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The Rating Scale Behind Michigan Mental Health SSDI Claims
A psychiatric chart in Michigan will often describe a patient’s depression as moderate, and the same word appears in Social Security’s disability listings with a different job. The listings rate limitation on a five-point scale, and where a claimant lands on that scale decides whether a mental health claim meets Listing 12.04, 12.06, or 12.15 at all.
Section 12.00F of the Listing of Impairments sets the scale at none, mild, moderate, marked, and extreme. To satisfy paragraph B of any of those listings, the disorder must produce an extreme limitation in one of the four areas of mental functioning or a marked limitation in two. Each point is then defined, and every definition turns on one phrase, whether the person can function in the area independently, appropriately, effectively, and on a sustained basis.
Neumann Law Group reads a Michigan Social Security Disability mental health file for that phrase first. A record from Kent County or anywhere else in the state that never addresses sustained functioning cannot support a marked rating, no matter how serious the diagnosis.
What Each Point on the Scale Means
The definitions in 12.00F2 are short, and the distance between the middle ones is the whole case.
- None. The person is able to function in the area independently, appropriately, effectively, and on a sustained basis.
- Mild. Functioning in the area on that basis is slightly limited.
- Moderate. Functioning in the area on that basis is fair.
- Marked. Functioning in the area on that basis is seriously limited.
- Extreme. The person is not able to function in the area independently, appropriately, effectively, and on a sustained basis.
A marked limitation, under 12.00F2, is functioning in an area of mental functioning that is seriously limited when measured independently, appropriately, effectively, and on a sustained basis. Fair and seriously limited sit one step apart on the scale and on opposite sides of the listing. The four areas the scale is applied to are understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; and adapting or managing oneself, and the two routes through each listing, paragraphs A and B or paragraphs A and C, are set out on our mental health conditions page.
A Clinician’s Moderate Is Not the Listing’s Moderate
Section 12.00F3a addresses the vocabulary collision directly. The medical evidence may include descriptors regarding the diagnostic stage or level of the disorder, such as mild or moderate, and clinicians may use those terms to characterize the medical condition. The listing then states that these terms will not always be the same as the degree of limitation in a paragraph B area. A psychiatrist describing moderate major depressive disorder is classifying an illness, not rating a patient’s capacity to concentrate through a workday.
The listing also refuses to let any one document settle the rating. Under 12.00F3d, no single piece of information, including test results, can establish the degree of limitation of an area of mental functioning, and the degree does not necessarily reflect a specific type or number of activities the person has difficulty doing. The rating is drawn from the whole record, which is what the special technique in 20 C.F.R. § 404.1520a requires the agency to rate and document in its decision.
A treatment record built from brief medication visits tends to read as moderate in every area, because nothing in it measures sustained functioning. The chart shows whether a file is in that condition, and reading it that way takes one conversation. Call our office at (800) 525-6386 and we will walk through it with you.
Functioning at Home Does Not Prove Functioning at Work
Section 12.00F3 draws the line between the kitchen and the workplace with care. The same four areas are used at home and at work, and difficulty using one at home may mean difficulty using it at work. The reverse does not follow. The listing states that where a person is able to use an area of mental functioning at home or in the community, the agency will not necessarily assume the same ability in a work setting where the demands and stressors differ.
Section 12.00D3 goes further about daily life. The fact that a person does routine activities without help does not necessarily mean the person has no mental disorder or is not disabled, and the listing names the activities it has in mind: taking care of personal needs, cooking, shopping, paying bills, living alone, and driving a car. A denial that lists those activities as proof of capacity has cited the listing’s own examples of what does not prove it.
Support and Structure Raise the Rating
The more help a person needs, the more limited the listing finds them. Section 12.00F3e states that the degree of limitation reflects the kind and extent of supports or supervision the person receives and the characteristics of any structured setting where they spend their time, and that the more extensive the support or the more structured the setting needed in order to function, the more limited the agency will find the person to be.
Section 12.00D1 gives the examples, and they describe ordinary Michigan households. They include family members who administer medication, remind the person to eat, shop and pay bills, or change their own work hours so the person is never home alone. They include a job held only with a job coach or a supervisor’s help, and wraparound mental health services delivered in the person’s own apartment.
The last example surprises people. It is a person who lives alone with no formal supports and has created a highly structured environment by eliminating all but minimally necessary contact with the world outside their living space. Each of these is evidence of limitation, and each is invisible in a chart unless someone puts it there.
The rating comes from the whole record rather than from the diagnosis, and a denial that rates a limitation as moderate is appealable on the 60-day track described on our SSDI denial page. The appeal is the place to supply the sustained-functioning evidence the initial file lacked.
Translating a Chart Into the Listing’s Terms
Fair and seriously limited are one step apart on the scale, and the step is proved with evidence about sustained functioning that most charts were never written to contain. We represent mental health claimants at Neumann Law Group across Michigan, from Grand Rapids to Detroit. Call us at (800) 525-6386 or contact our office to arrange a consultation.