How to Get Disability Benefits for Mental Retardation by Meeting a Listing
To determine whether your charge is disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will consider whether your charge’s mental retardation is severe enough to meet or equal the mental retardation listing. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that Social Security Administration presumes would prevent a person from performing substantial work. If your charge’s mental retardation is severe enough to meet or equal the listing, your charge will be considered disabled.
The listing for mental retardation is listing 12.05, which has four parts, A, B, C, or D. To meet the listing your charge must satisfy any one of the four parts. To satisfy any of the four parts of the mental retardation listing, your charge must demonstrate 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).
Meeting Social Security Administration Listing 12.05A for Mental Retardation
Your charge will meet listing 12.05A if he or she has mental incapacity evidenced by dependence upon others for personal needs (e.g., toileting, eating, dressing, or bathing) and inability to follow directions. This part of the listing is used when a claimant is too mentally retarded to cooperate in formal testing of IQ. They must live in highly protected environments and require constant supervision. These claims are never a problem—longitudinal medical records as well as family comments leave little doubt that such claimants are allowances.
Meeting Social Security Administration Listing 12.05B for Mental Retardation
Your charge will meet listing 12.05B if he or she has a valid verbal, performance, or full scale IQ of 59 or less. The lowest score from the IQ test is used, whether it is the verbal, performance, or full scale score.
Meeting Social Security Administration Listing 12.05C for Mental Retardation
Your charge will meet listing 12.05C if he or she hasa valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function.
Meeting Listing 12.05C – Physical Impairment
If a claimant with an IQ of 65 also has significant (i.e., more than not severe, at least of moderate severity) heart disease, he or she could qualify under part C. The general rule is that any physical impairment limiting a claimant to less than heavy work can serve as a significant impairment of work-related function as understood under part C. There may also be non-exertional physical impairments that can serve this role, such as visual disorders, imbalance of gait, asthmatic attacks, or epilepsy. The impairment must impose an additional significant work-related limitation apart from any limitation imposed by the mental retardation alone. IQs in the 60 through 70 range might be accompanied by significant adaptive function limitations, but there are exceptions.
When adaptive function is decreased, it is not because of a low IQ. Because IQ is only a score resulting from measurement of selected cognitive skills, it cannot produce a result (like decreased adaptive functioning) in the same way that blockage of a coronary artery produces a heart attack. Essentially, the IQ is itself the result rather than producing a result. To put it another way, a coronary artery blockage resulting in a heart attack is a matter of linear, temporal causation, while IQ and adaptive function are just different ways of describing a person’s intellectual performance and do not necessarily have to be closely associated. This is a simple conceptual matter, but confusion will arise if one thinks of IQ as synonymous with intelligence, or that scores in the 60 through 70 range imply some precise level of adaptive function.
Meeting Listing 12.05C – Mental Impairment
The impairment considered in addition to the IQ score need not be physical. Significant mental impairments also qualify. In these instances, however, there is the possibility that mental impairment and/or the drugs taken to treat that impairment can influence the IQ test results, rendering them invalid. For example, testing done during an active phase of schizophrenia is not valid. The claimant must be able and willing to maintain sufficient attention, cooperate, understand, and carry out instructions for the test. If the claimant is sleepy from drugs or unduly distracted by hallucinations, the test results will be influenced.
Individuals with schizophrenia continue to have a significant mental impairment even after treatment. They are often allowances under part C of this listing, if there is a valid IQ score in the range required. Incredible as it may seem, some mental hospitals have been known to regularly perform IQ testing on actively psychotic patients. Such results are useless in disability adjudication and such claimants require re-testing after stabilization of their condition.
In mental disorders of lesser severity than schizophrenia, it is more difficult to determine if they impose a significant work-related functional impairment in addition to the mental retardation, especially in dysthymic disorder, generalized anxiety disorder, and personality disorders. In these mental disorders, if the claimant has a history of psychiatric treatment and is under such treatment at the time of adjudication, then this is an indication that it may be significant in work-related terms, although that conclusion must be reached on a case by case basis.
The simple rule is that if a claimant has an impairment or combination of impairments, physical or mental, which would qualify for a RFC apart from any consideration of subaverage intellectual functioning, then the requirement for a second significant, work-related impairment is satisfied.
For example, a claimant with a valid IQ of 70 and a physical RFC for medium work meets 12.05C. Similarly, if the SSA adjudicator thinks to themselves that, in the absence of subaverage IQ, a claimant has an anxiety disorder sufficient to require a mental RFC, then the claimant’s overall impairment would meet 12.05C.
Meeting Social Security Administration Listing 12.05D for Mental Retardation
Your charge will meet listing 12.05D if he or she has a valid verbal, performance, or full scale IQ of 60 through 70, resulting in at least two of the following:
- Marked restriction of activities of daily living; or
- Marked difficulties in maintaining social functioning; or
- Marked difficulties in maintaining concentration, persistence, or pace; or
- Repeated episodes of decompensation (inability to maintain defense mechanisms in response to stress), each of extended duration.
Part D recognizes the fact that there are claimants with IQ scores of 60 through 70 who have marked limited adaptive functions without any additional impairment. Satisfaction of part D is by definition mental retardation. The SSA assesses functional limitations using the following criteria: social functioning; concentration, persistence, or pace; and episodes of decompensation. Ultimately, a clinical judgment is required to make or not make a diagnosis of mental retardation.
Go back to About Mental Retardation and Disability.