Facts about Mental retardation and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1) The term 'mental retardation' is being used less and less in North America. Many people prefer to use alternative and less insulting terms, such as developmental disability or intellectual disability. Even the non-profit organization that advocates for those with mental retardation changed their name in 2006 from the American Association on Mental Retardation, to the American Association on Intellectual and Developmental Disabilities.
2) To be diagnosed with mental retardation a child must meet certain criteria. First, they must have an IQ of less than 70. Second, they must show limitations in their adaptive behavior by falling into at least two of the three categories: social skills, communication skills, and daily living skills. Third and lastly, there must be evidence that the limitations in IQ and adaptive skills were present before the age of 18 years old.
3) An IQ between 70-80 suggests borderline intellectual functioning, an IQ of 50-69 suggests mild mental retardation, an IQ of 35-49 falls into moderate mental retardation, and an IQ of 20-34 is labeled severe mental retardation. If an IQ is below 20 it is categorized as profound mental retardation.
4) The most common causes of mental retardation present at birth are fetal alcohol syndrome, Down syndrome and Fragile X syndrome. Other common causes are genetic conditions, problems during pregnancy or during birth, exposure to toxins or certain diseases, iodine deficiency, and malnutrition.
5) Mental retardation is a disability, not a disease.
6) There are countless agencies that provide a wide variety of assistance to people with mental retardation. From privately run agencies and state-run agencies, to non-profit and for-profit agencies, there are many different ways to get help.
7) There are no medications specifically for mental retardation.
8) The goal of assistance for mental retardation is independence. Depending upon the level of mental retardation, independence may mean independence while getting dressed or brushing one's teeth, or independence living alone or raising a family.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
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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