marked difficulties in maintaining social functioning. Social Functioning includes the persons capacity to interact appropriately with others. Impaired social functioning can be shown by a history of altercations, firings, fear of strangers, and social isolation. Or,
3. Deficiencies of concentration, persistence, or pace resulting in frequent failures to complete tasks in a timely manner in work settings or elsewhere. Major impairments in this area are typically best determined by direct psychiatric evaluation or psychological testing. In work evaluations the claimant will be assessed in how long it takes him to do such tasks as filing index cards, disassembling or reassembling objects. Ability to concentrate will be assessed by frequency of errors, the time it takes to complete a task and the extent that assistance is needed to complete the task. Or,
4. Repeated episodes of deterioration or decompensation in work like settings which cause the person to withdraw from that situation or experience a worsening of symptoms. Stresses that commonly appear in work settings are decisions, attendance, schedules, completing tasks and interactions with supervisors and co-workers.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over nineteen years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 555 Executive Place and can be reached at 485-8020 or smithdickey@yahoo.com.