Social Security’s Listing 12.04 applies to Mood Disorders and provides decision makers with guidelines regarding what constitutes a disabling Mood Disorder. Generally, there are two Mood Disorders which can be disabling: Major Depressive Disorder and Bipolar Disorder. (Listing 12.04 doesn’t necessarily exclude other Mood Disorders but many would, by definition, not qualify. For example, “dysthymia” is a persistent low-grade depression that would not meet the severity requirements. Seasonal Affective Disorder is, of course, seasonal, and therefore would not satisfy Social Security’s rule that disabling impairments need to be expected to last one year or longer.)
Everyone can have variable moods but mood dysregulation can rise to the level of a disorder when: (1) there is a disconnect between someone’s mood and external environment (i.e. a depressed mood persists in the absence of acute grief or distress); and (2) the mood dysregulation negatively impacts someone’s daily functioning and/or social relationships.
Bipolar Disorder differs from Major Depressive Disorder in that it involves alternating phases of depression and mania. This may seems straightforward enough but these diagnoses are conflated and confused extremely often. They are mutually exclusive – someone can’t have both because bipolar requires both the depression and the mania, whereas depression only does not involve the manic phase. Nonetheless, I have seen countless clients with both diagnoses in their files, usually from different mental health professionals who have diagnosed the client differently. (Less experienced mental health professionals often interpret anger as mania, when this can actually be a symptom of depression, possibly leading to an inaccurate bipolar diagnosis. Or the professional may miss signs of mania and mislabel a bipolar disorder as depression.)
Social Security avoids this confusion at the early stages by lumping all mood disorders together when it lists a claimant’s impairments. However, when cases proceed to hearing and judges list impairments, they often include both, inadvertently showing their lack of sophistication about the very impairments they are judging.
Nonetheless, judges are trained to evaluate the functional impact of someone’s impairments, so this kind of error doesn’t necessarily prejudice a case. Listing 12.04 directs decision makers to consider problems in the following areas:
- Understanding, remembering, and applying information;
- Interacting with others;
- Maintaining concentration, persistence, and pace; and
- Adapting and managing oneself in daily life.
Judges understand that depression and mania can interfere with focus and concentration, making it difficult to retain new information and complete tasks. This can be very important to a case involving someone in their 50s, when the major question is whether they can perform their past work or continue to apply their skills. Focus and memory problems can often prevent this. However, younger workers need to be found to be incapable of any job whatsoever to prevail on a disability claim, and focus and concentration problems would need to be very severe for someone to be unable to do the very simple work which Social Security’s vocational experts will invariably say exists in significant numbers.
Often, depression makes formerly very social individuals less inclined to interact with others. The mania of bipolar disorder can lead to conflicts and poor decision making which can result in poor or even explosive social relationships. Extreme social functioning issues can surely make someone unable to work and thus qualify them for disability. However, Social Security’s decision makers hear so often about difficulty interacting with others that they may be reluctant to find that this alone qualifies someone for disability, even if the difficulty is severe. Also, the vocational experts will say there is work which requires very little interaction with others. On the other hand, someone in their 50s with a history of working in teams or interacting with the general public may be found unable to perform their past work because of social difficulty and then prevail on their claim.
Generally, Social Security is always interested in the daily life of someone seeking disability. After all, claimants are usually not working, so a consideration of their daily lives can be an effective way to assess functioning. Depression often involves a lack of self-care (showering, changing clothes) or a neglect of household chores. Judges may ask questions intended to determine if a mood disorder involves the most extreme symptoms. For example, sometimes a mood disorder can involve “psychotic features” when it’s particularly bad. These features include auditory and/or visual hallucinations, delusions, and paranoia. Also, those with mood disorders often lack insight into how their disorder affects their perception of physical symptoms. Depression can be a trigger for headaches and even result in widespread chronic pain. Depending on the symptomology and the doctor making the diagnosis, this could be called fibromyalgia or somatic symptom disorder a/k/a conversion disorder.
The old Listing 12.04 (before changing around a decade ago) included “episodes of decompensation” as criteria. These are periods of exacerbation of the mental health disorder, often resulting in hospitalization. With depression, suicidal ideation often leads to a hospitalization like this. With mania, someone could even be hospitalized involuntarily when someone poses a threat to themselves or others. Evidence of “episodes of decompensation” can still be very important to Social Security determinations.
Social Security’s decision makers will often consider the effectiveness of treatment for a Mood Disorder. Generally, a decision maker will feel most comfortable approving a Mood Disorder claim if disabling symptoms persist despite treatment, including medications and psychotherapy. While Social Security rules provide for someone to be denied disability if they have been non-compliant with treatment, they don’t provide that someone can be denied disability for a mental impairment merely because their treatment isn’t intensive enough. However, a decision maker could make such a decision through the “back door” by reasoning that someone’s mental impairment isn’t severe enough for disability, otherwise they would have gotten more treatment for it. So the bottom line is to seek appropriate treatment for mental disorders first. If you are experiencing a mood disorder, hopefully the professionals can help you overcome it so you can get back to a healthy level of functioning. If not, you can seek disability, and the legal professionals at Keller & Keller can discuss a disability claim with you.
