Last year, the Social Security Administration (SSA) published significant revisions to its mental impairment listings. These revised listings are a long-time in the making.
The new listings became effective January 17, 2017. This post provides a brief update on the listings to you.
There are some good revisions and some harmful changes.; For example, SSA has added a new listing pertaining to Post Traumatic Stress Disorders (PTSD) but has eliminated Listing 12.05C, which encompasses low IQ scores combined with another “significant” impairment. The revision also shows that SSA recognizes that Licensed Clinical Social Workers (LCSWs) frequently serve as therapists and call both “clinical mental health counselors.” Unfortunately, neither are acceptable medical sources. SSA does note that social workers, shelter staff, and other community support and outreach workers are examples of non-medical sources of evidence. But, the rules do not require these sources be given any weight in an adjudicator’s analysis of disability.
The revision does acknowledge the unique circumstances of some homeless claimants that make it difficult to provide longitudinal medical evidence. And, the revision notes that periods of lack of treatment or noncompliance may result from a claimant’s mental disorder. And, significantly, it rejected symptom validity testing to identify malingering.
But SSA’s revised listing does not include language about the effects of work-related stress and the questionable validity of mental status exams done by many consultative examiners at one time settings. Instead, these exams are among the list of evidence from medical sources that SSA will continue to consider, along with psychiatric or psychological rating scales. SSA also removed all references to standardized testing related to assessments, except in relation to Listing 12.05.
SSD does note that evidence of functioning in an unfamiliar setting does not necessarily show how a claimant would function on a sustained basis in a work setting. The listing specifies how different levels of support and structure should be evaluated. SSA says a “complete picture” of daily activities should be considered, with a recognition that the ability to perform “some routine activities without help and support does not mean that you do not have a mental disorder or that you are not disabled.” Routine activities include taking care of personal needs, cooking, shopping, paying bills, living alone, or driving.
The listing does leave in place the psychiatric review technique stating it is a useful tool for adjudicators and helps increase consistency in decision making.
Some notes on specific changes are:
SSA left the “A” criteria primarily intact.
The “B” criteria have been modified in an effort to better reflect a claimant’s functioning in more work-related terms:
- Understand, remember, or apply information (B1)
- Interact with others (B2)
- Concentrate, persist, or maintain pace (B3)
- Adapt or manage oneself (B4)
SSA removed reference to “activities of daily living” (ADL) stating it will continue evaluating how ADLs are performed as more background information rather than criteria for disability.
SSA shifted the focus of the “B” criteria to the mental abilities a person uses to perform work activities. Examples of the ability to understand, remember or apply information include following one-or-two step oral instructions. Interacting with others includes the ability to handle conflicts with others, responding to social cues, and keeping interactions free from excessive irritability. Adapting or managing oneself encompasses the ability to regulate emotions and control behavior, including but not limited to responding to demands, and maintaining personal hygiene. “Repeated episodes of decompensation” has been eliminated.
It should be noted that in B1 and B3, a claimant need demonstrate a limitation in any of the three parts of each section. It also acknowledges that if a claimant has a “marked” or “extreme” limitation in any single part of B1 or B3, such degree of limitation exists for all of that particular B criterion.
SSA has created a five-point rating scale (none, mild, moderate, marked, and extreme) to evaluate limitations under the B criteria. SSA’s definitions for these terms continue to be muddy. For example, “mild” means functioning is slightly limited, while "moderate" represents fair, “marked” is seriously limited, and “extreme” means an inability to function on a sustained basis. SSA acknowledges, however, in response to comments, that “extreme” does not mean a total lack or loss of ability to function.
SSA retained the “C” criteria as an alternative severity criterion for those situations where a claimant has achieved marginal adjustment, but whose symptoms are diminished because of psychosocial supports or treatment. The two-year documentation requirement and the requirement that the disorders are “serious and persistent” remain. SSA notes that “decompensation” refers to an extreme state of deterioration, often leading to hospitalization, and that exceeds the degree of impairment intended in the “C” criteria. Examples of deterioration, however, include becoming unable to function outside of a more restrictive setting without additional support.
