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Mental Retardation

Can My Charge Get Social Security Disability Benefits for Mental Retardation?

If you are the guardian/caretaker of someone with mental retardation, Social Security disability benefits may be available. To determine whether your charge is disabled by his or her mental retardation, the Social Security Administration first considers whether it is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. See How to Get Disability Benefits for Mental Retardation by Meeting a Listing. If your charge meets or equals a listing because of his or her mental retardation, your charge is considered disabled. If your charge’s mental retardation is not severe enough to equal or meet a listing, the Social Security Administration must assess your charge’s residual functional capacity (RFC) (the work your charge can still do, despite the mental retardation), to determine whether your charge qualifies for disability benefits at Step 4 and Step 5 of the Sequential Evaluation Process.

About Mental Retardation and Disability

According to the SSA, mental retardation refers to significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period (i.e., the evidence demonstrates or supports onset of the impairment before age 22).

All major intelligence tests view results as measures of intellectual performance, rather than intellectual capacity. However, it is a frequent misconception that such tests measure intelligence. Most psychologists would agree that intelligence is the ability of someone to constructively adapt to their environment and solve associated problems. Of course, intelligence that cannot be utilized is irrelevant to such adaptation and that is the rationale behind the significance of measuring intellectual performance by IQ testing. Do not be confused by test use of “verbal” and “performance” IQs; in these instances, the word “performance” is being used in a different sense meaning intellectual performance involving use of the limbs. Males are 1.5 times as likely to be mentally retarded as females.

The SSA purchases large numbers of IQ tests. In adults, the requested test will usually be the Wechsler Adult Intelligence Scale (WAIS), but the Stanford-Binet can also be used. On any IQ test the SSA must adjudicate with the lowest valid IQ. IQs stabilize by about age 16. There is no reason that the SSA cannot use IQ test results indefinitely after age 16, as long as there has been no event (like brain damage or dementia) that would invalidate the score.

That has been the conventional wisdom accepted by SSA, but it is now known to be wrong. Teenagers have been shown to increase or decrease performance or verbal IQ by as much as 20 points by age 20 over a period of 4 years. Functional MRIs showed brain changes compatible with changes in IQ, such as increased grey-matter volume. Actually, this finding should not be surprising since the brain also changes throughout adulthood. Performance and verbal IQs may not change in the same direction—one can go up while the other goes down. The development of advanced brain imaging has dispelled previously unsupported conjectures, but we do not know the upper limit at which significant IQ changes can occur. In most people, large IQ changes probably do not routinely occur in older adolescence, as it would have showed up on analysis of IQ scores in the past. The caveat is that there are certainly exceptions, and perhaps more than we would have thought possible in the past. While it is unlikely that someone with a very low IQ would be able to improve into the normal range, we need more information about age, malleability of IQ, and useful interventional techniques.

See Residual Functional Capacity Assessment for Mental Retardation.

Classification of Mental Retardation

The Diagnostic and Statistical Manual-III & IV (DSM-III & IV) of the American Psychiatric Association classify mental retardation as:

  • Mild mental retardation – IQ level 50–55 to approximately 70 (about 85% of individuals with mental retardation).
  • Moderate mental retardation – IQ level 35–40 to 50–55 (about 10% of individuals with mental retardation).
  • Severe mental retardation – IQ level 20–25 to 35–40 (about 3-4% of individuals with mental retardation).
  • Profound mental retardation – IQ level below 20 or 25 (about 1-2% of individuals with mental retardation).
  • (DSM-III & IV have a V code diagnosis of borderline intellectual functioning for IQs in the 71–84 range if a diagnosis of mental retardation was not warranted, i.e., if sufficient adaptive limitations are not present for the diagnosis of mental retardation.)

The above DSM adjective description of severity is essentially useless, at least for disability determination, but often appears in medical records. However, it is important that the SSA adjudicator not believe “mild” Mental Retardation rules out a disabling condition. Intellectual deficits the American Psychiatric Association considers “mild” are often considered disabled by the SSA even for any kind of unskilled work.

Issues Regarding Mental Retardation Diagnosis

The diagnosis of mental retardation requires significant deficits in adaptive functioning, in addition to low IQ. When the intellect is so impaired that testing cannot be done (as in listing 12.05A; see How to Get Disability Benefits for Mental Retardation by Meeting a Listing) or the IQ is less than 60 (listing 12.05B), there is an assumption by the SSA that adaptive functioning will be signficantly impaired without requiring additional documentation. Listing 12.05D is, by definition, mental retardation. Satisfaction of listing 12.05C does not imply mental retardation, but grants disability based on the fact that subaverage intellectual function, plus another limiting impairment, produces an overall functional result equivalent to mental retardation. It is confusing to put part C under this listing, because it leaves the erroneous impression that qualification under part C means mental retardation.

The diagnosis of mental retardation has sometimes been used in a sloppy and uninformed manner based on IQs alone, both within and without the SSA. This misuse leads to confusion and perpetuation of further misuse and abuse of the diagnosis. For example, there is never a legitimate question of whether mental retardation is severe enough to qualify under this listing. If mental retardation is present, the listing is always satisfied. IQs below normal that are not associated with significant adaptive limitations are properly diagnosed as subaverage intellectual functioning, not mental retardation. Due to erroneous coding, there are probably significant errors in the SSA’s statistical data base regarding the number of beneficiaries who actually have a diagnosis of mental retardation.

The importance of adaptive functioning cannot be over-emphasized. Unless IQs are near normal or extremely low, assumptions about functioning based on IQ is extremely unreliable. Children with subaverage intellectual functioning who grow up in a family environment which helps them learn adaptive skills take those abilities into adulthood. There are others with the same IQ who are protected or ignored and never develop very good adaptive abilities. This difference is particularly relevant to parts C and D of listing 12.05.

Continue to How to Get Disability Benefits for Mental Retardation by Meeting a Listing.

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