Social Security's listings are a shortcut that allows relatively rapid approval for disability claimants who are most seriously ill. Claimants do not have to meet a listing to be approved, but, unless working, a claimant who meets a listing will automatically be found disabled.
- Limitation of activities of daily living.
- Limitation in maintaining social functioning.
- Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.
- 14.05E. Repeated manifestations of polymyositis or dermatomyositis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
- 14.06 B. Repeated manifestations of undifferentiated or mixed connective tissue disease, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
- 14.07 C. Repeated manifestations of an immune deficiency disorder, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
- 14.09 D. Repeated manifestations of inflammatory arthritis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
What Social Security is saying is that if you have one of these immune system (or more accurately, rheumatic) disorders to a significant degree and also have rather significant psychiatric problems, you meet the listing and should be found disabled, even though neither the physical nor the mental illness on its own would otherwise meet a listing.
The "B" criteria language was not in the Notice of Proposed Rulemaking apart from the HIV/AIDS listing, so this came as quite a surprise to me. Social Security explains in the notice published with the new regulations that the "B" criteria were added to the new listings as a result of public comment.
What I am about to say may surprise readers who do not have significant experience working on the front lines with Social Security's disability programs, as will the vehemence with which I say it, but I do not think I will get many arguments from those who are experienced. There is a complex interplay between physical and mental illness. It is normal for chronic physical illness to lead to depression, often severe depression. Psychiatric illness is usually accompanied by physical symptoms. Panic disorder, for instance, is not uncommon and causes dramatic physical symptoms. Depression is even more common and produces symptoms that mimic all sorts of serious phyisical ailments. Somatoform disorders (psychosomatic illnesses) are not rare. To some extent, all of us have psychosomatic symptoms. Depression heightens the perception of pain. Separating physical and mental illness into two separate categories is impossible, since there is no clear boundary between the two. In many, many cases the claimant is clearly disabled but the disability is not produced by either physical illness or mental illness, but by the combination of the two. In theory, Social Security accepts that a claimant may be disabled by a combination of physical and mental illness, but only in theory. In practice, the agency tries to slice a claimant in half and evaluate the physical and mental components of a claimant's health problems separately.
These new listings reflect an understanding that the suffering caused by chronic physical illness extends to psychiatric symptoms and that the disability caused by those psychiatric symptoms must be considered.
By this point, I think that those who are well versed in Social Security disability determination have already leaped ahead to the logical corollary of these new listings. If the psychiatric "B" criteria should be imported into the immune system listings, logically they should be imported into virtually every physical listing. That would be a major change in the listings and, in my opinion, a major step forward.
Will this happen? No time soon. I doubt that such a result was intended. At least, I strongly doubt that anyone at a high level at Social Security intended this. I doubt that the implications of these new listings has even dawned upon the upper reaches of the Social Security Administration.
Certainly, the agency can try to tell the world that there is a vast difference between the chronic illness produced by immune system disoders and the chronic illness produced by other diseases, but is there? I keep thinking about chronic liver disease. Sure, it is vastly different than lupus, for instance, but my experience is that it is even more likely to produce symptoms that seem psychiatric and, indeed, are psychiatric. You can say much the same thing about low back pain, inflammatory bowel disease and multiple sclerosis, just to name three diseases. In fact, you can say it about any serious chronic illness.
This argument is going to be made the next time that Social Security publishes proposed new listings. How will the agency respond? What if there is a new President by the time the agency has to respond?
This issue should be coming up soon. Proposed changes in the cancer listings are due out before long.
The "B" criteria language was not in the Notice of Proposed Rulemaking apart from the HIV/AIDS listing, so this came as quite a surprise to me. Social Security explains in the notice published with the new regulations that the "B" criteria were added to the new listings as a result of public comment.
What I am about to say may surprise readers who do not have significant experience working on the front lines with Social Security's disability programs, as will the vehemence with which I say it, but I do not think I will get many arguments from those who are experienced. There is a complex interplay between physical and mental illness. It is normal for chronic physical illness to lead to depression, often severe depression. Psychiatric illness is usually accompanied by physical symptoms. Panic disorder, for instance, is not uncommon and causes dramatic physical symptoms. Depression is even more common and produces symptoms that mimic all sorts of serious phyisical ailments. Somatoform disorders (psychosomatic illnesses) are not rare. To some extent, all of us have psychosomatic symptoms. Depression heightens the perception of pain. Separating physical and mental illness into two separate categories is impossible, since there is no clear boundary between the two. In many, many cases the claimant is clearly disabled but the disability is not produced by either physical illness or mental illness, but by the combination of the two. In theory, Social Security accepts that a claimant may be disabled by a combination of physical and mental illness, but only in theory. In practice, the agency tries to slice a claimant in half and evaluate the physical and mental components of a claimant's health problems separately.
These new listings reflect an understanding that the suffering caused by chronic physical illness extends to psychiatric symptoms and that the disability caused by those psychiatric symptoms must be considered.
By this point, I think that those who are well versed in Social Security disability determination have already leaped ahead to the logical corollary of these new listings. If the psychiatric "B" criteria should be imported into the immune system listings, logically they should be imported into virtually every physical listing. That would be a major change in the listings and, in my opinion, a major step forward.
Will this happen? No time soon. I doubt that such a result was intended. At least, I strongly doubt that anyone at a high level at Social Security intended this. I doubt that the implications of these new listings has even dawned upon the upper reaches of the Social Security Administration.
Certainly, the agency can try to tell the world that there is a vast difference between the chronic illness produced by immune system disoders and the chronic illness produced by other diseases, but is there? I keep thinking about chronic liver disease. Sure, it is vastly different than lupus, for instance, but my experience is that it is even more likely to produce symptoms that seem psychiatric and, indeed, are psychiatric. You can say much the same thing about low back pain, inflammatory bowel disease and multiple sclerosis, just to name three diseases. In fact, you can say it about any serious chronic illness.
This argument is going to be made the next time that Social Security publishes proposed new listings. How will the agency respond? What if there is a new President by the time the agency has to respond?
This issue should be coming up soon. Proposed changes in the cancer listings are due out before long.
1 comment:
OTOH, many ALJs will find that although the physical criteria for disability are met, the claimant's description of her limited ADLs is not credible, and therefore no disability exists. In other words, by introducing a totally subjective criterion into what used to be a purely objective system, SSA has introduced new ways to refuse a finding of disability to claimants. (Yes, I know the listings have always had elements of subjectivity, but this enlarges it enormously)
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