Mood Disorders And SSA Disability Claims
By Pitt Dickey
This column will examine how the Social Security Administration evaluates Disability Insurance Claims for people who are diagnosed with mental health problems called Mood Disorders. A common mood disorder is bipolar disorder, which used to be called Manic Depression. 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 based upon a mental disorder, the SSA must have documentation of a medically determined impairment for the person seeking the disability benefits. Once such documentation is established, then the SSA will consider what limitation such an impairment places on the person’s ability to work and if that limitation can be expected to last at least one year.
To see how the SSA reviews claims that involve persons who have Mood Disorders it is helpful to take a brief look at the medical terms used in describing this mental illness and the process SSA uses to make its decision about disability. The SSA considers Bipolar Disorder to be an Affective Disorder. The terminology seems to change regularly and Affective Disorders are now sometimes referred to as Mood Disorders. Bipolar Disorder has been referred to as Manic-Depression in the past. The SSA describes Affective Disorders as a disturbance of mood accompanied by a full or partial manic or depressive syndrome. Bipolar disorder is a medical condition in which the person has alternating periods of depression and periods of manic (hyper) activity.
During a manic period the patient could feel euphoric, irritable, and powerful. In a period of depression the patient might very sad, hopeless, suffer sleep disorders, and have feelings of guilt.
To determine if the patient meets the Listing requirements for disability insurance benefits the SSA will first determine if the person meets the clinical tests for bipolar disorder. If the person does meet the clinical test for bipolar disorder, then the next test for SSA is to decide if the person’s health problem imposes Functional Restrictions on his work ability. The functional restrictions measure whether the person can still perform work related tasks. If the person meets the Listing requirements he will receive disability benefits.
The SSA uses a set of guidelines called the Residual Functional Capacity evaluation to help the SSA decide if the person can work or not. The Residual Functional Capacity test is a check list that the SSA has completed to determine the level of disability of a claimant.
To qualify for disability payments for an Affective Disorder, the patient must meet the following tests:
A. Medically documented persistence of at least one of the following:
1. Depression with at least four of the following: loss of interest in most activities; appetite change with change in weight; sleep disturbance; psychomotor agitation or retardation; decreased energy; feelings or worthlessness or guilt; difficulty in concentrating; thoughts of suicide; hallucinations, delusions or paranoid thinking; or:
2. Manic syndrome with at least 3 of the following: hyperactivity; pressure of speech (speaking rapidly and disjointedly); flight of ideas (multiple rapid ideas); inflated self esteem; decreased need for sleep; easy distractibility; or involvement in activities that have a high probability of painful consequences which are not recognized by the patient; or hallucinations, delusions or paranoid thinking; or
3. Bipolar syndrome with a series of episodes with full manic and depressive symptoms.
And
B. Which result in at least of two of the following limitations:
1. Marked restriction of activities of daily living; marked difficulties in maintaining social functioning; or deficiencies of concentration resulting in frequent failure to complete tasks on time; or repeated episodes of deterioration at work or in a work like setting which cause the patient to withdraw from that situation or to experience worsening signs and symptoms.
If the person meets these listings then the SSA should award Disability Insurance Benefits. It should be kept in mind that a person can still be found to be disabled by an Administrative Law Judge after a hearing 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 handling Social Security claims since 1978.