This is a newsletter of interest to professionals who provide services
to potential Social Security disability and SSI claimants
Proving Mental Impairments for SSI Claims
Clients with mental impairments present challenging legal situations for disability claims. However, there is a clear path to winning these cases. Once a clear diagnosis has been established, the key is proving functional impairment.
Sometimes medical providers and therapists wring their hands and ask "how do I prove those things?" The process is actually quite simple, and establishing functional impairment can mean the difference between winning and losing.
The first step is a diagnosis. Social Security law tracks the 1994 Diagnostic and Statistical Manual (DSM IV), and will eventually catch up to the more recent DSM. The standards will be familiar to those who work with mentally impaired clients. For example, to prove depression, you have to show at least four clinical signs - such as sleep disturbance, decreased energy, suicidal ideation, or appetite change. Similar findings are needed for other mental illnesses.
Most cases also require documented functional impairment. For depression, in our example, two functional impairments must be established. Some disorders are considered severe enough to prevent gainful activity without any additional assessment of functional limitations. For others the degree of functional limitation must be documented. If necessary, information should also be obtained from non-medical sources, such as family members and others, to supplement the record of impairment severity and longitude.
Functional impairment measures factors such as activities of daily living, social functioning, concentration, persistence, or pace. It also looks at episodes of decompensation - meaning deterioration in work-like settings. One or more “marked” functional impairments must be present.
"Marked" is one of the four measures for degree of limitation, and means "more than moderate but less than extreme." Social Security says a marked limitation may arise when several activities or functions are impaired, or even when only one is impaired, as long as the degree of limitation is such as to interfere seriously with ability to function "independently, appropriately, effectively, and on a sustained basis."
The mental impairment regulations were extensively revised several years ago. Although the detail required to prove a case appears daunting, we can show you exactly how to develop and present evidence that will maximize your client’s chances of winning. Please call us if we can help move your client or patient toward disability and health insurance benefits.
