Back to the BASICS.

There are 3 ways to be approved for SSDI.

1. Meet the requirements of a Listed Impairment. LINKS: http://www.ssa.gov/disability/profes...dult.htm#11_14
http://www.ssa.gov/disability/profes...dult.htm#12_04

2. Qualify via the GRID Rules. LINK: https://www.socialsecurity.gov/OP_Ho...04-app-p02.htm

3. Qualify via the 5 Step Evaluation Process. LINK: http://www.socialsecurity.gov/oidap/...Evaluation.pdf


The fastest way to be approved is to qualify with a Listed Impairment. Most of those approved at the first stage will do so with a Listed Impairment, and some via the GRID Rules.

Both PN and Bipolar Disorder are Listed Impairments. I have supplied the main links to requirements for both PN and BP above, and quoted the relevant sections here. SS has determined your impairments don't meet (or equal) the requirements for a Listed Impairment which have very specific rules. You may be able to prove your impairments meet or equal a Listing by getting additional medical documentation.

"11.14 Peripheral neuropathies. With disorganization of motor function as described in 11.04B, in spite of prescribed treatment."

"11.04 Central nervous system vascular accident. With one of the following more than 3 months post-vascular accident:

B. Significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements, or gait and station (see 11.00C)."

"C. Persistent disorganization of motor function in the form of paresis or paralysis, tremor or other involuntary movements, ataxia and sensory disturbances (any or all of which may be due to cerebral, cerebellar, brain stem, spinal cord, or peripheral nerve dysfunction) which occur singly or in various combinations, frequently provides the sole or partial basis for decision in cases of neurological impairment. The assessment of impairment depends on the degree of interference with locomotion and/or interference with the use of fingers, hands and arms."


"12.04 Affective disorders: Characterized by a disturbance of mood, accompanied by a full or partial manic or depressive syndrome. Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation.

The required level of severity for these disorders is met when the requirements in both A and B are satisfied, or when the requirements in C are satisfied.

A. Medically documented persistence, either continuous or intermittent, of one of the following:

1. Depressive syndrome characterized by at least four of the following:

a. Anhedonia or pervasive loss of interest in almost all activities; or

b. Appetite disturbance with change in weight; or

c. Sleep disturbance; or

d. Psychomotor agitation or retardation; or

e. Decreased energy; or

f. Feelings of guilt or worthlessness; or

g. Difficulty concentrating or thinking; or

h. Thoughts of suicide; or

i. Hallucinations, delusions, or paranoid thinking; or

2. Manic syndrome characterized by at least three of the following:

a. Hyperactivity; or

b. Pressure of speech; or

c. Flight of ideas; or

d. Inflated self-esteem; or

e. Decreased need for sleep; or

f. Easy distractibility; or

g. Involvement in activities that have a high probability of painful consequences which are not recognized; or

h. Hallucinations, delusions or paranoid thinking; or

3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently characterized by either or both syndromes);

AND

B. Resulting in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marked difficulties in maintaining social functioning; or

3. Marked difficulties in maintaining concentration, persistence, or pace; or

4. Repeated episodes of decompensation, each of extended duration;

OR

C. Medically documented history of a chronic affective disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following:

1. Repeated episodes of decompensation, each of extended duration; or

2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or

3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement."

"12.00 Mental Disorders


A. Introduction: The evaluation of disability on the basis of mental disorders requires documentation of a medically determinable impairment(s), consideration of the degree of limitation such impairment(s) may impose on your ability to work, and consideration of whether these limitations have lasted or are expected to last for a continuous period of at least 12 months. The listings for mental disorders are arranged in nine diagnostic categories: Organic mental disorders (12.02); schizophrenic, paranoid and other psychotic disorders (12.03); affective disorders (12.04); intellectual disability (12.05); anxiety-related disorders (12.06); somatoform disorders (12.07); personality disorders (12.08); substance addiction disorders (12.09); and autistic disorder and other pervasive developmental disorders (12.10). Each listing, except 12.05 and 12.09, consists of a statement describing the disorder(s) addressed by the listing, paragraph A criteria (a set of medical findings), and paragraph B criteria (a set of impairment-related functional limitations). There are additional functional criteria (paragraph C criteria) in 12.02, 12.03, 12.04, and 12.06, discussed herein. We will assess the paragraph B criteria before we apply the paragraph C criteria. We will assess the paragraph C criteria only if we find that the paragraph B criteria are not satisfied. We will find that you have a listed impairment if the diagnostic description in the introductory paragraph and the criteria of both paragraphs A and B (or A and C, when appropriate) of the listed impairment are satisfied.

The criteria in paragraph A substantiate medically the presence of a particular mental disorder. Specific symptoms, signs, and laboratory findings in the paragraph A criteria of any of the listings in this section cannot be considered in isolation from the description of the mental disorder contained at the beginning of each listing category. Impairments should be analyzed or reviewed under the mental category(ies) indicated by the medical findings. However, we may also consider mental impairments under physical body system listings, using the concept of medical equivalence, when the mental disorder results in physical dysfunction. (See, for instance, 12.00D12 regarding the evaluation of anorexia nervosa and other eating disorders.)

The criteria in paragraphs B and C describe impairment-related functional limitations that are incompatible with the ability to do any gainful activity. The functional limitations in paragraphs B and C must be the result of the mental disorder described in the diagnostic description, that is manifested by the medical findings in paragraph A.

