Schizophrenia and Social Security Disability Claims

Schizophrenia and Social Security Disability Claims
By Pitt Dickey

Mental illness as well as physical illness can qualify a person for disability insurance payments from the Social Security Administration. This column will exam how the Social Security Administration evaluates Disability Insurance Claims for people who suffer from schizophrenia, paranoia and other psychotic disorders. 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 obtain disability insurance benefit payments from the SSA a person must in general have a health problem that can be expected to last at least one year or to result in death and be unable to perform any type of substantial gainful employment.

To see how the SSA reviews claims that involve persons who suffer from schizophrenia it is helpful to take a brief look at the medical terms used in describing such illnesses. Schizophrenia is a mental illness that interferes with a person’s ability to think and act. In some cases the patient may not be able to tell the difference between reality and imaginary situations. It can effect normal emotional responses and impair the ability to function around other people.

There are several different categories of schizophrenia. Paranoid Schizophrenia causes a patient to feel persecuted, suspicious or extremely powerful. Symptoms include feeling mistrustful of other people, jealousy and feeling that other people have hidden motives behind their actions. Patients may experience visual hallucinations and auditory hallucinations. Disorganized Schizophrenia can cause a person to be incoherent but not necessarily have delusions. Catatonic Schizophrenia is a condition in which the patient is withdrawn, may refuse to speak to others, and may get into contorted physical positions.

A psychotic disorder is a severe mental disorder in which the patient withdraws into an inner world of disorganized thinking or feeling or cannot function in basic ways due to severe mood impairment.

For further information about mental illness you can contact the Mental Health Association, 310 Green Street, Suite 201A, Fayetteville, N.C. 28301 or the National Alliance for the Mentally Ill at 3483 Thamesford Road, Fayetteville, N.C. 28311. The SSA’s Listings for Schizophrenia call for an award of Disability Insurance Benefits if the patient meets the following tests:

The patient has an onset of psychotic features which represent a deterioration of the person’s previous ability to function. The person will be awarded benefits if the level of severity of the psychotic features meets the following test:

1. Medically documented persistence of one or more of the following symptoms:
   1. Delusions ( strong false beliefs such as that the person can read other people’s minds) in or hallucinations (seeing or hearing things that do not exist) ; or
      
      
   2. Catatonic ( the patient is mute and does not react to outside stimulus) or other grossly disorganized behavior; or
      
      
   3. Incoherence, loosening of associations (speech shifts from one unrelated topic to another), illogical thinking or poverty of content of speech if associated with at least one of the following:

      Blunt affect, flat affect ( patient’s external expressions are dull, speaking in a monotone), or inappropriate affect ( unusual reaction to stimulus such laughing while in pain); or emotional withdrawal and/or isolation.

In addition to one of the features described above, the patient must also have at least two of the following limitations:

1. Marked (marked means more than moderate but less than extreme) restrictions in activities of daily living ( this refers to routine activities such as cleaning, shopping, cooking, caring for personal appearance) ; or
   
   
2. Marked difficulties in maintaining social functioning (this means a person’s ability to interact and get along with other people) ; or
   
   
3. Deficiencies in concentration, persistence or pace (this means an inability to sustain focused attention sufficiently long to allow completion of work related tasks) resulting in a frequent failure to complete tasks in a timely manner; or
   
   
4. Repeated episodes of deterioration or decompensation ( this means a repeated failure to adapt to stressful circumstances) in a work or worklike setting which causes the patient to withdraw from that situation or to experience worsening of symptoms; OR

Medically documented history of one or more episodes of acute symptoms, signs and functional limitations which at the time met the Listings described above but are currently attenuated by medication or therapy plus one of the following conditions:

1. Repeated episodes of deterioration or decompensation in situations that cause the patient to withdraw from that situation to experience an aggravation of symptoms. Or
   
   
2. Documented history of being unable to function outside a highly supportive living situation.

It should be kept in mind that a person can still be found to be disabled by an Administrative Law Judge even if he does not meet a particular listing if he has health problems that in combination are the equivalent of a listing. The Judge has the discretion to decide if a person’s health problems are serious enough to warrant an award of disability benefits despite not meeting the specific technical requirements of one of the SSA listings for disability.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years.