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Current course:  SSI/SSDI Outreach, Access, and Recovery (SOAR) Online Course: Adult Curriculum

The Listings and Mental Illness

The Listings are SSA’s categorized lists of illnesses and conditions and the specific severity criteria – symptoms, duration, and impairments – of each illness/condition that must be met for a person to be considered disabled by the illness/condition. It is helpful for case managers to become familiar with these requirements.

Disability Resulting from Mental Illnesses

Determining disability for individuals with mental illness can be challenging. 
  • Diagnosing mental illness is to some extent subjective and may change over time based on behavioral observation, gathering a thorough history, effective treatments, improvements in functioning and getting to know the person over time
  • To assess disability, the whole story needs to be told
  • Consider that the observation of behavior in one moment of time is like a photo image, but a good longitudinal history is like a full video of the person’s life
  • Strive to capture the full story, not just a snapshot in time!
 

Listing of Impairments (The Listings) or “Blue Book”

  • SSA’s categorized lists of illnesses and conditions and the specific severity criteria that must be met for a person to be considered disabled by the illness/condition
  • The Listings are selective not exhaustive; many serious and potentially disabling medical conditions, diseases, illnesses, and impairments are not found in the Listings
  • The Listings are categorized into two parts, Part A: Adult Listings and Part B: Childhood Listings
  • The criteria in the Listing of Impairments apply only to one step of the multi-step sequential evaluation process
  • The Listings are categorized by body system (e.g. musculoskeletal, cardiovascular). There are currently 14 categories for adults. Mental disorders are found in category 12
 

Using the Listings for Mental Disorders*

In the Adult Listings, mental disorders are further categorized into eleven diagnostic categories (listed below). The listing categories, except for 12.05 Intellectual disorder, provide requirements in 3 different sections, A, B and C. However, not every listing contains each section.
  • Section A – medical criteria that must be present in your medical evidence
  • Section B – functional criteria that is assessed on a five-point rating scale from “none” to “extreme”
  • Section C - the impairment is “serious and persistent” with a documented history over a period of at least 2 years with evidence of both medical treatment and marginal adjustment
 

Requirements to Qualify

For most categories or disorders, the applicant can meet the listing with symptom criteria listed in A and the level of functional severity listed in B.
  • That is, A + B = eligibility
  • Or, in some listings (5) the applicant can also be found eligible if they meet the requirements in sections A and C
  • For one diagnostic category, 12.05 Intellectual disorders, the applicant must meet the unique sections in Part A or Part B. This listing does not follow the general structure of the other mental disorders.
 

Requirements for 12.05,  Intellectual Disorder

For listing 12.05 Intellectual disorder, the applicant’s impairment can meet the listing with criteria listed in either A or B.
  • Section A – identifies significantly subaverage general intellectual functioning by the cognitive inability to function at a level required to participate in standardized intelligence testing
  • Section B – identifies significantly subaverage general intellectual functioning by an IQ score(s) on an individually administered standardized test of general intelligence
 
Sample Listing for a Mental Disorder
Excerpt from: Disability Evaluation Under Social Security
12.03 Schizophrenia spectrum and other psychotic disorders, satisfied by A and B, or A and C:
  1. Medical documentation of one or more of the following:
    1. Delusions or hallucinations;
    2. Disorganized thinking (speech); or
    3. Grossly disorganized behavior or catatonia.

AND

  1. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:
    1. Understand, remember, or apply information
    2. Interact with others
    3. Concentrate, persist, or maintain pace
    4. Adapt or manage oneself

OR

 
  1. Medical documentation of one or more of the following:
    1. Delusions or hallucinations;
    2. Disorganized thinking (speech); or
    3. Grossly disorganized behavior or catatonia.

AND

  1. Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:
    1. Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder; and
    2. Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life.

Categories of Mental Impairments

As noted earlier, The Listings differ from the Diagnostic & Statistical Manual of the American Psychiatric Association (DSM-5)
  • Even though it is not the case manager’s job to make a diagnosis, being aware of the SSA disability criteria can be helpful in addressing what needs to be documented
  • Developmental disabilities are included in the mental disorder listings
 
Mental Disorder Listing Categories*
12.02 Neurocognitive disorders
12.03 Schizophrenia spectrum and other psychotic disorders
12.04 Depressive, bipolar, and related disorders
12.05 Intellectual disorder
12.06 Anxiety and obsessive-compulsive disorders
12.07 Somatic symptom and related disorders
12.08 Personality and impulse-control disorders
12.10 Autism spectrum disorder
12.11 Neurodevelopmental disorders
12.13 Eating disorders
12.15   Trauma- and stressor-related disorders

 More information about each mental disorder listing will be provided in the following articles. 

*On January 17, 2017 SSA enacted updates to the mental disorder listings and areas of functional information. Applications filed on or after January 17th will be evaluated using the updated mental health listings in this article and throughout the SOAR Online Course. More information about the updates can be found here.