Wednesday, November 14, 2007

Mental Testing When You Apply for Disability for Depression (few Medical Records)

Individuals who list depression on their applications for social security or SSI disability tend to fall into 2 separate camps. The first group comprises those individuals who are actively being treated for depression and are expressly filing for disability based on depression.

The second group comprises individuals who are listing depression on their applications for disability, but consider other impairments that they have to be more fundamental to their claims.

In either situation, however, the simple fact that depression is listed on an application means that a disability examiner (examiners make decisions on disability claims at the initial claim and reconsideration levels) or a disability judge (administrative law judges make decisions on claims at the hearing level) will be forced to consider the viability of an approval based on depression. And this can be problematic if, in fact, a disability claimant has A) not received actual treatment for depression, B) has received only sporadic treatment, or C) has not received recent treatment for depression. In all three of these scenarios, a disability applicant is likely to be sent to a mental consultative exam.

What is a consultative exam? Consultative examinations (known by the abbreviation CE) are what some claimants refer to as "social security medical exams". These are examinations that are paid for and scheduled by the social security administration and are conducted by independent physicians, psychologists, and psychiatrists. Generally, these exams are ordered for the purpose of gathering additional evidence for use by a disability examiner or a disability judge. However, in most instances, a consultative exam is specifically ordered when a claimant has not been treated for an alleged impairment (i.e., one that was written on the disability application), or does not have a sufficient record of treatment to evaluate the claim.

What kind of mental testing does social security send claimants to? There is a range of testing for mental consultative exams, including a full psychiatric exam and a psychological exam which is essentially an IQ test. Very often, however, (and this is based on my own experience as an examiner in one state agency--practices may be different in other state agencies and, in fact, practices sometimes vary between individual units of a single state agency) a claimant who has listed depression on a claim but does not seem to have a developed history of treatment for depression will be sent to an abbreviated form of exam, known as a mental status exam.

A mental status exam is designed to gauge exactly what the term implies, the mental status of the claimant. Accordingly, the report that is generated from such an exam (and sent to the disability examiner working on the case) will include data regarding presentation and appearance, observable motor coordination and gait, eye contact, speech (was it pressured?, did it occur at a normal rate and volume?), memory and recall, concentration and attention, orientation as to time and place, alertness, judgement, and ability to abstract (such as the ability to interpret a proverb).

Can you be approved for disability on the basis of a mental status exam? Based on my experience as an examiner, I would conclude that the odds of this happening are slim to none. However, that does not mean that a claimant who is sent to a mental status exam cannot be approved. Sometimes, psychological testing is scheduled simply to obtain recent medical evidence and in many cases the existing medical evidence is sufficient to warrant an award of benefits. However, it is also true that the mere fact that a mental status exam has been ordered often indicates that the claimant's mental treatment records are either out of date, or lacking altogether.

For this reason, individuals who file for disability on the basis of depression, or, really, any mental impairment, should (for the sake of a disability application) strive to maintain a record of continuous and ongoing treatment. They should also stay compliant with their prescribed medications as a failure to do so may contribute to the basis for a denial.

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