Linking Functional Information to Diagnosis and Impairment

Making the Link

Case managers must make a link between a person's illness and their ability to function. This information is rarely included in medical records, so you must describe how your applicant's illness(es) interfere with his or her ability to work using detailed descriptions, quotes, and anecdotes. Your description should be linked to the Listings that the DDS examiner uses to determine disability. This article looks at the levels of impairment. The four areas of mental functioning are discussed in subsequent articles.

Functional Limitations

For DDS to determine that a person is disabled under the mental disorder listings (i.e.: meets or medically equals a listing) there must be marked limitation in two areas of mental functioning or extreme limitation in one area.

• The medical condition must significantly limit ability to do basic work activities.
• Basic work activities include walking, sitting, remembering, understanding and carrying out simple instructions, and responding appropriately to supervisors, co-workers, and usual working situations.
• Impairment must last or have lasted for at least one year.
• If the medical condition doesn’t meet this level of severity, the applicant will not meet the criteria for SSI/SSDI at Step 3 of the sequential evaluation.

Marked Impairment

For mental disorders, the application must demonstrate functional impairments that meet the Listings. This includes “marked” impairment in at least two of four functional areas

• “Marked” is defined as 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 the applicant’s ability to function independently, appropriately, effectively, and on a sustained basis.
• DDS is looking at the “nature and overall degree of interference with function"

For physical impairments, the applicant must demonstrate significant limitations in meeting the physical, mental, sensory and other requirements of work. A limited ability to perform certain physical demands of work activity (e.g. sitting, standing, walking, lifting, carrying, etc.) may reduce a person's ability to do past work and other work.

Extreme Impairment

DDS determines that an applicant has an extreme impairment if the applicant is not able to function in that area independently, appropriately, effectively, and on a sustained basis.

• Extreme limitation does not necessarily mean a total loss or lack of functioning
• An example of this is someone who requires substantial in-home health supports in order to complete basic activities such as bathing, eating, and dressing

The Areas of Mental Functioning

When evaluating mental disorders, DDS considers four functional areas:

• Understand, remember, or apply information (memory, following instructions, solving problems, etc.)
• Interact with others (getting along with others, anger, avoidance, etc.)
• Concentrate, persist, or maintain pace (as they relate to the ability to complete tasks)
• Adapt or manage oneself (hygiene, responding to change, setting realistic goals, etc.)