A neurocognitive disorder is a condition with a wide variety of causes and a range of potential impacts. MedlinePlus, an online resource provided by the National Library of Medicine, notes that neurocognitive disorder is “a general term that describes decreased mental function due to a medical disease other than a psychiatric illness.” The entry further lists many of the causes of neurocognitive disorder, including causes connected to brain injury, breathing conditions, cardiovascular disorders, degenerative disorders, metabolic disorders, the effects of drugs or alcohol, and infections.
Neurocognitive disorder is distinct from other mental disorders such as dementia. The condition can range in level of severity, and at least one estimate suggests that 5 million people in the US live with some degree of the disorder. Given the variation in severity among many million people, the actual impacts of neurocognitive disorder on day-to-day functioning can also vary widely.
The Social Security Administration includes neurocognitive disorders as one of the listed impairments that they consider. If an individual applying for disability benefits has a medically determinable neurocognitive disorder, the disorder’s effects meet the stringent requirements of this listing, and technical eligibility requirements are otherwise met, then the Administration should find such a claimant disabled. The relevant listing is 12.02. It has three subparts, and to meet the listing, a claimant must meet the requirements of the first subpart and either the second or third subparts.
The first subpart requires medical documentation “of a significant cognitive decline from a prior level of functioning” in at least one cognitive area that the agency considers. These areas are complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition.
The second part requires that the neurocognitive disorder has caused an extreme limitation of one area of mental functioning, or alternatively a marked limitation of two areas of mental functioning. The four areas are understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; and adapting or managing oneself.
The third part requires that the disorder is “serious and persistent,” defined further to mean that the claimant has “a medically documented history of the existence of the disorder over a period of at least 2 years,” with both evidence of ongoing treatment or an ongoing highly structured setting that diminishes the symptoms and signs of the disorder and evidence of a minimal capacity to adapt to changes in the environment or demands that are not already part of the claimant’s daily life.
It’s certainly a complex standard, and there is room for interpretation. For instance, what is an “extreme” limitation versus a “marked” one? The listings define these terms, but not very clearly. A marked limitation means that “functioning in this area independently, appropriately, effectively, and on a sustained basis is seriously limited.” In contrast, an extreme limitation means that a claimant is “not able to function in this area independently, appropriately, effectively, and on a sustained basis.” When is someone seriously limited in their functioning, versus unable to function independently? Furthermore, what is the difference between “seriously limited,” functioning at a “fair” level, or “slightly limited”? Yet these are the definitions that the agency uses to divide marked, moderate, and mild limitations. If this seems confusing, that’s because it is. The standard is far less than clear and has often led to further review by the courts.
With such a confusing standard, it should be no surprise that it is very difficult to be found disabled under these listed impairments. However, if an adjudicator decides that a claimant does not meet the listing (or medically/functionally equal it—a parallel and similar but not quite the same analysis), then they have to decide how much they think the claimant can still do. This analysis is known as assessing someone’s residual functional capacity. Once that is in place, the adjudicator seeks testimony about jobs from a vocational expert. If the vocational expert establishes that a claimant cannot do their past work or other work as a result of the functional limitations that the adjudicator thinks exist, then the claimant should still be found disabled. Oftentimes, someone with a neurocognitive disorder may also have other mental or physical impairments that further limit the things they can do, making it a little more likely that an adjudicator like an Administrative Law Judge might ultimately find a claimant disabled. In all of this, having the opinion of a treating or examining medical expert, especially a specialist like a neuropsychologist, can go a long way in demonstrating just how exactly an individual patient is limited.
As with all other physical and mental impairments, while the Social Security Administration requires a claimant to provide objective evidence that the impairment exists, at the end of the day the far more important and difficult step (at least most of the time) is showing that the impairment meets or equals the stringent listings or otherwise prevents the performance of a significant number of jobs. It is advisable to discuss your case early with a disability attorney to understand what evidence will likely be needed to best support your claim.
If you’ve been diagnosed with an organic mental disorder or a neurocognitive disorder, and you’re thinking about applying for disability benefits, please contact the attorneys at Keller & Keller to evaluate your case.