The structure of the listing for intellectual disability (12.05) is different from that of the other mental disorders listings. Listing 12.05 contains an introductory paragraph with the diagnostic description for intellectual disability. It also contains four sets of criteria (paragraphs A through D). If your impairment satisfies the diagnostic description in the introductory paragraph and any one of the four sets of criteria, we will find that your impairment meets the listing. Paragraphs A and B contain criteria that describe disorders we consider severe enough to prevent your doing any gainful activity without any additional assessment of functional limitations. For paragraph C, we will assess the degree of functional limitation the additional impairment(s) imposes to determine if it significantly limits your physical or mental ability to do basic work activities, i.e., is a "severe" impairment(s), as defined in §§ 404.1520(c) and 416.920(c). If the additional impairment(s) does not cause limitations that are "severe" as defined in §§ 404.1520(c) and 416.920(c), we will not find that the additional impairment(s) imposes "an additional and significant work-related limitation of function," even if you are unable to do your past work because of the unique features of that work. Paragraph D contains the same functional criteria that are required under paragraph B of the other mental disorders listings.

The structure of the listing for substance addiction disorders, 12.09, is also different from that for the other mental disorder listings. Listing 12.09 is structured as a reference listing; that is, it will only serve to indicate which of the other listed mental or physical impairments must be used to evaluate the behavioral or physical changes resulting from regular use of addictive substances.

The listings are so constructed that an individual with an impairment(s) that meets or is equivalent in severity to the criteria of a listing could not reasonably be expected to do any gainful activity. These listings are only examples of common mental disorders that are considered severe enough to prevent an individual from doing any gainful activity. When you have a medically determinable severe mental impairment that does not satisfy the diagnostic description or the requirements of the paragraph A criteria of the relevant listing, the assessment of the paragraph B and C criteria is critical to a determination of equivalence.

If your impairment(s) does not meet or is not equivalent in severity to the criteria of any listing, you may or may not have the residual functional capacity (RFC) to do substantial gainful activity (SGA). The determination of mental RFC is crucial to the evaluation of your capacity to do SGA when your impairment(s) does not meet or equal the criteria of the listings, but is nevertheless severe.

RFC is a multidimensional description of the work-related abilities you retain in spite of your medical impairments. An assessment of your RFC complements the functional evaluation necessary for paragraphs B and C of the listings by requiring consideration of an expanded list of work-related capacities that may be affected by mental disorders when your impairment(s) is severe but neither meets nor is equivalent in severity to a listed mental disorder.

B. Need for medical evidence: We must establish the existence of a medically determinable impairment(s) of the required duration by medical evidence consisting of symptoms, signs, and laboratory findings (including psychological test findings). Symptoms are your own description of your physical or mental impairment(s). Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception, as described by an appropriate medical source. Symptoms and signs generally cluster together to constitute recognizable mental disorders described in the listings. The symptoms and signs may be intermittent or continuous depending on the nature of the disorder.

C. Assessment of severity: We measure severity according to the functional limitations imposed by your medically determinable mental impairment(s). We assess functional limitations using the four criteria in paragraph B of the listings: Activities of daily living; social functioning; concentration, persistence, or pace; and episodes of decompensation.

Where we use "marked" as a standard for measuring the degree of limitation, it means more than moderate but less than extreme. A marked limitation may arise when several activities or functions are impaired, or even when only one is impaired, as long as the degree of limitation is such as to interfere seriously with your ability to function independently, appropriately, effectively, and on a sustained basis. See §§ 404.1520a and 416.920a.

1. Activities of daily living include adaptive activities such as cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, caring appropriately for your grooming and hygiene, using telephones and directories, and using a post office. In the context of your overall situation, we assess the quality of these activities by their independence, appropriateness, effectiveness, and sustainability. We will determine the extent to which you are capable of initiating and participating in activities independent of supervision or direction.

We do not define "marked" by a specific number of different activities of daily living in which functioning is impaired, but by the nature and overall degree of interference with function. For example, if you do a wide range of activities of daily living, we may still find that you have a marked limitation in your daily activities if you have serious difficulty performing them without direct supervision, or in a suitable manner, or on a consistent, useful, routine basis, or without undue interruptions or distractions.

2. Social functioning refers to your capacity to interact independently, appropriately, effectively, and on a sustained basis with other individuals. Social functioning includes the ability to get along with others, such as family members, friends, neighbors, grocery clerks, landlords, or bus drivers. You may demonstrate impaired social functioning by, for example, a history of altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships, or social isolation. You may exhibit strength in social functioning by such things as your ability to initiate social contacts with others, communicate clearly with others, or interact and actively participate in group activities. We also need to consider cooperative behaviors, consideration for others, awareness of others' feelings, and social maturity. Social functioning in work situations may involve interactions with the public, responding appropriately to persons in authority (e.g., supervisors), or cooperative behaviors involving coworkers.

We do not define "marked" by a specific number of different behaviors in which social functioning is impaired, but by the nature and overall degree of interference with function. For example, if you are highly antagonistic, uncooperative, or hostile but are tolerated by local storekeepers, we may nevertheless find that you have a marked limitation in social functioning because that behavior is not acceptable in other social contexts.

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3. Concentration, persistence or pace refers to the ability to sustain focused attention and concentration sufficiently long to permit the timely and appropriate completion of tasks commonly found in work settings. Limitations in concentration, persistence, or pace are best observed in work settings, but may also be reflected by limitations in other settings. In addition, major limitations in this area can often be assessed through clinical examination or psychological testing. Wherever possible, however, a mental status examination or psychological test data should be supplemented by other available evidence.

