Guidelines for Psychiatric Evaluation of Social Security Disability Claimants

The Social Security Disability insurance (SSDI) program, which pays benefits to those too disabled to continue working, has been under serious scrutiny during the past year by Congress, the executive branch, the media, and concerned organizations such as the American Psychiatric Association. APA has fostered changes in the program that are nowpending in Congress and in the Social Security Administration-changes that will work to the benefit of individuals with severe mental impairments.

Concern about the program has arisen from the changed adjudicative climate within which it operates-stressing terminations and denials over continuances and allowances-and the all-too-hurried manner in which disability adjudication has taken place in the past year. Current interpretation of the law and regulations further exacerbates the problems.

These issues are being addressed by APA through legislation and regulations, but there are also other concerns. Of special importance is the adequacy of the medical records provided to disability determination officers for the adjudication of claims for the mentally impaired. Simply stated, improved psychiatric case records provided by psychiatrists, other physicians, and nonphysician mental health professionals can help ensure that proper disability determination decisions can be made.

This document can help. By using the information it presents, clinicians can prepare medical information and histories for their mentally impaired patients that will help assure that such patients do not risk inappropriate denial ofSSDI benefits.

The nature of the SSDI program dictates the need for certain case-building information that might not appear to be part of a usual medical record. Its requisites for detail are substantially dsfferent from and more demanding than those imposed by third-party insurers.

The goal of tbis document is to assure that clinicians are providing the best medical evidence to the Social Security Administration about their patients, and that they are able to act as advocates for their patients by being informed not only about the medical implications of disability, but also about the disability determination process.