Filing for disability with Schizophrenia
There's a reason why most claimants will benefit from representation on a Social Security Disability or SSI claim. And that reason is the simple fact that the criteria for disability can be fairly complex. In this post, I'll demonstrate how complex it can be for those individuals who are applying for disability on the basis of schizophrenia.
Schizophrenia is addressed in the social security administration's impairment listing manual (the blue book) in Listing 12.03, titled Schizophrenic, Paranoid, and Other Psychotic Disorders. The actual reading of the listing is fairly extended, but it can be summarized as follows.
To qualify for disability benefits by either meeting or equaling the specifications of listing 12.03, a disability applicant's records must show the existence of intermittent or continuous--
A) delusions or hallucinations
B) catatonic or other grossly disorganized behavior
C) A state of llogical thinking, incoherence, loosening of associations, or poverty of content of speech (associated with either a blunt, flat, or inappropriate display of mood or affect)
D) Emotional withdrawal and/or isolation
For a claimant to satisfy the requirements of listing 12.03, their records must also indicate that at least two of the following apply:
A) Markedly restricted daily activities;
B) Marked restrictions in maintaining concentration, persistence, or pace;
C) Marked restriction in the ability to maintain social functioning;
D) Extended and repeated episodes of decompensation;
Now, if a disability applicant does not qualify for disability on the basis of the aforementioned criteria, then listing 12.03 also sets forth the following criteria by which an individual may be approved if they have schizophrenia. In this second set of criteria, a claimant must be able to show ---
A) A medically documented history of a psychotic disorder (schizophrenia, paranoid, or other) that has lasted at least 2 years and has resulted in a limitation of the ability to do basic work activities.
B) The medical history must show the existence of repeated and extended episodes of decompensation or the existence of the inability to function outside a highly supportive living arrangement for at least one full year or the existence of a residual disease process whose effects are far-reaching enough that even a minimal increase in mental demands, or even a minimal change in environment, would be predicted to cause the individual to decompensate.
Listing 12.03 (Schizophrenic, Paranoid, and Other Psychotic Disorders) can seem fairly complicated. And it is. Even disability examiners who have handled hundreds of psychotic disorder cases need to refer to the impairment listing manual each time they evaluate a case involving schizophrenia. Because the listing is detailed enough to require it.
Because the listing approval requirements for many conditions are this complex (or more complex), claimants who go to disability hearings before federal administrative law judges without representation will generally be at a disadvantage versus represented claimants.
Of course, satisfying the requirements of a listing is not the only way to get approved for disability. Most applicants actually get approved via a Medical Vocational Allowance.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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