On mental status examinations, concentration is assessed by tasks such as having you subtract serial sevens or serial threes from 100. In psychological tests of intelligence or memory, concentration is assessed through tasks requiring short-term memory or through tasks that must be completed within established time limits.

In work evaluations, concentration, persistence, or pace is assessed by testing your ability to sustain work using appropriate production standards, in either real or simulated work tasks (e.g., filing index cards, locating telephone numbers, or disassembling and reassembling objects). Strengths and weaknesses in areas of concentration and attention can be discussed in terms of your ability to work at a consistent pace for acceptable periods of time and until a task is completed, and your ability to repeat sequences of action to achieve a goal or an objective.

We must exercise great care in reaching conclusions about your ability or inability to complete tasks under the stresses of employment during a normal workday or work week based on a time-limited mental status examination or psychological testing by a clinician, or based on your ability to complete tasks in other settings that are less demanding, highly structured, or more supportive. We must assess your ability to complete tasks by evaluating all the evidence, with an emphasis on how independently, appropriately, and effectively you are able to complete tasks on a sustained basis.

We do not define "marked" by a specific number of tasks that you are unable to complete, but by the nature and overall degree of interference with function. You may be able to sustain attention and persist at simple tasks but may still have difficulty with complicated tasks.

Deficiencies that are apparent only in performing complex procedures or tasks would not satisfy the intent of this paragraph B criterion. However, if you can complete many simple tasks, we may nevertheless find that you have a marked limitation in concentration, persistence, or pace if you cannot complete these tasks without extra supervision or assistance, or in accordance with quality and accuracy standards, or at a consistent pace without an unreasonable number and length of rest periods, or without undue interruptions or distractions.

4. Episodes of decompensation are exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning, as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace. Episodes of decompensation may be demonstrated by an exacerbation in symptoms or signs that would ordinarily require increased treatment or a less stressful situation (or a combination of the two). Episodes of decompensation may be inferred from medical records showing significant alteration in medication; or documentation of the need for a more structured psychological support system (e.g., hospitalizations, placement in a halfway house, or a highly structured and directing household); or other relevant information in the record about the existence, severity, and duration of the episode.

The term repeated episodes of decompensation, each of extended duration in these listings means three episodes within 1 year, or an average of once every 4 months, each lasting for at least 2 weeks. If you have experienced more frequent episodes of shorter duration or less frequent episodes of longer duration, we must use judgment to determine if the duration and functional effects of the episodes are of equal severity and may be used to substitute for the listed finding in a determination of equivalence.

D. Documentation: The evaluation of disability on the basis of a mental disorder requires sufficient evidence to (1) establish the presence of a medically determinable mental impairment(s), (2) assess the degree of functional limitation the impairment(s) imposes, and (3) project the probable duration of the impairment(s). See §§ 404.1512 and 416.912 for a discussion of what we mean by "evidence" and how we will assist you in developing your claim. Medical evidence must be sufficiently complete and detailed as to symptoms, signs, and laboratory findings to permit an independent determination. In addition, we will consider information you provide from other sources when we determine how the established impairment(s) affects your ability to function. We will consider all relevant evidence in your case record.

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1. Sources of evidence.

a. Medical evidence. There must be evidence from an acceptable medical source showing that you have a medically determinable mental impairment. See §§ 404.1508, 404.1513, 416.908, and 416.913. We will make every reasonable effort to obtain all relevant and available medical evidence about your mental impairment(s), including its history, and any records of mental status examinations, psychological testing, and hospitalizations and treatment. Whenever possible, and appropriate, medical source evidence should reflect the medical source's considerations of information from you and other concerned persons who are aware of your activities of daily living; social functioning; concentration, persistence, or pace; or episodes of decompensation.

Also, in accordance with standard clinical practice, any medical source assessment of your mental functioning should take into account any sensory, motor, or communication abnormalities, as well as your cultural and ethnic background.

b. Information from the individual. Individuals with mental impairments can often provide accurate descriptions of their limitations. The presence of a mental impairment does not automatically rule you out as a reliable source of information about your own functional limitations. When you have a mental impairment and are willing and able to describe your limitations, we will try to obtain such information from you. However, you may not be willing or able to fully or accurately describe the limitations resulting from your impairment(s). Thus, we will carefully examine the statements you provide to determine if they are consistent with the information about, or general pattern of, the impairment as described by the medical and other evidence, and to determine whether additional information about your functioning is needed from you or other sources.

c. Other information. Other professional health care providers (e.g., psychiatric nurse, psychiatric social worker) can normally provide valuable functional information, which should be obtained when available and needed. If necessary, information should also be obtained from nonmedical sources, such as family members and others who know you, to supplement the record of your functioning in order to establish the consistency of the medical evidence and longitudinality of impairment severity, as discussed in 12.00D2. Other sources of information about functioning include, but are not limited to, records from work evaluations and rehabilitation progress notes.

2. Need for longitudinal evidence. Your level of functioning may vary considerably over time. The level of your functioning at a specific time may seem relatively adequate or, conversely, rather poor. Proper evaluation of your impairment(s) must take into account any variations in the level of your functioning in arriving at a determination of severity over time. Thus, it is vital to obtain evidence from relevant sources over a sufficiently long period prior to the date of adjudication to establish your impairment severity.

