Disabling Condition: Mental Disorders

Posted on September 6, 2010 by Editorial Board

Conditions covered include organic brain problems, psychosis, mood (depression, bipolar), mental retardation, anxiety (PTSD, panic, agoraphobia) somatoform, personality, substance abuse, and autism.

Mental

  1. Do you see a psychiatrist, psychologist or other mental health care provider?
  2. Have you sought treatment at MHMR?
  3. How does your mental condition affect your ability to perform:
  • Activities of daily living
  • Social functioning, or
  • Completing tasks in a timely manner
  1. Do you take medications and do you have adverse side effects to them?
  2. Have you ever been hospitalized for this condition?
  3. Do you have anxiety attacks?  If so, what is the frequency and duration?
  4. Do you use alcohol or illegal drugs?
  5. Do you use illegal drugs or alcohol and then experience symptoms of other mental disorders?
  6. Do you use illegal drugs or alcohol to stop the symptoms of your mental disorder?
  7. Are you able to read and write?  Have you had IQ tests performed?  Were you in special education classes?

Psychiatric experts diagnose mental conditions using the criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  As such, Social Security’s requirements also conform to these criteria.  Once a proper diagnosis is made, the severity of the condition is considered based on how the condition affects functioning.  Many of these disorders can be found disabling if they prevent functioning outside of a highly supportive setting.  Mental disorders can also be episodic and repeated episodes (3 a year) can also establish a disability, depending on duration.

Some individuals with limited intellectual functioning are able to work in simple jobs until another medical condition worsens.  This combination of problems can also be found disabling if IQ tests confirm the limited intellectual abilities of the individual.  We often request school records for adults who were in special education programs as a child and ask Social Security to perform IQ tests to establish disability.  We also ask family members to assist in establishing deficits in adaptive functioning (how well the person copes with common life demands).

A common obstacle to establishing disability based on mental impairments is the patient’s concurrent use/abuse of illegal drugs and alcohol (DAA).  This often shows up in medical records as a dual-diagnosis.  While both Social Security and the DSM include substance abuse as a mental disorder, Social Security will not award benefits for this condition if it is “material” to the determination of disability.  This means that the decision maker will have to try to sort out whether the person remains disabled if they stop DAA.

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Disabling Condition: Neurological Disorders

Posted on September 6, 2010 by Editorial Board

Conditions covered include epilepsy/seizures (grand mal, petit mal), stroke, brain or spinal cord tumors, brain trauma, Parkinson, cerebral palsy, MS, ALS, MD, peripheral neuropathies.

Seizures

  1. What is the frequency and duration of your seizures?
  2. Are you on medications to control your seizures?
  3. Does your doctor take blood to check to see how much of this medication is in your body?
  4. Does the dosage of medication that you take that controls the seizures cause unwanted side effects?
  5. Have you had an EEG test?
  6. Do you keep a log, journal, or a calendar of episodes?

Stroke

  1. Are you status post physical therapy with residual problems?  If so, what are they (balance, weakness, left sided paralysis, vision, shaking, speech, bladder, etc)?
  2. If you have mental problems since the stroke, have you had neuro-psychiatric testing?
  3. Do you take medications for high blood pressure to prevent another stroke?

Multiple sclerosis (MS)

  1. Have you had a brain MRI?  If so, did it show demyelination?
  2. Do you take Amitrex?  Do you have side effects?
  3. Do you have vision problems?
  4. Do you experience fatigue?

Our nervous system relays electrical signals throughout our body to direct behavior and movement.  Disorders are usually related to a disturbance of this pathway from the brain, thru the spinal cord and down the peripheral nerves.

For instance, seizures start with abnormal electrical activity in the brain causing the body to shake rapidly and uncontrollably.  They are disabling when they occur more than once a month despite treatment.  Although most seizures last for only a few minutes, most people will sleep afterwards and still feel disoriented when they wake up.  Critical to establishing the severity of this disorder is documentation establishing the frequency and duration of an episodes or attacks.   It is also important to have on-going treatment, preferably with a neurologist to establish compliance.  Only seizures which are not controlled by medical intervention will be considered.

When blood vessels in the brain become weak, they can leak causing the affected area to die.  This is known as a stroke and it is often caused by high blood pressure (a less than adequate force exerted to circulate blood in the blood vessels).  Strokes can vary in intensity but most leave a person with residual neurological problems.  If the stroke was not severe, many people recover eventually from the damage and regain use of their body.  As such, Social Security does not consider every stroke disabling, only those that result in permanent and significant damage.  Social Security will review post-stroke medical records to make this determination.

Multiple sclerosis (MS) is really an autoimmune disorder.  The body attacks the protective myelin which coats and insulates nerve fibers in and around the brain and spinal cord.  Like seizures and other autoimmune disorders (lupus, rheumatoid arthritis), it is episodic.  But this condition is much more unpredictable in duration of both episodes and remissions.   While the National Multiple Sclerosis Society (NMSS) includes the use of a brain MRI to diagnose the condition, the criteria does allow diagnosis in the clinical setting (physical examination) without an MRI if at least 2 episodes are observed.  Social Security also does not require an MRI to establish the disabling nature of the condition in any particular individual.  Most people with MS experience a chronic fatigue which can lead to a misdiagnosis of chronic fatigue syndrome.

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Disabling Condition: Hypertension

Posted on September 6, 2010 by Editorial Board

Hypertension (or high blood pressure) is no longer a listed impairment but if it leads to a stroke, it can be evaluated under the neurological disorders.

HBP/HTN

  1. Are you taking medications?
  2. If not under control, why not?

Symptoms of high blood pressure (chest pain, confusion, ear noise or buzzing, irregular heartbeat, nosebleed, tiredness, vision changes, headaches) would affect the ability to work.  However, treatment (medication and lifestyle changes) is usually effective in treating the condition.  Lifestyle changes include exercise, weight loss and diet.  If the condition is not controlled because the patient fails to follow these treatment options, Social Security will not consider the condition disabling.

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Disabling Condition: Endocrine System Problems

Posted on September 6, 2010 by Editorial Board

Conditions covered include hyperparathyroidism, hypoparathyroidism, diabetes mellitus.

Diabetes

  1. Are you on pills, insulin, none or both?
  2. Do you follow a diabetic diet and/or have you attended any classes on this?
  3. Do you monitor you blood-sugar and adjust meals, activity, or medications?
  4. If your doctor has diagnosed peripheral neuropathy, have you had a confirming EMG test?
  5. Has your vision been affected (retinopathy, cataracts, glaucoma)?  If so, have you had surgical repair?

Thyroid

  1. Are you taking medications?
  2. If not under control, why not?

The endocrine system is responsible for communicating, controlling and coordinating a large number of bodily functions such as energy levels, reproduction, growth and development, responses to stimuli/stress and homeostasis (adjustment of physiological processes to maintain internal balance).  This is accomplished by the secretion of hormones from a number of glands (thyroid, pancreas, adrenal, pituitary, just to name a few).

Thyroid disorders are often effectively treated by medications.  Social Security will not normally find a thyroid disorder disabling unless the medical evidence establishes that the medications are not effective and the condition has worsened to cause specific damage such as weak bones, cataracts, involuntary muscle contractions, etc.

Diabetes is also usually controllable with medication and lifestyle management.  As such, Social Security will not find the diagnosis alone disabling until there is end-organ damage, such as neurological damage to the feet and/or hands, amputation of limbs or vision loss.  If fluctuating blood sugars are frequent and persistent despite treatment the condition will be found disabling.  Social Security will look for acidosis (the inability to excrete acid via the kidney) in the medical record.

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