Monday, August 31, 2009

Social Security Disability, the VA, Mental Conditions, and Consultative Exams

The following situation and questions were received from "XZillR8"

Due to my strong ongoing advice, my husband is about to apply for SSDI due to numerous conditions (i.e. Schizoaffective, Anxiety, Depression, ADHD, Bi-Polar, and Chronic Headaches).

Obviously most of the conditions fall under the mental category. How does he determine the exact date that the disability started since his condition has gotten progressively worse over time and doesn't necessarily fall on an exact incident date? I saw on another post how the date is determined based on the medical records...however my husband's regular doctor wasn't very sociable so my husband wasn't asked and didn't go out of his way to tell the doctor "oh, by the way, I'm not working anymore because I can't handle it". So how do we determine AND prove the exact date the disability began?

Also, it was hard for my husband to openly discuss his schizo conditions (i.e. hallucinations, voices, etc.) with family practitioners and even some mental health professionals because he has been shunned by some of those people in the past when he's told them about it. Therefore, details about his mental disorders are not going to be mentioned much in his family doctor's records. However, he did have psychiatric assessments done at the VA hospital every 6 months to a year. Will the lack of documentation of work status & psychological details in the family doctor's medical records be a problem?


I will start with how Social Security will determine when your husband became disabled. To understand how Social Security determines if a person's condition is disabling we must first take a look at Social Security's definition of disability.

The definition of disability for Social Security purposes is basically as follows: a person may be considered to be disabled when:

A) they have a medically determinable mental or physical condition that has prevented them from engaging in substantial work activity for twelve months


B) they have a medically determinable mental or physical condition that is expected to prevent substantial work activity for twelve months


C) they have a medically determinable mental or physical condition that is expected to result in death.

To recap, for social security disability and SSI disability eligibility, an individual must have a severe impairment that prevents them from engaging in work activity at the SGA or substantial gainful activity level for 12 months or longer (or, as mentioned, may result in death). So, your husbands established date of onset would be when he stopped work due to his impairments.

In addition to a claimant's vocational history, i.e. when the individual stopped working (and earning at least the substantial gainful activity amount), Social Security has to consider medical information in order to make a medical determination. Generally, Social Security likes to have at least a twelve month longitudinal treatment history to make their decision, so it's good that your husband has had mental health evaluations at the VA every six months to a year, particularly if they show that your husband has these diagnoses or even that mental health issues exist.

The disability system that the federal government uses requires Social Security to determine if your husband is able to perform any of the jobs he performed in the past 15 years at a substantial work level. If they determine that his mental health problems prevent him from performing his past work, they have to consider whether or not his residual functional capacity and other factors (age, education, work skills) rules out the possibility of performing suitable types of "other work".

I cannot say that lack of medical evidence will not be a problem, because I do not how recent your husband's VA psychiatric evaluations are (Social Security also has to have at least some current medical information to make their determination and that would be information that is ninety day or less old).

And if he has current psychiatric medical information, has he made the medical professionals at the VA aware that he is hearing voices and having hallucinations? It all depends on what is in the notes from your husband's VA evaluations. If the disability examiner does not feel there is enough psychiatric information, or they have no current medical information, they may have to schedule a one-time psychiatric consultative examination to make a disability determination.

It is my opinion that your husband should start getting routine psychiatric treatment if he is not receiving it through the VA. His chances of being approved are substantially improved if he is being treated by an mental health professional.

Generally, consultative examinations--which are scheduled in the absence of sufficient medical record documentation--are fairly "thin" examinations that are not likely to be a true evaluation of your husband's functional capacity. However, if that is the only choice a disability examiner has, they are obligated to obtain some kind of current mental health information to make their determination.

Additionally, if your husband is scheduled for a consultative examination, make sure that he attends the examination. If he fails to go to the examination and does not call to reschedule , he could be denied for failure to cooperate.

I know all of this seems like a lot of information to take in, but I believe it boils down to this. Social Security will determine that his disability began when he was unable to work at a substantial gainful level. Secondly, if your husband has not been getting treatment for his mental health issues, he needs to start being treated through the VA or a private mental health professional. Because current treatment notes from his treating mental health professional will most likely present a truer picture of how disabling his mental conditions are than a one-time consultative examination performed by someone who has no history of providing treatment and, basically, knows little about the progression of his illness.

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Blogger XZillR8 said...

Thank you for your response. We moved a year ago, so there is appx a 1.5 year gap in Psych assessment. However, he just started seeing a psychiatrist last month and will be visiting him monthly from now on (couldn't afford to go before).

His family doctor has been prescribing his 'maintenance meds' for his psychiatric/physical conditions consistently over the years (my husband has faithfully been taking his meds without a gap). There is mention of his psychiatric conditions in his family doctor's medical records, just not to the extent obviously that a psychiatric assessment does. He did tell the VA about his conditions (i.e. seeing things, hearing voices, having maigraines, etc.) so there is definitely record and diagnoses over the last several years.

He has been working odd jobs over the last 10 years (making less than $10k per year), so when you look at his Social Security Statement, it's apparent that his work has dropped off since 1999. I think the last time he was able to work full-time was back in 2004 for about 6 months.

He has been stubborn in the past about applying for disability (which he should have done a long time ago) and I finally opened him up to it. I have been doing everything to get all the needed documentation together for him so we can go apply in person later this month when we get his medical records in. Hopefully his delay in applying won't hurt his case.

12:44 PM  

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