3. Work attempts. You may have attempted to work or may actually have worked during the period of time pertinent to the determination of disability. This may have been an independent attempt at work or it may have been in conjunction with a community mental health or sheltered program, and it may have been of either short or long duration. Information concerning your behavior during any attempt to work and the circumstances surrounding termination of your work effort are particularly useful in determining your ability or inability to function in a work setting. In addition, we should also examine the degree to which you require special supports (such as those provided through supported employment or transitional employment programs) in order to work.

4. Mental status examination. The mental status examination is performed in the course of a clinical interview and is often partly assessed while the history is being obtained. A comprehensive mental status examination generally includes a narrative description of your appearance, behavior, and speech; thought process (e.g., loosening of associations); thought content (e.g., delusions); perceptual abnormalities (e.g., hallucinations); mood and affect (e.g., depression, mania); sensorium and cognition (e.g., orientation, recall, memory, concentration, fund of information, and intelligence); and judgment and insight. The individual case facts determine the specific areas of mental status that need to be emphasized during the examination.

5. Psychological testing.

a. Reference to a "standardized psychological test" indicates the use of a psychological test measure that has appropriate validity, reliability, and norms, and is individually administered by a qualified specialist. By "qualified," we mean the specialist must be currently licensed or certified in the State to administer, score, and interpret psychological tests and have the training and experience to perform the test.

b. Psychological tests are best considered as standardized sets of tasks or questions designed to elicit a range of responses. Psychological testing can also provide other useful data, such as the specialist's observations regarding your ability to sustain attention and concentration, relate appropriately to the specialist, and perform tasks independently (without prompts or reminders). Therefore, a report of test results should include both the objective data and any clinical observations.

c. The salient characteristics of a good test are: (1) Validity, i.e., the test measures what it is supposed to measure; (2) reliability, i.e., the consistency of results obtained over time with the same test and the same individual; (3) appropriate normative data, i.e., individual test scores can be compared to test data from other individuals or groups of a similar nature, representative of that population; and (4) wide scope of measurement, i.e., the test should measure a broad range of facets/aspects of the domain being assessed. In considering the validity of a test result, we should note and resolve any discrepancies between formal test results and the individual's customary behavior and daily activities.

6. Intelligence tests.

a. The results of standardized intelligence tests may provide data that help verify the presence of intellectual disability or organic mental disorder, as well as the extent of any compromise in cognitive functioning. However, since the results of intelligence tests are only part of the overall assessment, the narrative report that accompanies the test results should comment on whether the IQ scores are considered valid and consistent with the developmental history and the degree of functional limitation.

b. Standardized intelligence test results are essential to the adjudication of all cases of intellectual disability that are not covered under the provisions of 12.05A. Listing 12.05A may be the basis for adjudicating cases where the results of standardized intelligence tests are unavailable, e.g., where your condition precludes formal standardized testing.

c. Due to such factors as differing means and standard deviations, identical IQ scores obtained from different tests do not always reflect a similar degree of intellectual functioning. The IQ scores in 12.05 reflect values from tests of general intelligence that have a mean of 100 and a standard deviation of 15; e.g., the Wechsler series. IQs obtained from standardized tests that deviate from a mean of 100 and a standard deviation of 15 require conversion to a percentile rank so that we can determine the actual degree of limitation reflected by the IQ scores. In cases where more than one IQ is customarily derived from the test administered, e.g., where verbal, performance, and full scale IQs are provided in the Wechsler series, we use the lowest of these in conjunction with 12.05.

d. Generally, it is preferable to use IQ measures that are wide in scope and include items that test both verbal and performance abilities. However, in special circumstances, such as the assessment of individuals with sensory, motor, or communication abnormalities, or those whose culture and background are not principally English-speaking, measures such as the Test of Nonverbal Intelligence, Third Edition (TONI-3), Leiter International Performance Scale-Revised (Leiter-R), or Peabody Picture Vocabulary Test-Third Edition (PPVT-III) may be used.

e. We may consider exceptions to formal standardized psychological testing when an individual qualified by training and experience to perform such an evaluation is not available, or in cases where appropriate standardized measures for your social, linguistic, and cultural background are not available. In these cases, the best indicator of severity is often the level of adaptive functioning and how you perform activities of daily living and social functioning.

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7. Personality measures and projective testing techniques. Results from standardized personality measures, such as the Minnesota Multiphasic Personality Inventory-Revised (MMPI-II), or from projective types of techniques, such as the Rorschach and the Thematic Apperception Test (TAT), may provide useful data for evaluating several types of mental disorders. Such test results may be useful for disability evaluation when corroborated by other evidence, including results from other psychological tests and information obtained in the course of the clinical evaluation, from treating and other medical sources, other professional health care providers, and nonmedical sources. Any inconsistency between test results and clinical history and observation should be explained in the narrative description.

8. Neuropsychological assessments. Comprehensive neuropsychological examinations may be used to establish the existence and extent of compromise of brain function, particularly in cases involving organic mental disorders. Normally, these examinations include assessment of cerebral dominance, basic sensation and perception, motor speed and coordination, attention and concentration, visual-motor function, memory across verbal and visual modalities, receptive and expressive speech, higher-order linguistic operations, problem-solving, abstraction ability, and general intelligence.