Some listings do not include C Criteria at all. These include 12.07 (Somatic symptom disorder), 12.08 (Personality and impulse control disorders). 12.10 (Autism Spectrum Disorder), 12.11 (Neurodevelopmental disorders), and 12.13 (eating disorders).
Specific Listings12.02 – Neurocognitive disorders
Previously known as “Organic Mental Disorders,” the new listing requires “significant cognitive decline in one or more cognitive areas and the usual B criteria.” Examples include dementia related to various medical conditions, including Alzheimer’s. It also covers traumatic brain injuries (TBI) and substance-induced cognitive disorders.
12.03 – Schizophrenia spectrum and other psychotic disorders
Examples in this category include schizophrenia, schizoaffective disorder, delusional disorder, and psychotic disorders due to another medical condition.
12.04 – Depression, bipolar and related disorders
Previously known as “affective disorders.” Examples of disorders evaluated under this listing include bipolar disorders, cyclothymic disorders, major depressive disorder, and persistent depressive disorder (dysthymia).
12.05 – Intellectual Disorder
Significant changes are in this section. The name has been changed to underscore that an intellectual disability may not be a disability in the eyes of SSA. The listing does not require a diagnosis of intellectual disability.
The listing has been reorganized to reflect the diagnostic criteria from the DSM-5 and the American Association on Intellectual and Developmental Disabilities. It now has only two paragraphs and drops the previous 12.05C. 12.05A is for those claimants whose cognitive limitations prevent them from taking a standardized intelligence test, and 12.05B applies to those who are able to test. Each requires evidence that demonstrates or supports the conclusion that the disorder began prior to age 22. Examples of proof include school records indicating a history of special education, statements from employers or supervisors and from people who may be able to describe the claimant’s functioning in the past and currently.
Changes to how SSA evaluates both intellectual functioning and adaptive functioning are implemented.
Listing 12.06 –Anxiety and obsessive-compulsive disorders
Previously known as “Anxiety Related Disorders,” the new listing includes social anxiety, panic, and generalized anxiety disorders, agoraphobia, and obsessive-compulsive disorder. This listing does not include trauma and stressor-related disorders, which are covered by new Listing 12.15
Listing 12.07 – Somatic symptom and related disorders
Examples include symptom disorder, illness anxiety disorder, and conversion disorder – disorders characterized by physical symptoms that are not feigned but cannot be fully explained by a general medical condition, mental disorder, substance use, or culturally sanctioned behavior or experience.
Listing 12.08 – Personality and impulse-control disorders
This applies to personality disorders and includes intermittent explosive disorder, which was added.
Listing 12.09 – Substance Abuse Disorder was eliminated
Listing 12.10 – Autism Spectrum Disorder
SSA removed references to Asperger’s disorder. All four of the B criteria are used to evaluate individual cases.
Listing 12.11 – Neurodevelopmental disorders
These include disorders characterized by onset during the developmental period (22 or younger), and include learning disorder, borderline intellectual functioning, and tic disorders, such as Tourette syndrome. Possible signs and symptoms of these disorders include but are not limited to abnormalities in cognitive processing, deficits in attention or impulse control, low frustration tolerance, or deficits in social skills.
Listing 12.13 – Eating disorders
This is new, previously only existing in the childhood listings. Disorder included are anorexia nervosa, bulimia nervosa, binge-eating disorders, and avoidant/restrictive food disorder.
Listing 12.15 – Trauma—and—stressor-related disorders
This is another new listing that includes posttraumatic stress disorder (PTSD) and other specified related disorders. These are characterized by “experiencing or witnessing a traumatic or stressful event, or learning of a traumatic event occurring to a close family member or friend, and the psychological aftermath of clinically significant effects on functioning.”
If you or someone you love is fighting for Social Security disability benefits and they have a mental disability, give us a call at Louisiana Disability Law. We have the experience to guide you through this difficult process and help you understand these new changes.
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