One of the more tragic mental impairments that often appear in our office are eating disorders.
One of the more tragic mental impairments that often appear in our office are eating disorders. Often impacting younger people the pain and ongoing suffering for the client, and the supportive family, are real and often disabling.
In its last revision of the Mental Impairment portion of the Listings of Impairments Social Security finally recognized that eating disorders may be a basis for being totally disabled.
There are several diagnosable eating disorders – SSA includes examples of anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food disorder. Generally, the guidelines in the Listings describe these disorders as characterized by eating behavior and preoccupation with, and excessive self-evaluation of, body weight and shape. Symptoms may include restrictive eating compared with what that person really needs; binge eating or other weight prevention activities such as vomiting, excessive exercise or misuse of laxatives; mood disorders; amenorrhea; dental problems; and other abnormal laboratory findings.
As with almost every medical issue, however, diagnosis alone is not determinative of whether a laimant is “totally disabled” under the Social Security Act. Like most mental impairments, this Listing is divided into Part A (diagnosis) and the Part B (functional issues) which we describe often in these newsletters. If there is medical proof of a “persistent alteration in eating or eating-related behavior that....significantly impairs physical or psychological health” SSA will agree with the diagnosis of an eating disorder and satisfy Part A.
The battle, almost always, is in the B Criteria describing functional limitations caused by the symptoms from the diagnosis.
To meet the Listing the medical proof must document that at least two of the B Criteria must be “markedly impaired”: Understand, remember, or apply information; Interact with others; Concentrate, persist, or maintain pace; and Adapt or manage oneself. The “markedly impaired” standard has been defined in the Listing as proof that functioning in this area independently, appropriately, effectively, and on a sustained basis is seriously limited.
Finally, the “proof” requirement for this disorder is the same as in any mental impairment claim. The words of the claimant and the close family are not determinative. The core proof must come from the clinical charts of the ongoing medical specialists – in these cases the treating psychiatrist supported by a treating therapist, or the ongoing treatment records of a psychologist.
These claims are often challenging because of the stigma attached to eating disorders and the difficulty patients have opening up to their family and medical providers about these issues. Careful discussion with an empathetic, experienced representative may help persuade a patient to get the needed treatment, and, at the same time, create the evidence necessary to get these benefits.
Shout Out to Health and Social Services Workers
As we enter the next stage of the pandemic, the strain on health and social service workers is extraordinary. We want to recognize and express gratitude as you assist the people in your community as well as manage your own families. If we can provide any assistance for your clients seeking advice on any disability, mental or physical, please reach out to our office.
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