In addition, there should be a clinical interview geared toward evaluating pathological features known to occur frequently in neurological disease and trauma; e.g., emotional lability, abnormality of mood, impaired impulse control, passivity and apathy, or inappropriate social behavior. The specialist performing the examination may administer one of the commercially available comprehensive neuropsychological batteries, such as the Luria-Nebraska or the Halstead-Reitan, or a battery of tests selected as relevant to the suspected brain dysfunction. The specialist performing the examination must be properly trained in this area of neuroscience.

9. Screening tests. In conjunction with clinical examinations, sources may report the results of screening tests; i.e., tests used for gross determination of level of functioning. Screening instruments may be useful in uncovering potentially serious impairments, but often must be supplemented by other data. However, in some cases the results of screening tests may show such obvious abnormalities that further testing will clearly be unnecessary.

10. Traumatic brain injury (TBI). In cases involving TBI, follow the documentation and evaluation guidelines in 11.00F.

11. Anxiety disorders. In cases involving agoraphobia and other phobic disorders, panic disorders, and posttraumatic stress disorders, documentation of the anxiety reaction is essential. At least one detailed description of your typical reaction is required. The description should include the nature, frequency, and duration of any panic attacks or other reactions, the precipitating and exacerbating factors, and the functional effects.

If the description is provided by a medical source, the reporting physician or psychologist should indicate the extent to which the description reflects his or her own observations and the source of any ancillary information. Statements of other persons who have observed you may be used for this description if professional observation is not available.

12. Eating disorders. In cases involving anorexia nervosa and other eating disorders, the primary manifestations may be mental or physical, depending upon the nature and extent of the disorder. When the primary functional limitation is physical; e.g., when severe weight loss and associated clinical findings are the chief cause of inability to work, we may evaluate the impairment under the appropriate physical body system listing. Of course, we must also consider any mental aspects of the impairment, unless we can make a fully favorable determination or decision based on the physical impairment(s) alone.

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E. Chronic mental impairments. Particular problems are often involved in evaluating mental impairments in individuals who have long histories of repeated hospitalizations or prolonged outpatient care with supportive therapy and medication. For instance, if you have chronic organic, psychotic, and affective disorders, you may commonly have your life structured in such a way as to minimize your stress and reduce your symptoms and signs. In such a case, you may be much more impaired for work than your symptoms and signs would indicate. The results of a single examination may not adequately describe your sustained ability to function. It is, therefore, vital that we review all pertinent information relative to your condition, especially at times of increased stress. We will attempt to obtain adequate descriptive information from all sources that have treated you in the time period relevant to the determination or decision.

F. Effects of structured settings. Particularly in cases involving chronic mental disorders, overt symptomatology may be controlled or attenuated by psychosocial factors such as placement in a hospital, halfway house, board and care facility, or other environment that provides similar structure. Highly structured and supportive settings may also be found in your home. Such settings may greatly reduce the mental demands placed on you. With lowered mental demands, overt symptoms and signs of the underlying mental disorder may be minimized.

At the same time, however, your ability to function outside of such a structured or supportive setting may not have changed. If your symptomatology is controlled or attenuated by psychosocial factors, we must consider your ability to function outside of such highly structured settings. For these reasons, identical paragraph C criteria are included in 12.02, 12.03, and 12.04. The paragraph C criterion of 12.06 reflects the uniqueness of agoraphobia, an anxiety disorder manifested by an overwhelming fear of leaving the home.

G. Effects of medication. We must give attention to the effects of medication on your symptoms, signs, and ability to function. While drugs used to modify psychological functions and mental states may control certain primary manifestations of a mental disorder, e.g., hallucinations, impaired attention, restlessness, or hyperactivity, such treatment may not affect all functional limitations imposed by the mental disorder.

In cases where overt symptomatology is attenuated by the use of such drugs, particular attention must be focused on the functional limitations that may persist. We will consider these functional limitations in assessing the severity of your impairment. See the paragraph C criteria in 12.02, 12.03, 12.04, and 12.06. Drugs used in the treatment of some mental illnesses may cause drowsiness, blunted affect, or other side effects involving other body systems. We will consider such side effects when we evaluate the overall severity of your impairment. Where adverse effects of medications contribute to the impairment severity and the impairment(s) neither meets nor is equivalent in severity to any listing but is nonetheless severe, we will consider such adverse effects in the RFC assessment.

H. Effects of treatment. With adequate treatment some individuals with chronic mental disorders not only have their symptoms and signs ameliorated, but they also return to a level of function close to the level of function they had before they developed symptoms or signs of their mental disorders. Treatment may or may not assist in the achievement of a level of adaptation adequate to perform sustained SGA. See the paragraph C criteria in 12.02, 12.03, 12.04, and 12.06.

I. Technique for reviewing evidence in mental disorders claims to determine the level of impairment severity. We have developed a special technique to ensure that we obtain, consider, and properly evaluate all the evidence we need to evaluate impairment severity in claims involving mental impairment(s). We explain this technique in §§ 404.1520a and 416.920a"


SS then would have ruled out that you qualified via the GRID Rules even though you are over the age of 50. When going through the 5 Step Sequential Process, they determined you could no longer perform your prior work (step 4) but could perform other work (step 5).

Wow. I'm even more depressed after reading all of that. GHEZ. Complicated. I appreciate all the hard work that I imagined went into creating that. Thank you. Now on to your conclusion. You wrote:

SS then would have ruled out that you qualified via the GRID Rules even though you are over the age of 50. When going through the 5 Step Sequential Process, they determined you could no longer perform your prior work (step 4) but could perform other work (step 5).

