20. What happens if I have a mental impairment?

The "Mental Disorder" Disability Criteria

The EAEDC "Medical Standards" contain over eight different listings for "mental disorders" that automatically confer disability without a vocational evaluation. 106 C.M.R. § 703.192(L). The regulations list the following categories of mental impairments:

■        dementia, with or without delirium;

■        schizophrenic, paranoid or other psychotic disorders;

■        affective disorders;

■        mental retardation and autism;

■        anxiety-related disorders;

■        psycho-physiological disorders;

■        personality disorders;

■        substance addiction disorders combined with another impairment such as organic mental disorder, depressive syndrome, anxiety disorders, liver damage, gastritis, seizures, etc.

For each of these mental health impairments, DES will look for clinical signs, symptoms and/or laboratory test findings and an assessment of the severity of the impairment(s). 106 C.M.R. § 703.192(L).

Be sure to specify on the Disability Supplement (and in the information provided by your doctor, psychologist or other health care provider) how your daily activities, social functioning, and concentration are affected, as well as the effects of any medication you take.

Combination of Impairments

If you do not meet the medical standards but you suffer from both a physical and a mental impairment, DES will first evaluate your condition under the physical impairment rules described above.

If DES concludes you have a physical disability, there is no further evaluation of mental impairments.

If you suffer from a mental impairment and do not have any physical impairments at all, or your physical condition is not disabling by itself, DES must do an assessment of the combination of your impairments and must use an expanded set of factors listed in 106 C. M. R. § 703.193(D).

DES does not use the Grid for mental impairments. 106 C.M.R. § 703.193(D).

DES is supposed to look at specific vocational factors and functional limitations in determining whether there is significant work in the Northeast economy that you can do. The factors DES looks at include:

■        your "functional capacity": what you can do and what your condition prevents you from doing. For example, do you have trouble remembering things, concentrating, working as fast as employers expect, or getting along with co-workers?

■        whether you are taking medication that has side effects limiting your abilities; and

■        your past work experience.

Advocacy Reminders:

ü  DES should also consider all of the factors for physical impairments (except for the Grid). If a significant amount of appropriate work does not exist based on your limitations, DES must find you disabled.

ü  If you have never been diagnosed with or treated for a mental impairment, you have a right to have a psychological evaluation when you apply and/or DES may schedule a psychological consultative evaluation.

ü  DES has issued a number of Procedural Standards that address mental and psychological impairments that may be useful to advocates including:

• DES Standard 01-02, “Evaluation of Cases Involving Major Depressive Disorder with Psychotic Features” (August 14, 2014) https://www.masslegalservices.org/content/ps-01-02-medical-equivalence-psychotic-depression,
• DES Standard 03-01, “Evaluation of Disability on the Basis of Mental Disorders” (November 10, 2011) https://www.masslegalservices.org/content/ps-03-01-evaluation-disability-basis-mental-disorders​,
• DES Standard 99-05, “Consultative Exams by Psychiatrists and Psychologists” (December 2, 2003) https://www.masslegalservices.org/content/ps-99-05-consultative-examinations-psychiatrist-and-psychologists-revision and
• DES Standard 98-01, “Determining Disability for Applicants and Recipients Alleging Drug and Alcohol Addiction (DAA) Including Materiality” (March 19, 2007) https://www.masslegalservices.org/content/ps-98-01-determining-disability-applicants-and-recipients-alleging-drug-and-alcohol.