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Evaluating Claims of Mental Disorders - Criteria Revision

Author: Shifrin Newman Smith Inc.

Published: 2010-12-13


US Social Security Administration has proposed major revisions to the criteria used to evaluate adult and child claims of mental disorders.

Main Digest

SSA is seeking comment on its proposed revisions to the criteria used to evaluate claims of mental disorders. The SSA has already received hundreds of comments on the changes.

The Social Security Administration (SSA) has proposed major revisions to the criteria used to evaluate adult and child claims of mental disorders. This marks the first major revision of the Listings of Impairments since the 1985 release for adults and the first change since 1990 for children. The revisions are designed to be reflective of advances in medical technology, recommendations from the report, Mental Retardation: Determining Eligibility for Social Security Benefits, published in 2000, and public comments sought in a policy conference in 2003.

Proposed Changes to the Criteria

Currently, mental disorders are evaluated in three, or sometimes four, parts. These parts include: - A general diagnostic description of the disorder - Paragraph "A" criteria: The specific symptoms, signs and laboratory findings substantiating the presence of the disorder - Paragraph "B" criteria: The functional limitations that are incompatible with an ability to work, of which two are required - Paragraph "C" criteria: For some listings only, alternatives to the paragraph "B" criteria that provide a means for individuals who do not meet the paragraph "B" criteria, but can nevertheless not tolerate the stress of work, can meet listing-level disability

The proposed amendments would remove the general diagnostic description and paragraph "A" criteria. Listings are instead divided into categories of impairments and claimants will be required to show a "medically determinable mental disorder" for one of the ten listings. The SSA says this approach is more inclusive and covers a broader range of mental disorders.

All but one listing (intellectual disability/mental retardation) have the same paragraph "B" criteria: - Understand, remember and apply information - Interact with others - Concentrate, persist, and maintain pace - Manage oneself

The claimant must show marked limitations in two criteria or extreme limitation in one criterion. "Marked" limitation is present when symptoms and signs of the mental disorder interfere seriously with independent, appropriate and effective use of mental ability on a sustained basis to function in a work setting. It is at least two but less than three standard deviations below the mean score on testing. "Extreme" limitation is defined as at least three standard deviations below the mean score on testing.

Almost all categories of the listings could use paragraph "C" criteria as an alternative to "B" criteria to evaluate serious and persistent mental disorders with a duration of at least one year.

The changes would also broaden most of the current listing categories, add new paragraphs "B" and "C" criteria, and extend paragraph "C" criteria to almost all listings. While the term "mental retardation" has assumed negative connotations over the years, the new rule would continue use along with the more currently accepted phrase "intellectual disability," since the older term is still widely used in many government programs and included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

Comments and Responses

The SSA received nearly 500 comments in response to its advance notice of rule-making and considered comments on the proposed changes through November 17. While it did not publish individual answers to every comment, the agency did respond generally to some comments.

Regarding suggestions to include all mental disorders described in the DSM-IV in the listings, the agency declined, saying some mental disorders may be unlikely to result in functional limitations of listing-level severity. One example of this could be minor depression.

The SSA did agree with mental health advocates that it should provide criteria for evaluating a person's functioning in work-related terms. The addition of the extreme limitation qualification in paragraph "B" criteria was also in response to public comment.

The agency expanded and clarified its rules regarding recognition of professional non-physicians in response to a recommendation. The proposed changes explain that the agency will consider all relevant medical evidence, including from "health care providers, such as physician assistants, nurses, licensed clinical social workers and therapists. These other medical sources can be very helpful."

The SSA has extended the time for public comment to December 9 regarding only the proposed definition of the terms "marked" and "extreme" in section 12.00 and 112.00 of its Impairments. As the agency continues to receive and consider public comments and move forward with implementation, those with questions about the changes to the mental disorder criteria should contact a Social Security disability lawyer. An experienced attorney can answer questions about how the changes may affect their ability to qualify for benefits, and can assist with the application process for mentally disabled adults and children.

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