So . . . I came close? Got tripped up on the last and final step?!

That final step is your ability to work ANY job at the SGA level ($1090 per month) due to your functional limitations. You will have to prove you're not capable of working unskilled, sedentary jobs like that of a Surveillance System Monitor. This is a very difficult standard and is as complicated as being approved with a Listed Impairment.

http://www.occupationalinfo.org/37/379367010.html

"CODE: 379.367-010
TITLE(s): SURVEILLANCE-SYSTEM MONITOR (government ser.)

Monitors premises of public transportation terminals to detect crimes or disturbances, using closed circuit television monitors, and notifies authorities by telephone of need for corrective action: Observes television screens that transmit in sequence views of transportation facility sites. Pushes hold button to maintain surveillance of location where incident is developing, and telephones police or other designated agency to notify authorities of location of disruptive activity. Adjusts monitor controls when required to improve reception, and notifies repair service of equipment malfunctions.
GOE: 04.02.03 STRENGTH: S GED: R3 M1 L3 SVP: 2 DLU: 86"

A certain neurologist who I no longer see because I agree with echoes that the person is an idiot . . . told me to get more bed rest. His nurse told me 'for every hour on your feet . . . you need to be in your bed for two hours."

I have told my GP (for some reason his records did not get considered by the SSA) as much recently. Hopefully he wrote something in his notes that in HIS opinion I need plenty of bed-rest. These are true facts. Apparently they had not been written into my medical records at the time the SSA made their decision. I hope to soon get records to the SSA about my NEED for bed-rest.

I can't imagine a job that lets me lays down on a bed often . . .

When I was teaching school, during my lunch hour, at 1130am - almost every day, I would bring a mat into my small office. I would lay on my back with my feet up on my chair for about 30 minutes before I would eat . . . usually this was not long enough . . . but tough luck . . . I had to eat and then I had to teach in the afternoon.

One day late in Feb of 2015 . . . when I was very concerned about being able to safely drive home with feet that felt as if they were encased in cement . . . .I called my MD bro. He said, "You cannot finish the year blah, blah, blah..." FMLA started.

I think I can meet standard 5. I already meet it but apparently my neurologist did not write my need in his notes. I have his summaries. They are very confusing and contradicting. For example, after my first visit, 'come back and see him in three months'.

I made it one month due to pain in my feet. He changed my gabapentin from 900mgs per day to 2400mgs per day. YET, in his summary for that visit, he wrote that my 'symptoms were less severe." REALLY?! Then why did I come in TWO months EARLIER? Why more than DOUBLE my Gabapentin dose (irresponsible of him to raise it so high in ONE shot) if I was getting better? My 'symptoms were less severe.' Yeah, right . . . I could give a dozen more examples of stuff like this . . .

Hence my team being my shrink, my GP and myself. No neuro needed. Thank you for the skin bio (done by a DIFFERENT neurologist in the same group) me and my team will handle the TX now . . . and according to a 2003 article titled 'Painful Small Fiber Neuropathy' this is just fine. The article was written in the New England Journal of Medicine. My brother said, 'that is a good journal.'

If you want to claim BP and depression are serious impairments effecting your ability to engage in SGA (again, making $1090 per month) than you will be expected to have longitudinal records of intensive mental health treatment with a psychiatrist or a psychiatrist and a licensed therapist. Going once or twice a year for meds will be viewed by SS that your impairments are adequately be managed with medication alone. Weekly appointments with a therapist would be the norm. Many people end up amending their Alleged Onset Date to when they started going to weekly therapy, for example.

When you go to your ALJ hearing the ALJ or your attorney will ask the Vocational Expert whether certain accommodations would be allowed in order for you to manage to work. The ALJ will also determine if those limitations are consistent with your medical record. Some employers might allow you to keep your feet elevated at a desk job several times a day, for example.

Being able to safely drive at the end of your work day will not be a consideration, btw. If you need to utilize public transportation, than that is what SS will expect you to do. You might get some feedback from those active in the PN forum about how severe there disorder was for those with lower extremity issues before they were approved for SSDI. Understand that even those that require a cane to ambulate are often denied. It is only when an applicant requires the use of a walker that they are approved with a Listed Impairment.

One last thing, just because you had a negative experience with one neurologist, I don't really understand why you don't try to find one that you can work with. It is doubtful that SS will consider your PN as a serious problem unless you see a neurologist or someone else that specializes in PN.. You ARE expected to exhaust all options of treatment before AND after being approved for SSDI, so that you can potentially return to work. Just because you can reference an article from 2003, which will be considered outdated anyway, doesn't mean that SS will accept such an opinion. Since PN is a Listed Impairment, they have expectations of how a person with severe limitations should be handling their treatment. (--Considering your GP has zero experience with the disorder, he can't possibly be your best treating option.)

What do your employment records state regarding why you left? In other words, what is the school district's version of your employment in the year prior to your Alleged Onset Date? Did you ever request special accommodations due to your PN before quitting, for example?

^^^Wow. You are an amazing source of info! Thank you! Are you like a professional advocate for folks on this stuff or what?!

expected to exhaust all options of treatment before AND after being approved for SSDI, so that you can potentially return to work. Just because you can reference an article from 2003, which will be considered outdated anyway, doesn't mean that SS will accept such an opinion. Since PN is a Listed Impairment, they have expectations of how a person with severe limitations should be handling their treatment. (--Considering your GP has zero experience with the disorder, he can't possibly be your best treating option.)

