How does the Social Security Administration evaluate a claim for Louisiana disability benefits based on a mental disorder?

Mental disorders are a commonly-cited impairment in claims for Social Security disability benefits. Moreover, many physical impairments raise psychological issues, and chronic physical problems can wear on a person psychologically.

The Social Security regulations provide that a person is “under a disability” if his “physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education and work experience, engage in any other kind of substantial gainful work which exists in the national economy .” As described below, the Social Security Administration engages in a complex, multi-step analysis to determine whether an applicant who claims to have a mental disorder is indeed “under a disability” and entitled to an award of Louisiana Social Security disability benefits.

Does the claimant have a medically determinable mental impairment? (The “A” criteria)

The Social Security Administration’s review of a claim for benefits based on a mental disorder begins with an analysis of whether the claimant has a medically determinable impairment. To make this determination, the Social Security decision-maker relies on the diagnostic criteria set forth in the Listings of Mental Impairments. These are known as the “A” criteria. The nine Listings of Mental Impairments are:

12.02 Organic Mental Disorders
12.03 Schizophrenic, Paranoid and Other Psychotic Disorders
12.04 Affective Disorders
12.05 Mental Retardation
12.06 Anxiety-Related Disorders
12.07 Somatoform Disorders
12.08 Personality Disorders
12.09 Substance Addiction Disorders
12.10 Autistic Disorder and Other Pervasive Developmental Disorders

Each Listing Impairment has its own set of diagnostic criteria. You can access the Mental Disorder Listings at http://www.socialsecurity.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm).

Is the claimant’s mental impairment severe?

If the claimant’s impairment meets the A criteria, then the Social Security Administration will assess the severity of the impairment using the “B” criteria and, in some cases, the “C” criteria, as described below.

The “B” criteria

Using the B criteria, the Social Security Administration evaluates a claimant’s functional limitations in four areas:

  1. Activities of daily living
  2. Social functioning
  3. Concentration, persistence, or pace
  4. Episodes of decompensation

The claimant’s functional limitations in areas 1-3 are rated as “extreme,” “marked,” “moderate,” “slight” or “none.” Episodes of decompensation are rated as “four or more,” “three,” “one or two,” or “never.” A claimant will meet the listing for a mental disorder and be considered disabled if the claimant meets the A criteria and:

  • One of the B criteria is rated “extreme”; or
  • Two of the B criteria are rated “marked” and, regarding episodes of decompensation, three episodes of decompensation have occurred.

A “moderate” rating suggests a severe impairment, but not an impairment that meets or equals Listing Impairment. In that case, the Social Security Administration will assess the claimant’s residual functional capacity. (This is discussed below in reference to claimants who meet the A criteria, but not the B or C criteria.)

The C criteria

If the claimant does not meet the B criteria, then the Social Security Administration will consider the C criteria if the claimant has one of the following impairments:

  • An organic mental disorder
  • A schizophrenic, paranoid, or other psychotic disorder
  • An affective disorder, or
  • An anxiety-related disorder

As a rule, the C criteria must be assessed when a claimant appears to function too well to meet the B criteria.

The C criteria for organic disorders, psychotic disorders, and affective disorders require (1) a two-year history of a chronic mental impairment with more than minimal limitation in the ability to do basic work activities, and (2) at least one of the following:

  • Repeated episodes of decompensation, each of extended duration.
  • A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate.
  • A current history of one or more years’ inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.

There is only one C criterion for anxiety-related disorders: a complete inability to function independently outside the area of one’s home.

Claimants who meet some, but not all, the criteria

Claimants who meet the B or C criteria, but not the A criteria

Claimants who do not meet the A criteria, but do meet the B or C criteria, may still be considered disabled. According to the Social Security Administration, the A criteria of the mental disorders Listings “are only examples of common mental disorders that are considered severe enough to prevent an individual from doing any gainful activity. When [a claimant has] a medically determinable severe mental impairment that does not satisfy the diagnostic description or the requirements of the paragraph A criteria of the relevant listing, the assessment of the paragraph B and C criteria is critical to a determination of equivalence.”

Claimants who meet the A criteria, but not the B or C criteria

If the B or C criteria are not met (that is, if the claimant’s mental disorder causes only a moderate degree of functional limitations), then the Social Security Administration must assess the claimant’s residual functional capacity in order to make a disability determination. The claimant’s residual functional capacity is the claimant’s ability to perform work-related functions, despite the limitations caused by his or her impairment. The Social Security Administration will assess whether the claimant is capable of skilled, semiskilled, or unskilled work. A claimant with a significant impairment in any of the functions required for unskilled work will be awarded disability benefits, even in the absence of any physical impairment.

Proving that a claimant meets the B or C criteria

Sometimes, the Social Security Administration will deny a claim for Louisiana disability benefits in a mental impairment case based largely on the claimant’s statements about his or her daily activities, social functioning, and ability to get things done in a timely manner. However, because mental disorders often rob claimants of the ability to realistically assess their limitations, the claimant’s opinion of his or her ability to function may be vastly different from the opinions of those close to the claimant. Consequently, the claimant’s family, friends, and neighbors are often the best sources of information about the B criteria and the best witnesses on the claimant’s behalf.

In contrast, the strongest proof that a claimant’s impairment meets the C criteria likely will come in the form of an expert opinion, ideally from the claimant’s treating doctors. One mental status examination may not be enough to demonstrate the full extent of the claimant’s impairment. For example, a claimant with a long history prolonged outpatient care with supportive therapy and medication, or of repeated hospitalizations often has rigidly structured his or her life so as to reduce symptoms and minimize stressors. This type of claimant may be much more impaired for work than his or her symptoms and signs would indicate.

Louisiana disability attorney, , can help in these complex cases

As you can surmise from this brief overview of the rules and regulations governing mental disorder claims for Social Security disability benefits, these cases are complex and challenging. I have been helping Louisiana disability applicants obtain benefits for mental impairments for more than 15 years. I know how these impairments are evaluated under the Listings and I can help you bring the most important facts in your case to the attention of the Social Security Administration decision-maker. If you would like me to review your mental impairment case, please complete the Free Claim Evaluation form, located on the right side of this page. If you prefer, please call me or send me an email.

Louisiana Social Security lawyer

West Monroe, Louisiana 71292