In earlier newsletters, we have described the functional issues Social Security has identified as critical in determining the severity of the symptoms of mental, neurological and several other medical impairments. These “B Criteria” issues focus upon how severely symptoms impact the ability to: Understand, remember or apply information; Interact with others; Concentrate, persist or maintain pace; or, Adapt or manage oneself.
Before those terms are defined it must always be kept in mind that the primary source of evidence is the content of the clinical charts. Medical reports are helpful, but usually not determinative if not consistent with the charts. Testimony is helpful but definitely not determinative if not consistent with the charts. Social Security’s medical staff, and the Administrative Law Judge, will make their decisions based upon the content of the charts.
An experienced advocate will always explain these issues and teach their clients to keep at least part of their counseling focused upon these four questions.
Social Security ranks the degree of limitation in the B Criteria on a five-point scale: none, mild, moderate, marked and extreme.
“No limitation” means that the Claimant is able to function in this area independently, appropriately, effectively and on a sustained (full time work day and week) basis.
“Mild limitation” means that independent, appropriate, effect functioning on a sustained basis is slightly limited.
“Moderate limitation” means that functioning in this area independently, appropriately, effectively, and on a sustained basis is fair.
“Markedly limited” means there is a serious limitation in the ability to function independently, appropriately, effectively and on a sustained basis in that realm.
An “Extreme limitation” means an inability to function in this area independently, appropriately, effectively, and on a sustained basis.
While the Regulations state that the ability to perform some of these mental areas of functioning at home does not translate automatically to being able to use them in a competitive work environment, in actual cases that guideline is often ignored. ALJs will focus upon the ability to care for children, or pay bills, or go to Church as indicating a less than marked limitation in functioning. Therefore, if these activities will on occasion aggravate underlying symptoms that needs to be noted in the clinical charts.
Clients are often encouraged to keep calendars or symptom diaries to help them to remember to relate functional challenges to their medical providers. This additional information should improve their medical case as the provider will have more detail.
Social Security does note that supportive housing or extensive supervision may ameliorate symptoms that would worsen in a work environment. If this is documented in the records, it should be pursued with Social Security.
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