^^^So, yes - it is dated. BUT, does that make it wrong? I still have the med sheet the neurologist gave me. PT seems to be counter-productive except for simple things such as working on my balance at home. My GP can follow a first line, second line, third line chart as good as anyone else can. Hopefully better than neurologist I mention above. Do you think this said expert did my gabapentin dosage correctly? Not in small, gradual increments . . . BUT from 900mgs all the way up to 2400mgs in just one day. Do gradual building up.


What do your employment records state regarding why you left?

***I don't remember. I think due to health reasons.

In other words, what is the school district's version of your employment in the year prior to your Alleged Onset Date?

^^^^I was on FMLA. . . until the end of the school year. So, I imagine their version is for health reasons since that is what FMLA is usually used for. They knew mine was for medical reasons. They had a note from my shrink.

Did you ever request special accommodations due to your PN before quitting, for example?

^^^^With my mind 'gone' and my feet about the same . . . no special accommodations were requested. Keep in mind I had preexisting mental health conditions that were made worse by my SFN. And, divorce, bankruptcy, foreclosure. In three months during the school year, I had lived in three different places. And, my EX set it up for MAX hurt to me for some reason. I was tossed out of my own house unexpectedly. I have no police record. I have never abused my kids or my wife . . . I have NEVER and neither have my friends . . . heard of a person just being tossed out of their own home without warning . . . So . . .my world was (and still is) falling apart . . . Regarding how my EX started the whole drama - one writer wrote the following:

Don’t blindside your spouse.

Those are not easy questions to answer, but much will depend on whether or not your spouse has any idea of how you feel. If you have been in marital therapy together or have had numerous discussions about how troubled you are by the relationship, or if the feelings are clearly mutual, you will have more options. The words, “I would like a divorce,” as challenging as they may be to say and hear, won’t necessarily be a shock. But if your spouse has no idea, you will likely blindside him or her and that can be devastating. It may also result in a much more difficult transition for both because your spouse will be experiencing the early stages of grief — denial and anger — while you are not only accepting that the marriage isn’t working, but also ready and eager to move on with your life.

It’s all about timing.

Ideally, you’ll want to tell your spouse you’re considering divorce as soon as you realize you want to end your marriage. Saying it when you’re calm and have time to talk about it together, such as at the beginning of the weekend, is a good idea. You already know when your spouse is open to hearing bad news; take that into account. When it comes to finding the right words to say, it’s much more powerful to state your feelings about the relationship clearly, honestly and as kindly as possible, than calling your spouse on all the things you think he or she has done wrong in the marriage. Saying, “I feel sad that we don’t spend time together anymore and that we’ve grown apart,” is easier to hear than a blaming, shaming, “You never do things with me anymore, and it’s your fault that I feel lonely.”


I know. Let me guess. The SSA could care less about my personal life and that is fine. But it is, what it is. Just like their many rules are what they are . . . Hence my hiring a good attorney because it is all quite confusing to me.

Lit Love wrote:

If you want to claim BP and depression are serious impairments effecting your ability to engage in SGA (again, making $1090 per month) than you will be expected to have longitudinal records of intensive mental health treatment with a psychiatrist or a psychiatrist and a licensed therapist. Going once or twice a year for meds will be viewed by SS that your impairments are adequately be managed with medication alone.

^^^^I go at least four times a year.

Weekly appointments with a therapist would be the norm. Many people end up amending their Alleged Onset Date to when they started going to weekly therapy, for example.

^^^^Seriously?! Sounds like a co-dependency problem seeing a therapist EVERY week. Transference!!!

^^^^Doesn't the fact that I made it to step 5 mean something? I have 'significant impairments' don't I? Wasn't that determined by the SSA since I got to step 5? And since THEY said I can no longer do my former job -- that would infer that they think all is not well in the Land of Oz. Nothing personal, and I do appreciate your knowledge and your frankness -- but frankly, you make it sound as if nothing is 'wrong' with me. It appears to me that the SSA think otherwise. And, when they finally get some good records to look at regarding my SFN, that might get me past step 5. Your thoughts? Thanks.

No, I'm not an advocate. I've simply put the time in to learn how the system works over the years, which has included learning from other posters here and elsewhere, and by digging in and reading actual SS policy.

New medications and treatments are constantly being developed. If you wish to develop your own treatment plan that is your business, but SS will not consider it acceptable in terms of qualifying for SSD, IMO.

So you had a bad experience with one neurologist. Find another.

"What do your employment records state regarding why you left?

***I don't remember. I think due to health reasons.

In other words, what is the school district's version of your employment in the year prior to your Alleged Onset Date?

^^^^I was on FMLA. . . until the end of the school year. So, I imagine their version is for health reasons since that is what FMLA is usually used for. They knew mine was for medical reasons. They had a note from my shrink.

Did you ever request special accommodations due to your PN before quitting, for example?

^^^^With my mind 'gone' and my feet about the same . . . no special accommodations were requested. Keep in mind I had preexisting mental health conditions that were made worse by my SFN. And, divorce, bankruptcy, foreclosure. In three months during the school year, I had lived in three different places. And, my EX set it up for MAX hurt to me for some reason. I was tossed out of my own house unexpectedly. I have no police record. I have never abused my kids or my wife . . . I have NEVER and neither have my friends . . . heard of a person just being tossed out of their own home without warning . . . So . . .my world was (and still is) falling apart . . . Regarding how my EX started the whole drama..."

