By Kathleen Overton, Attorney
Parmele Law Firm, P.C.
Mental health impairments can be difficult to prove. Unlike some physical impairments, the judge isn’t able to see a mental disability. There is no x-ray or MRI that can show how severe the disability has become. Rather, judges and lawyers rely heavily on the treatment notes from the psychiatrist, psychologist, or therapist. Mental status examinations show how well the client is coping and details the patient’s ability to concentrate, remember, and interact. But, what happens when a chronically mentally ill patient has normal mental status examinations? Does that ruin a claim for disability based on a mental impairment? Must patient be actively psychotic or actively suicidal in order to receive benefits? The answer is no, but it takes proper development of the record to ensure a favorable decision.
The Social Security Administration understands that people with chronic mental illness will sometimes have periods of relatively stable functioning. Indeed, in the listing of impairments, the Social Security Administration has acknowledged that a cessation of symptoms and the resultant normal mental status examinations may be the result of a structured living environment. Listing 12.04C, for examples, explains that a chronically depressed person may still be disabled if the person has a medically documented history of a chronic affective disorder of at least 2 years’ duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms of signs currently attenuated by medication or psychosocial support and either (1) repeated episodes of decompensation, or (2) marginal ability to adjust, or (3) inability to function outside of a highly supportive living environment. The key to proving this type of case is obtaining sufficient documentation that the reason the psychological signs or symptoms are attenuated is because of psychosocial support and any increase in mental demands would cause the individual to decompensate.
Unlike many other mental health cases, in this type of case, a Medical Source Statement asking for the doctor’s opinion of the claimant’s functioning is not enough. Rather, the doctor should be asked about a claimant’s ability to adjust in even minimal changes, or to complete the Medical Source Statement with the understanding that the patient is in the competitive work environment and not the structured setting the patient has established. Obtaining a narrative letter from the doctor or third-parties addressing the claimant’s structured setting—i.e., avoiding triggers that may cause increased anxiety or depression, isolating, or performing extensive soothing techniques—can also help explain why a claimant is disabled despite relatively normal mental status examinations.
The key to winning a complicated disability case involving mental health impairments is proper development of the record. Consultation with an experienced disability attorney is critical to proper presentation of the claim.