By Robert J. Osborne, Esq.

The Listings include a category of impairments for affective disorders. Affective disorders must be 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.

To meet the required level of severity for these disorders, an individual seeking Social Security Disability benefits must meet several requirements.  For depression, an individual must have medically documented persistence, either continuous or intermittent, of depressive syndrome characterized by at least four of the following

• Anhedonia or pervasive loss of interest in almost all activities;
•  Appetite disturbance with change in weight;
• Sleep disturbance;
• Psychomotor agitation or retardation;
• Decreased energy;
•  Feelings of guilt or worthlessness;
• Difficulty concentrating or thinking;
• Thoughts of suicide; or
• Hallucinations, delusions, or paranoid thinking.

In addition, these symptoms must result in at least two of the following:

• Marked restriction of activities of daily living;
• Marked difficulties in maintaining social functioning;
• Marked difficulties in maintaining concentration, persistence, or pace; or
• Repeated episodes of decompensation, each of extended duration.

Otherwise, a person can show that he or she has a medically documented history of a chronic affective disorder of at least two 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:

• Repeated episodes of decompensation, each of extended duration;
• 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
• Current history of one or more years’ inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.

Activities of Daily Living

Activities of daily living include activities such as cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, grooming and hygiene, using telephones, and using a post office.  The Social Security Administration will look at an individual’s ability to perform activities of daily living independently, appropriately, effectively, and sustainably in determining eligibility for Social Security Disability benefits.

The Social Security Administration will determine the extent to which an individual can initiate and participate in activities without supervision or direction. The term “marked” does not require impairment of functioning in a specific number of different activities of daily living.  Instead, the Social Security Administration will evaluate the way in which and extent to which a person suffers impairment of function.  This means that a person may do a wide range of activities of daily living, but that person may have a marked limitation in his or her daily activities because he or she has serious difficulty performing those activities without direct supervision, or in a suitable manner, or on a consistent, useful, routine basis, or without undue interruptions or distractions.

Social Functioning

Social functioning refers to an individual’s 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.  Impaired social functioning may manifest itself in a history of altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships, or social isolation.

The Social Security Administration will look at how a person cooperates with others and considers others’ feelings.  The Social Security Administration will also evaluate a person’s social maturity.  Social functioning in work situations may involve interactions with the public, coworkers and supervisors.  As with activities of daily living, the term “marked” does not require impairment of functioning in a specific number of different behaviors, but by the nature and overall degree of interference with function.  For example, the Social Security Administration may find that an individual has a marked limitation in social functioning because that individual behaves in a very antagonistic, uncooperative, or hostile way.

Concentration, Persistence or Pace

Concentration, persistence, or pace refers to an individual’s ability focus his or her attention and concentration sufficiently long to permit the completion of tasks commonly found in work settings in a timely and appropriate manner.  Observations in work settings of limitations in concentration, persistence, or pace provide the best evidence.  However, limitations in other settings can demonstrate these limitations.

Additionally, the Social Security Administration can assess major limitations in concentration, persistence or pace through clinical examinations or psychological tests. However, an individual should try to supplement a mental status examination or psychological test data should with other available evidence, where possible.  Often the Social Security Administration will assess concentration with tasks such as having an individual subtract serial sevens or serial threes from 100; through tasks requiring short-term memory; or through tasks that must be completed within established time limits.

Again, the term “marked” does not refer to an individual’s inability complete a specific number of tasks, but refers to the nature and overall degree of interference with function.  An individual may have the ability to sustain attention and persist at simple tasks but may still have difficulty with complicated tasks.  If a person can complete many simple tasks, the Social Security Administration may nevertheless find a marked limitation in concentration, persistence, or pace if a person 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.

Episodes of Decompensation

Episodes of decompensation involve the worsening of, or temporary increases in, symptoms or signs accompanied by a loss of adaptive functioning.  A loss of adaptive functioning would show as difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace.  A person might demonstrate episodes of decompensation by a worsening of symptoms or signs that would ordinarily require increased treatment or a less stressful situation.  The Social Security Administration may infer episodes of decompensation from medical records that show a significant alteration in medication; or hospitalizations, placement in a halfway house, or a highly structured and directing household; or other relevant information.  The term repeated episodes of decompensation, each of extended duration, generally means three episodes within one year, or an average of once every four months, each lasting for at least two weeks.