SS is going to look at your medical records and your employment records, and the adjudicator/ALJ will question if you stopped working due to your physical impairment, your mental impairment, or both. IMO, there is a lack of sufficient treatment for someone with potentially career ending impairments, to the extent needed for SS to approve an SSDI claim in most instances--sometimes approvals happen that are outside the norm.

Your personal issues with regards to your impending divorce, bankruptcy and foreclosure are significant, even without the preexisting issue of BP. As you say, these things exacerbated your Neuropathy. Well, then SS will want to see that you're in therapy to help you deal with those issues, which will hopefully decrease some of your limitations. And perhaps that won't happen, but until you put in the effort, you won't know, and SS won't know the effects a therapist will have on your ability to function. --Had you requested accommodations for your Neuropathy PRIOR to your life imploding, then you would have had documented evidence that your physical impairment was beginning to effect your ability to work.

It is impossible to know how much effort your attorney will put into your case. It's not uncommon for attorneys to wait until shortly before your ALJ hearing to review your file. By that time, it's often too late to get sufficient medical documentation for an approval.

And can I say, even if you weren't applying for SSDI, it would still be appropriate for you to find a new neurologist and a therapist to help you deal with all of these major life stressors that have hit you all at once? If you have to go to multiple providers until you find one that works for you, that's what you have to do.

Neither I nor SS is claiming that you don't have impairments. But do you have the medical documentation required to prove you can meet or equal a Listing Impairment, OR that you are incapable of working at the SGA level, performing any job? There are countless Americans that are able to work despite there disabilities.

You can't have it both ways. If your BP disorder is being managed sufficiently by medication alone, then it shouldn't be an issue with regards to your being able to work.

After a claimant is approved for SSDI, SS determines the likelihood of that person's condition improving enough to return to work. They then perform a Continuing Disability Review every 3,5 or 7 years. One of the most common reasons SSI/SSDI beneficiaries benefits are terminated, is their failure to continue treatment. So, not only will SS expect you to see a therapist in order to be approved for SSDI, they're going to expect you to continue that treatment while you continue to collect SSDI.

A month or so ago you said you were looking for someone to do "talk therapy" with. Why is suddenly not something you are willing to pursue? Has your psychiatrist ever suggested you need to see a therapist?

Read this: http://www.nolo.com/legal-encycloped...-disorder.html

Is it preferable to be at Step 5, rather than be denied at an earlier step? Sure, but Step 5 is by far the most complicated Step. SS routinely determines claimants can not perform prior work, but can perform other work. If you read the link I provided, it will explain some of it. Here it is again: http://www.socialsecurity.gov/oidap/...Evaluation.pdf

Applicants often assume the important part of SSDI approval is their diagnosis and their doctor's support. Those are just starting points. Medical documentation of your attempt to treat your impairments and your functional limitations can mean the difference between approval and denial.

^^^The divorce is not pending. It is over. Thank God. I am a bear of small brain and cannot deal with all the issues you bring up at one time so I hit this one:

You wrote:

And can I say, even if you weren't applying for SSDI, it would still be appropriate for you to find a new neurologist

****I'm 0 - 2 with neurologists. I like my GP. He is a good listener. He is wise. The med chart is from the University hospital. Other than meds - what effective treatments are there for SFN? I have read of none. None that are effective any way. Sure. If one has a B-12 problem or a diabetes problem, if a cause is known, treat it but that is not the case for me. I had my blood check. I am idiopathic. Therefore, other than meds, (BTW, was the neurologist responsible or irresponsible with his dosing of my Gabpentin?), what kind of treatment is there for SFN that is idiopathic? I haven't seen/read of any.

and a therapist to help you deal with all of these major life stressors that have hit you all at once?

^^^^I live in a small town of 30K. I picked the best therapist we have. We talked for an hour. I told her I am familiar with DBT and CBT having been through intensive out-patient three times a week therapy - for about ten weeks - three years ago during my first stint of FMLA. Plus, I read and study a lot on my own. She asked me, "Ask your shrink just what exactly we are suppose to be doing with you?" I guess I was having a 'good head day' and was actually talking with some wisdom for a refreshing change. She said, "What do you want me to do, pick up the phone and call an attorney for you?" I have on going legal issues . . . When I talked to my brother about therapy he said, "What for?" M. Scott Peck wrote in 'The Road Less Travelled' that if his patients eventually do not become their own best therapist, then he has not done his job correctly. Know thyself. I think I do. To an adequate degree. The mountain can never entirely see the mountain. I know, the SSA will look down on me for not having a therapist. I will talk with my shrink about this issue on 9/10/15.

If you have to go to multiple providers until you find one that works for you, that's what you have to do.

I like my shrink. I like my GP. I like myself. I think the three of us make a good team. SSA has already called my impairments 'significant' right? They have already said, "You can not do your old line of work" . . . or something to that effect. . . Right? There are five bases to go around . . . I made it to fifth base on the first try. That seems like a good start. . . . But let me guess . . . EVERYBODY makes it to FIFTH BASE . . . and they stay stuck there . . . and therefore . . . never get benefits . . . and that is what is eventually going to happen to me. Correct? Once I am on fifth base - can they change their mind during the process and throw me back to third base? Thanks for sharing your knowledge with me.