This column will examine how the
Social Security Administration evaluates Disability Insurance
Claims for people who are diagnosed with mental health problems
called Mood Disorders. A common mood disorder is bipolar disorder,
which used to be called Manic Depression.
The Social Security
Administration (SSA) has a set of criteria that it uses called
Listings to determine whether a person is eligible for monthly
disability insurance payments. To obtain disability insurance
benefit payments from the SSA based upon a mental disorder, the
SSA must have documentation of a medically determined impairment
for the person seeking the disability benefits.
documentation is established, then the SSA will consider what
limitation such an impairment places on the personís ability to
work and if that limitation can be expected to last at least one
To see how the SSA reviews claims
that involve persons who have Mood Disorders it is helpful to take
a brief look at the medical terms used in describing this mental
illness and the process SSA uses to make its decision about
disability. The SSA considers Bipolar Disorder to be an Affective
The terminology seems to change regularly and
Affective Disorders are now sometimes referred to as Mood
Disorders. Bipolar Disorder has been referred to as Manic-Depression
in the past. The SSA describes Affective Disorders as a
disturbance of mood accompanied by a full or partial manic or
Bipolar disorder is a medical
condition in which the person has alternating periods of depression
and periods of manic (hyper) activity.
During a manic period the patient
could feel euphoric, irritable, and powerful. In a period of
depression the patient might very sad, hopeless, suffer sleep
disorders, and have feelings of guilt.
To determine if the patient meets
the Listing requirements for disability insurance benefits the SSA
will first determine if the person meets the clinical tests for
If the person does meet the clinical test for
bipolar disorder, then the next test for SSA is to decide if the
personís health problem imposes Functional Restrictions on his
work ability. The functional restrictions measure whether the
person can still perform work related tasks. If the person meets
the Listing requirements he will receive disability benefits.
The SSA uses a set of guidelines
called the Residual Functional Capacity evaluation to help the SSA
decide if the person can work or not. The Residual Functional
Capacity test is a check list that the SSA has completed to
determine the level of disability of a claimant.
To qualify for disability
payments for an Affective Disorder, the patient must meet the
A.. Medically documented
persistence of at least one of the following:
1. Depression with at
least four of the following: loss of interest in most activities;
appetite change with change in weight; sleep disturbance;
psychomotor agitation or retardation; decreased energy; feelings
or worthlessness or guilt; difficulty in concentrating; thoughts
of suicide; hallucinations, delusions or paranoid thinking; or:
2. Manic syndrome with at
least 3 of the following: hyperactivity; pressure of speech
(speaking rapidly and disjointedly); flight of ideas (multiple
rapid ideas); inflated self esteem; decreased need for sleep; easy
distractibility; or involvement in activities that have a high
probability of painful consequences which are not recognized by
the patient; or hallucinations, delusions or paranoid thinking; or
3. Bipolar syndrome with a
series of episodes with full manic and depressive symptoms.
B. Which result in at least of
two of the following limitations:
1. Marked restriction of
activities of daily living; marked difficulties in maintaining
social functioning; or deficiencies of concentration resulting in
frequent failure to complete tasks on time; or repeated episodes
of deterioration at work or in a work like setting which cause the
patient to withdraw from that situation or to experience worsening
signs and symptoms.
If the person meets these
listings then the SSA should award Disability Insurance Benefits.
It should be kept in mind that a person can still be found to be
disabled by an Administrative Law Judge after a hearing even if he
does not meet a particular listing if he has health problems that
in combination are the equivalent of a listing.
The Judge has the
discretion to decide if a personís health problems are serious
enough to warrant an award of disability benefits despite not
meeting the specific technical requirements of one of the SSA
listings for disability.