FEBRUARY 2017

 

Social Security Disability Newsletter

 


Social Security Revises
Mental Impairment Listings - Part 3

The new revisions will require significant training for all service providers—we can help..

 

Social Security’s new mental impairment listings became effective in January 2017. We have devoted several newsletters to reviewing these changes because of the impact this new analysis will have on claimants suffering mental illness issues. This will affect both applications directly based upon mental impairments, and on those where depression/anxiety/PTSD are either co-morbid with other impairments, or are secondary to chronic pain or other severe physical medical issues.

In the old listings, the battle often focused upon the “B Criteria” which SSA used to determine the severity of the mental health symptoms on the ability to function. This is usually the hardest struggle with Social Security adjudicators and ALJs. The new Listings revise these criteria, and more precisely de ne how to evaluate the limitations.

There are 4 revised “B Criteria” functional considerations: the ability to understand, remember or apply information; interact with others; concentrate, persist or maintain pace; and adapt or manage oneself.

SSA deleted consideration of limitations of activities of daily living and the impact of recent hospitalizations. SSA stated that while ADL limitations will be considered, the focus of the new B criteria is more on work activities. Problems dressing, showering and caring for oneself will be considered based upon why someone has that problem, i.e. is it being unable to concentrate on the activity, or stay on task, or is there a loss of self-control and the inability to manage the activity.

SSA acknowledged there is an “overlap” between the first and third criteria. However, the agency feels that the ability to understand focuses on neuro-cognitive functioning and the ability to concentrate, persist and maintain pace focuses more on “initiative and persistence.” In the “real world” it is going to be hard to parse such distinctions from clinical notes and charts.

The new #4 criteria is explained as “managing oneself” in the workplace. Can the claimant deal with work stress, set realistic goals, distinguish between good and poor performance and work independently? Can he/she manage emotions in the workplace? Maintaining appropriate hygiene and attire is a consideration of the ability to adapt or manage.

It is important to note that SSA did change the initial draft of the B Criteria to delete “and” and insert “or” for each factor. This means that a claimant will be rated by the most severe limitation in any portion of those abilities – so someone who is able to understand, but extremely impaired in applying information may be disabled.

There is, finally, a definition of how to rate the “B Criteria” issues. SSA retained the five-level rating system of “none” “mild” “moderate” “marked” and “extreme.” The new regulations define these terms to provide some clarity.

  • “mild” is defined as the Claimant is functioning in this area independently, appropriately and effectively with only a slight limitation in sustaining activity.
  • “moderate” is defined the same, but the ability to sustain the activity is only fair.
  • “marked” is defined the same, but the ability to sustain activity is seriously limited.
  • “extreme” limitations means that the ability to function in this area independently, appropriately, effectively on a sustained basis is precluded by the mental health symptoms.

Each “B Criteria” must be rated based upon the content of the treating medical sources’ charts and opinions.

The new mental health listings contain further changes that will impact claimants. We have prepared in-service materials to review and discuss these changes with mental health providers, counselors and support groups.

If you wish to arrange for a review of these changes please call or email our office.



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