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The New Social Security Mental Disorder Listings Catch Up With Science: Trauma- and Stressor-Related Disorders

Thursday, 27 October 2016 10: 10
Written by Joni B. Bailey
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On January 17, 2017, the new rules for evaluating mental disorders will go into effect.  These changes are important for Southern Illinois Social Security Disability attorneys and their clients.  Among the many changes are three new listings: 12.11 Neurodevelopmental disorders, 12.13 Eating Disorders, and 12.15 Trauma- and Stressor-Related Disorders.  

This article focuses on Listing 12.15 Trauma- and Stressor-Related Disorders.

For most listings, there is a parallel listing for evaluating mental disorders in children. For example, 112.02 is the parallel listing to 12.02 for neurocognitive disorders in children.  This article will focus on the adult listings.

This table shows the old and new listing numbers and titles:

OLD

 

NEW

 

12.02

Organic mental disorders

12.02

Neurocognitive disorders

12.03

Schizophrenic, paranoid and other psychotic disorders

12.03

Schizophrenia spectrum and other psychotic disorders

12.04

Affective disorders

12.04

Depressive, bipolar and related disorders

12.05

Intellectual disability

12.05

Intellectual disorder

12.06

Anxiety-related disorders

12.06

Anxiety and obsessive-compulsive disorders

12.07

Somatoform disorders

12.07

Somatic symptom and related disorders

12.08

Personality disorders

12.08

Personality and impulse-control disorders

12.09

Substance addiction disorders

12.09

Reserved

12.10

Autistic disorder and other pervasive developmental disorders

12.10

Autism spectrum disorder

 

 

12.11

Neurodevelopmental disorders

 

 

12.12

Reserved

 

 

12.13

Eating disorders

 

 

12.15

Trauma- and stressor-related disorders

 

The Social Security Administration Office of Medical Policy explained the reason for the new 12.15 listing as follows:

Final listing 12.15 is a new listing we will use to evaluate trauma- and stressor-related disorders such as posttraumatic stress disorder. Prior versions of the DSM, such as the DSM-IV-TR, included trauma- and stressor-related disorders as a type of anxiety disorder. Under our prior rules, we evaluated trauma- and stressor-related disorders under prior listing 12.06, anxiety-related disorders. However, the DSM-5 created a separate diagnostic category for trauma- and stressor-related disorders. As a result, we created new listing 12.15 to evaluate these types of impairments.

The paragraph A criteria in final listing 12.15 reflect diagnostic criteria of posttraumatic stress disorder, which is a type of trauma- and stressor-related disorder included in the DSM-5. Final listing 12.15 includes paragraph C criteria because prior listing 12.06 included the criteria, and because our medical and psychological experts advised us that the unique medical situation that we identify with the paragraph C criteria often applies to trauma- and stressor-related disorders.

The American Psychiatric Association published this fact sheet highlighting the change in diagnostic criteria for PTSD in the DSM-5 compared to the DSM-IV.  The DSM is the Diagnostic and Statistical Manual of Mental Disorders, a manual used by clinicians and researchers to diagnose and classify mental disorders published by The American Psychiatric Association (APA).

What are Trauma- and stressor-related disorders?  In the preface to the individual listings, they are explained this way:

12.00B11 Trauma- and stressor-related disorders (12.15).
  1. These disorders are characterized by experiencing or witnessing a traumatic or stressful event, or learning of a traumatic event occurring to a close family member or close friend, and the psychological aftermath of clinically significant effects on functioning.

    Symptoms and signs may include, but are not limited to:
  • distressing memories, dreams, and flashbacks related to the trauma or stressor;
  • avoidant behavior;
  • diminished interest or participation in significant activities;
  • persistent negative emotional states (for example, fear, anger) or persistent inability to experience positive emotions (for example, satisfaction, affection);
  • anxiety;
  • irritability;
  • aggression;
  • exaggerated startle response;
  • difficulty concentrating;
  • and
  • sleep disturbance.
  1. Examples of disorders that we evaluate in this category include posttraumatic stress disorder and other specified trauma- and stressor-related disorders (such as adjustment-like disorders with prolonged duration without prolonged duration of stressor).
  2. This category does not include the mental disorders that we evaluate under anxiety and obsessive-compulsive disorders (12.06), and cognitive impairments that result from neurological disorders, such as a traumatic brain injury, which we evaluate under neurocognitive disorders (12.02).

