Social Security Disability and Getting a Different Diagnosis on a Mental Condition

Someone wrote in and stated that she had received different labeling of her condition (different diagnoses) after being seen by a number of different psychologists and, perhaps, M.D.s as well. Her questions were A) why does this occur and B) do disability examiners notice this in the medical records they read and, if so, how does it affect their evaluation of a case.

As to why it happens, I think that's really part and parcel of the mental diagnostic process and the fact that mental conditions are subjective, both for the individuals who suffer with their conditions and for those who must attempt to properly categorize their condition for the purpose of delivering proper and effective treatment.

In my own experiences in assisting others in mental health settings (this would not be in the capacity of an examiner), I've found that it is fairly common to received different--and sometimes even dissimilar diagnoses--from different psychiatrists and psychologists. For example, patient A could receive treatment from Doctor A and then, for whatever reason, switch to Doctor B. Doctor B, after performing his or her own evaluation of the patient may determine the prior diagnosis was incorrect, or perhaps that the patient's condition has changed in some way that affects the current diagnosis. Sometimes, this means dropping the old diagnosis in favor of a different one, or adding a new diagnosis to the current list of diagnosed conditions.

This is fairly routine and normal, based on my experience as an examiner, but also from my own personal observations taken within the mental health system.

However, it does lend some insight as to why mental health disability claims sometimes have an uphill battle.

As I've said many times, the process of making a decision on a disability claim is highly subjective. If that wasn't true, then certainly would not have so many individuals being denied at the first appeal level (request for reconsideration), with such a high percentage of those denials effectively being overturned by federal judges at social security disability hearings.

Also, there is the fact that (and I base this on my own direct experience as an examiner) a case could be taken to several different processing units at a disability determination services agency (where disability claims get worked on for the social security administration) and you could literally get back more than one type of decision. Meaning the system is subjective and not so objective as many would pretend is the case. And it becomes more subjective with mental claims, particularly when you consider the fact that, so often, treating mental health professionals cannot even agree on a diagnosis.

As to the second question: how do disability examiners deal with this phenomenon? Actually, quite easily. Because, as I've said many times on this blog and on www.ssdrc.com, it is not the diagnosis, not the name of the condition that everything rests on. All social security disability and SSI cases are decided according to the functional limitations that are demonstrated by the claimant's medical records. And cases are approved if those records indicate the claimant cannot return to their past relevant work or perform some type of other work while earning a substantial and gainful income. To a large degree in most cases, the name of the condition itself is barely relevant.



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