From 1992 to 2007, the number of annual applications for a Social Security Disability (SSD) claim has increased substantially from 1,335,139 to 2,190,196 [1]. Moreover, this figure does not likely reveal the true number of claims because benefit applications for children and widows aren’t included.

SSD claims are not formally broken down by category in these statistics so it is difficult to determine the number of annual applications for a mental health disability. Currently, there are nine categories of adult mental disorders as set out by Social Security in the Mental Disorders section of their manual, section 12.00 of the “blue book” [2]. Each category has a number of criteria associated with it and reviewing these earmarks can provide valuable information for health professionals assisting in a client’s application process. The most commonly alleged adult Disability impairments are Organic Disorders, Schizophrenic, Paranoid and Other Psychotic Disorders, Affective Disorders and Anxiety-Related Disorders.

The Nine Categories of SSD Adult Mental Disorders

In addition to meeting one of these 9 categories, all SSD claimants must meet another standard. Claimants must be incapable of “sustained gainful activity” (SGA). Presently, this is seen in terms of a dollar amount of monthly earnings which is $940 or less [3].

The claimant will be deemed eligible for benefits if they receive one of any of the following three SSD determinations: 1) meeting The Listing of Impairments, known simply as “the listings”, the SSD coding according to body system [4]; 2) equaling a listing; or 3) med-voc allowance. There are exceptions, however, so the criteria have some latitude for considering extenuating situations where the phrase “meets or equals” may not apply to a particular claimant’s psychiatric disorder. In addition, “pace”, (the ability to keep going at a steady rate on a task), “persistence” (remaining with the task until it is completed) and “concentration” (not becoming distracted from the task), known collectively as PPC, is critical as being able to maintain PPC enables claimants to engage in SGA. More extensive information on the actual standards set for determining mental health disabilities can be found in the Program Operations Manual System (POMS; available online at https://secure.ssa.gov/apps10/poms.nsf/aboutpoms).

However, even when individuals seemingly meet the necessary criteria, it is not uncommon for applicants to be rejected on their initial application. The total number of individuals in what is termed “pay status” (i.e., receiving benefits) in 2007 was 7,101,355. This figure becomes even more daunting when you consider that 525,012 were terminated from pay status during 2007 [1]. Although the statistics are not categorized regarding the disability that was determined to be present for terminated claimants, the reasons for cessation of benefits are often the same.

Among the most common reasons for termination are: 1) a healthcare provider not providing a report; and 2) an inadequate report or a report from a consultative exam (CE) [5]. The latter is an exam for psychological or mental status testing performed by an outside vendor (i.e., an MD or licensed psychologist) which may not accurately reflect the claimant’s true, longitudinal behavior.

For example, in the delimited assessment context, claimants with a variety of disorders may present in a manner which makes them appear much higher functioning. It goes without saying that this works to the detriment of claimants who, wanting to do their best and not wanting to appear dysfunctional, may minimize their symptoms. Some may exaggerate their symptoms; also a detrimental pattern as this may diminish their credibility.

Taken together, this information suggests that effective, behaviorally-based disability report writing for mental health claimants is of the utmost importance in this domain – in both the attainment and maintenance of SSD status.