What are the criteria for meeting Listing 12.15?

12.15 Trauma- and stressor-related disorders (see 12.00B11), satisfied by A and B, or A and C:

Medical documentation of all of the following:

  1. Exposure to actual or threatened death, serious injury, or violence;
  2. Subsequent involuntary re-experiencing of the traumatic event (for example, intrusive memories, dreams, or flashbacks);
  3. Avoidance of external reminders of the event;
  4. Disturbance in mood and behavior; and
  5. Increases in arousal and reactivity (for example, exaggerated startle response, sleep disturbance).

AND

Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):

  1. Understand, remember, or apply information (see 12.00E1).
  2. Interact with others (see 12.00E2).
  3. Concentrate, persist, or maintain pace (see 12.00E3).
  4. Adapt or manage oneself (see 12.00E4).

OR

  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:
  2. 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 (see 12.00G2b).
  3. 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 (see 12.00G2c).

How will this new listing impact Social Security disability claims for people suffering from trauma- and stressor-related disorders?

As a Southern Illinois Disability attorney, I have represented many people who would have benefited from this new listing—soldiers injured in active service, soldiers who watched their buddies suffer injuries, soldiers who lived in a state of fear for so long they could not unwind when they were discharged from active duty, parents who sat by the bedside as their child suffered and died from a long battle with cancer, and people who were victims of sexual abuse and assault.  Those cases were difficult because they did not fit neatly into the old listing framework.  Some were approved; some were denied.

Just about everyone today has heard about PTSD, but that was not always the case.

We can credit the tireless advocacy of attorneys like Wade R. Bosley who has represented victims of Post Traumatic Stress Disorder (PTSD) in Veterans Benefits Administration (VA) disability claims and National Organization of Veterans' Advocates for increasing understanding—in both public and professional arenas--of the reality of PTSD and related disorders. The United States Department of Veterans Affairs has developed an instrument to evaluate PTSD in the context of treatment and compensation and pension claims. 

We can also credit the tremendous intellect, talent and dedication of litigators like my friend, Barry Schultz, who argued the case of Parker v. Astrue, 597 F.3d 920 (7th Cir., 2010).  Parker was actually two cases (Denise Parker’s and Nary Kheng’s) combined at the appellate level because they presented similar problems.

In Nary Kheng’s case the administrative law judge rolled out the infamous boilerplate assessment of the claimant’s symptoms: “after considering the evidence of record, the undersigned finds that the claimant's medically determinable impairments would reasonably be expected to produce the alleged symptoms, but that the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are not entirely credible.” The United States Court of Appeals for the Seventh Circuit found that this analysis was inadequate. 

Ms. Kheng suffered from multiple impairments, including depression and PTSD. The administrative law judge failed to properly consider the evidence of the progression of Ms. Kheng’s problems over the years and found that her impairments did not become disabling until after her date last insured. 

I predict that the new 12.15 listing based on the new DSM-5 diagnostic criteria for PTSD will make it easier for skilled Social Security Disability representatives to win cases like Ms. Kheng’s at the first hearing instead of after years of administrative and federal appeals. 

A claimant has one shot at winning disability benefits at the hearing level without waiting 5-7 years for a reversal and rehearing.  Claimants need a dedicated Social Security disability representative that understands their claims as well as the complicated laws, rules and regulations under which the claim will be decided.

See also:  A New Method of Evaluating Dementia and Other Neurocognitive Disorders in Social Security Disability Claims

Joni Beth Bailey is a Southern Illinois Social Security Disability representative.


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